Advocacy

    2021 Legislative Session

    Click here for the Week 7 update on bills the FCACC is following.

    Week 7 Highlights

    Lawmakers have just concluded week seventh of their nine-week Session.

    After Tuesday, April 20 most of the House and Senate committees will no longer be meeting.  As a result, may bills that still have to be heard in multiple committees will die from lack of action.  For the final two weeks, lawmakers will be meeting in their respective chamber to take up issues that still have a chance.  The only issue that lawmakers must pass each Session is the General Appropriations Act.  Lawmakers are expected to begin the budget conference process this weekend which will allow enough time for them to resolve their differences on a spending plan before Session concludes on April 30. 

    NEW DEVELOMPENTS 

    Cardiopulmonary Resuscitation Training in Public Schools

    Legislation that requires CPR in certain school grades was approved this week in a Senate committee.  Both the House (HB 157) and Senate (SB 280) bills have one more committee stop before heading to the floor in each chamber for final consideration.  The legislation specifies that school districts provide basic training in first aid, including CPR, and the use of an automated external defibrillator during the instruction.

    Practice of Physician Assistants

    The House this week passed HB 431 which revises how Physician Assistants can perform their work. The bill heads to the Senate where it will be matched up with SB 894 that awaits one more committee hearing before heading to the Senate floor for final passage. 

    An agreement between the physician assistants organization and the medical specialties resulted in a legislative compromise that expands the scope of practice of physician assistants by allowing them to:

        • Prescribe psychiatric mental health controlled substances to minors under certain circumstances;
        • Procure certain medical equipment and devices;
        • Supervise medical assistants;
        • Sign and certify documents that currently require a physician’s signatures such as Baker Act commitments, do-not-resuscitate orders, school physicals, and death certificates;
        • Expands the number of PAs that a physician can supervise to 10; and
        • Authorizes physician assistants to directly bill for and receive payments from public and private insurance companies for the services they deliver.

    Rare Disease Advisory Council

    HB 1373 is heading to the House floor after unanimously passing thru the last committee this week. The Senate bill, SB 272 has already passed the Senate and is awaiting to be matched up in the House for final passage. The bill calls for a twenty member Council is to provide recommendations on ways to improve health outcomes for individuals with rare diseases.

    Data Privacy

    The House Commerce Committee this week passed the Data Privacy legislation, HB 969.  The bill is expected to be taken up on the House floor next Tuesday. The Senate bill, SB 1734 has passed all committees and is also expected to be taken up next week. The Senate is expected to release yet another version of SB 1734 just prior to considering it on the floor.

    Both House and Senate bills add “biometric data” to the definition of “personal information” which requires commercial and governmental entities to take reasonable measures to protect. But there are still major differences in the two bills.  For example, under the House bill, consumers whose personal information has been breached, sold, or shared after opting-out, or retained after a request to delete or correct may bring a cause of action against the controller, processor, or person in certain limited circumstances. The “private cause of action” provision is strongly opposed by many businesses, corporations and financial institutions. The House wants this provision while the Governor and Senate do not. For the data privacy legislation to pass and become law, the House, the Senate and the Governor must reach an agreement on a final product. It appears that they are still a long way from resolving their differences.

    Medicare Transportation Services

    Having passed both the House and Senate, SB 348 goes to the Governor for final approval.  The legislation requires Florida Medicaid to reimburse for Medicare “crossover claims” for nonemergency ambulance services. Currently, Medicaid pays for emergency transportation crossover claims but not for non-emergency transportation crossover claims. A “crossover claim” is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or coinsurance. The bill requires Florida Medicaid to pay all deductibles and coinsurance for Medicare-covered services provided to Medicare-eligible recipients by ambulances licensed pursuant to chapter 401, Florida Statutes, according to the corresponding procedure codes for such services. Currently, Medicaid must pay all deductibles and coinsurance for Medicare emergency transportation services provided by ambulances licensed pursuant to chapter 401, Florida Statutes.

    Telehealth Practice Standards 

    HB 247 unanimously passed the Health & Human Services Committee this week and heads next to the House floor.  The bill will allow practitioners to prescribe Schedule III, IV, and V controlled substances through telehealth. Unlike Schedule I drugs that have a high potential for abuse and no accepted medical use, drugs classified in schedules II through V still have the potential for abuse, but also have well established medical uses.

    Hospital, Hospital System, or Provider Organization Transactions

    HB 1219 passed the second of three committees this week.  The bill amends the Florida Antitrust Act relating to the transactions by hospitals, hospital systems, and provider organizations. The bill imposes certain reporting requirements when a transaction between two entities in the health care market results in an affiliation or a material change to the health care market which could create a monopoly. An entity that fails to comply with these reporting requirements is subject to a civil penalty up to $500,000. The notice requirements will provide a mechanism for the Office of the Attorney General to review transactions before they occur to determine whether a proposed transaction has antitrust implications and, if warranted, pursue action to prevent coercive monopolies from forming in the health care market.

    Drones

    The Senate Rules Committee unanimously passed SB 518 this week.  The bill is expected to be taken up on the Senate Floor next week.  It provides an additional exception to the statutory ban on certain uses of drones by law enforcement agencies, fire departments, state agencies, and political subdivisions of the state. The bill would no longer prohibit a state agency or political subdivision to use a drone for the assessment of damage due to a hurricane, a flood, a wildfire, or any other natural disaster.

    Administration of Vaccines

    SB 768 unanimously passed the Senate Rules Committee this week and heads next to the Senate floor. Having passed all of its committees, HB 1063 is ready to be taken up on the House floor.  The legislation authorizes pharmacists and pharmacy interns to administer any immunization or vaccine that is:

        • Listed in the federal Centers for Disease Control and Prevention’s (CDC) Recommended Immunization Schedule;
        • Listed in the CDC’s Health Information for International Travel;
        • Listed in the Food and Drug Administration’s (FDA) Vaccines Licensed for Use in the United States; or
        • Authorized vaccine for emergency use by the FDA.

    Prescription Drug Coverage

    The Senate Appropriations Subcommittee on Agriculture, Environment, and General Government committee unanimously passed SB 390 on Tuesday in the second of three committees.  The next stop for this bill is the Senate Appropriations Committee. Meanwhile, a similar version, HB 1155 awaits a hearing in its final committee stop before going to the full House for a final vote.

    The Senate bill revises provisions of the Florida Insurance Code (code) relating to the oversight of pharmacy benefit managers (PBMs) by the Office of Insurance Regulation (OIR). Specifically, the bill:

        • Authorizes the OIR to conduct market conduct examinations of PBMs to determine compliance with applicable provisions of the code;
        • Requires a health insurer or Health Maintenance Organizations (HMO), and any entity acting on their behalf, including a PBM, to comply with the pharmacy audit provisions;
        • Provides that a health insurer or HMO may only contract with a PBM that complies with specified statutory requirements;
        • Authorizes an audited pharmacy to appeal certain pharmacy audit findings made by health insurers or HMO; and
        • Clarifies that an insurer or HMO remains responsible for any violations of the pharmacy audit requirements and the prompt pay law by a PBM acting on its behalf.

    The OIR estimates that it will incur a negative fiscal impact, ranging from $100,000 to $200,000, to contract with a pharmacist to provide oversight of PBM market conduct examinations and respond to complaints involving pharmacy audits.

    Medicaid

    HB 1057 unanimously passed the House this week and heads to the Senate.  The Senate Appropriations Committee will hear SB 1292 on Monday.  The Legislation revises a number of provisions regarding the State’s Medicaid program. Among other things, the legislation makes changes to provisions setting reimbursement rates for providers of prescribed drugs.

    Currently, a provider of prescribed drugs must be reimbursed the least of the amount billed by the provider, the provider’s usual and customary charge, or the Medicaid maximum allowable fee established by the agency, plus a dispensing fee. The Medicaid maximum allowable fee for ingredient cost must be based on the lowest of: the average wholesale price minus 16.4 percent, the wholesaler acquisition cost plus 1.5 percent, the federal upper limit, the state maximum allowable cost, or the usual and customary charge billed by the provider.

    Under the bill, a provider of prescribed drugs will be reimbursed in an amount not to exceed the lesser of the actual acquisition cost based on the federal CMS National Average Drug Acquisition Cost pricing files plus a professional dispensing fee, the wholesale acquisition cost plus a professional dispensing fee, the state maximum allowable cost plus a professional dispensing fee, or the usual and customary charge billed by the provider.

    Tobacco and Nicotine Products

    This week, SB 1080 passed in its last committee before moving to the Senate floor for a final vote. The legislation:

        • Increases the minimum age to lawfully purchase and knowingly possess tobacco products, nicotine products, and nicotine dispensing devices in Florida from 18 to 21 years of age.
        • Prohibits the sale, delivery, bartering, furnishing, shipping, or giving tobacco products, nicotine products, or electronic nicotine dispensing devices to persons under the age of 21 years.
        • Creates regulations for the sale and delivery of nicotine products and nicotine dispensing devices through the mail and over the Internet, which are similar to the regulations for tobacco products.
        • Preempts the establishment of the minimum age to possess or purchase nicotine dispensing devices, nicotine products, and tobacco products and the marketing, sale, and delivery of such products to the state.
        • Modifies current exceptions to the minimum age requirements to purchase or knowingly possess tobacco products and applies the same exceptions to nicotine products and nicotine dispensing devices.

    Of Note: In 2019, Federal law was amended to raise the minimum age to 21 for purchasing or knowingly possessing tobacco products, nicotine products, and nicotine dispensing devices, unless the person falls under an exemption such as being in the military or handling tobacco products as a part of a person’s lawful employment.

    NEW LEGISLATION FILED THIS WEEK 

    The House Ways and Means Committee released a new proposed committee bill on taxation. PCB WMC 21-01 provides for several sales tax holidays and other tax-related modifications designed to directly impact both families and businesses. The bill is the annual tax package and will be assigned a bill number and referred to committees.

    For sales tax, the bill includes:

        • Changes to ch. 212, F.S., that will  allow businesses to pay sales tax on behalf of their customers in certain circumstances, and allows the businesses to advertise this ability.
        • A 5-year extension of the deadline for a new data center to apply for an existing tax exemption.
        • A seven-day “back-to-school” tax holiday in early August for certain clothing, school supplies, and personal computers;
        • A seven-day “disaster preparedness” tax holiday in late May and early June for specified disaster preparedness items; and
        • A seven-day “recreation” tax holiday the first week of July for specified admissions and supplies used to enjoy the entertainment options and natural beauty Florida has to offer.

    For property taxes, the bill:

        • Increases a property tax discount from 50 percent to 100 percent for certain multifamily projects that provide affordable housing to low-income families;
        • Clarifies the application of an exemption from ad valorem taxation for portions of property used for charitable, religious, scientific, or literary purposes; Specifically, the bill provides that the portions of a property that are not predominantly used for charitable, religious, scientific, or literary purposes are not exempt from taxation, but that portions of a property used for charitable, religious, scientific, or literary purposes are exempt as long as the predominant use of the exempted property is for those purposes. The provisions of the bill apply to taxable years beginning on or after January 1, 2022, and do not provide a basis for an assessment of any tax not paid or create a right to a refund or credit of any tax paid before July 1, 2021.
        • Requires the tax collector to accept late payments on the first installment of prepaid property taxes; and removes the late payment penalty.
        • Exempts structures and equipment used in the production of aquaculture products from separate ad valorem assessment.
        • For tourist development and convention development taxes, the bill:
        • Provides that each of the tourist development and convention development taxes can be used for flood mitigation projects at the discretion of local government; and
        • Requires that all new or increased tourist development and convention development taxes must be approved by voters at a referendum.

    For corporate income tax and other taxes, the bill:

        • Creates the Strong Families Tax Credit Program, capped at $5 million total annually, for businesses that make monetary donations to certain eligible charitable organizations that provide services focused on child welfare and well-being.

    BILLS HEARD THIS WEEK BUT MAY NOT ULTIMATELY PASS

    Step Therapy

    The legislation defines “step therapy protocol” (HB 1001) as a protocol or program that establishes the specific sequence in which prescription drugs, medical procedures, or courses of treatment must be used to treat a health condition. The bill also requires a process to receive a “protocol exemption”, which is a determination by an insurer or HMO to exempt an insured patient from an existing step therapy protocol. The bill requires an insurer or HMO to publish on its website, and provide to an insured in writing, a procedure for an insured patient and health care provider to request a protocol exemption.

    The legislation has passed all committees of reference but none of the comparable Senate bills (SB 528, SB 1290) have been heard in the Senate.  With time running out, this issue may have to wait until next Session.

    Health Care Expenses

    Among other things, HB 1067 requires hospitals and ambulatory surgical centers to post a consumer-friendly list of standard charges for at least 300 shoppable health care services on a facility website, consistent with federal rule. The bill unanimously passed its final committee this week and heads to the House floor and will be taken up next week.  However, the Senate version, SB 1952 has not been given a hearing in the Senate and may not pass this Session.

    Health Care Licensure Requirements

    This week the full House unanimously passed HB 1097.  The bill requires the Department of Health (DOH) to grant physicians, as defined under the bill, who are employees of the U.S. Department of Veterans Affairs (VA) an exemption from Florida’s physician licensure requirements if such physicians submit proof of out-of-state licensure, proof of VA employment, and an attestation that they will only treat veterans in Florida-licensed hospitals or pursuant to their employment with the VA.

    Unfortunately, the Senate version, SB 780 is stuck in a committee that is not scheduled to meet again this Session.

    Recovery of Damages in Claims for Medical Negligence

    This week, the full House passed HB 651 which allows parents of a child who is 25 years old or older and has no surviving spouse or children to recover for mental pain and suffering in a medical malpractice wrongful death action. The Senate version, SB 1112 has not been heard this Session.  



      CORONAVIRUS AND YOUR HEART: DON'T IGNORE HEART SYMPTOMS

      ACC CardioSmart recently published the infographic below to emphasize the importance of maintaining heart health through the epidemic. Click here for additional information.

      Heart Health During COVID-19 graphic

      TALLAHASSEE

      The FCACC has a strong presence in the state capital where we meet with lawmakers and work with other like-minded organizations to support legislation. Our goal is to be the source of knowledge for cardiovascular health information.  Updates on bills we follow in session are posted on this page along with update on activities in the Capital.
      Click here to find your Florida Senators and Representatives. WASHINGTON, DC

      Although a state chapter, the FCACC has an impact and voice at the Federal level. Working in concert with the other 49 chapters of the ACC and with Heart House leaders and staff we have a network of contacts with our Congressional delegation. If you would like to serve as a key contact email jennifer@accfl.org. Key contacts sit down with lawmakers in-district and in Washington to explain in detail the impact of bills on our patients and profession and form a relationship with our lawmakers and their staff. 

      ADVOCACY COMMITTEE

      Charge: The Advocacy Committee is charged with advocating for CV medicine and communicating with the lawmakers and regulators of Florida on issues relating to improving the cardiovascular health of all Floridians and to promoting access to quality cardiovascular care in Florida.
       
      David Kenigsberg, MD, FACC, Chair, Plantation


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