Legislative News

 AmyYoung   Amy Young-Governmental Consultant
   

 

The Dead Session

Strangely enough, this was one of the busiest Sessions we have had in many years on behalf of ob-gyn’s in Florida, however, very little passed this year. Fortunately, for the most part, we were playing defense against many proposals including expansion of scope of practice for Certified Nurse Midwives, broad telemedicine laws that would have allowed out of state physicians to practice in Florida, trial bar efforts to water down NICA, mandatory Hepatitis C testing, and many other issues.

Unfortunately, we do know that these issues will be back next year, with more momentum and we are preparing for that battle during our campaign visits this Summer.

ARNP/CNM scope of practice issues (SB 1352 by Senator Denise Grimsley and HB 1352 by the House Healthcare Workforce Committee) 

HB 1352 was passed by all committees of reference and off the House floor with only 42 (out of 120) dissenting votes. As previously reported, this legislation was a top priority of House Leadership. This bill basically granted full independent practice for all Advanced Registered Nurse Practitioners (including Certified Nurse Midwives) along with full prescriptive authority with no supervision or physician protocols required. We were fortunate that one of our ACOG, District XII legislative committee members, Dr. Meridith Farrow was in attendance at one of the early committee hearings and did an excellent job in testimony against the bill. Ultimately we were able to exempt Certified Nurse Midwives completely out of both the House and Senate bills, which would have meant that they would have to comply with current law regarding supervision and protocols.

The Senate bill stalled in the Senate Appropriations committee and was ultimately killed due to the opposition of the Senate leadership.

NICA legislation (SB 1344 by Senator Oscar Braynon and HB 1344 by Representative Jim Boyd)

After negotiating for several months with the trial bar regarding attempts to water-down our valuable NICA program, they conceded not to pursue changes this Session. We, however, took advantage of legislation filed that is technical in nature to change the reference to FOGS in the NICA statutes to the American Congress of Obstetricians and Gynecologists, District XII. We will be keeping a close eye on the progress of this legislation anticipating adverse amendments from the Florida Justice Association representing the trial lawyer’s in Florida who are adamantly opposed to the entire NICA Program.

STATUS:

The legislation was one of the only bills of interest to pass this Session. The trial bar did attempt to use this legislation as a vehicle for adverse amendments, however those efforts were defeated and the bill was sent to the Governor.

Abortion legislation--HB 1047

Our legislative friends fought hard to kill this very bad legislation, but, once again, the vote came down to a predominantly partisan vote. We are certain that this law will be signed by the Governor, however many challenges will be forthcoming. I felt it was important to include the entire bill for your review (as attached) so you can be fully informed on the specific provisions. 

Insurance Reform Package (HB 7157 by House Health and Human Services Committee)

ACOG District XII  had significant concerns with aspects of HB 7157, State Group Insurance Program that may have a dramatic impact on the private practice of medicine in the State of Florida.  Portions of HB 7157 will impact contract negotiations between physicians and the State Employee Group Health Insurance Carrier.

We adamantly oppose this legislation and have distributed the following talking points to the Legislature as follows:

  • HB 7157 requires the State Health Plan to publish CONTRACTED RATES for procedures that the State Health Plan negotiates with providers.  This public disclosure of contracted rates has never been done before. Typically all data made public is usual and customary charges, not negotiated contracted rates.  This will significantly impact the ability of physician practices to negotiate with the state health insurance plan.
  • The proposal requires the carrier to benchmark providers based on COST alone.  It does not take into consideration quality of care or outcomes.  It simply collects and reports on contracted rates.
  • The proposal would compensation patients directly on savings if they visit physicians that have agreed to lower contracted rates as compared to their colleagues.  This punishes practices that have invested in advanced technology, adequate staffing levels, or may have specialized training in their specialty. 
  • Publishing contracted rates will give a significant competitive advantage to hospital-employed groups and large multi-specialty group practices that have an easier time cost shifting loss leaders within the business to make sure for specific service lines that may not be profitable.  This will significantly expand the number of private practices being purchased by hospitals and health systems.

We support quality measures and evidenced-based medicine that focuses on improving patient outcomes.  We do not support comparing physicians on cost alone.  This proposal will drive medicine to the lowest cost providers without consideration of overall disease management, quality measurements, and outcomes data.  It would expand upon the limitations of the current fee for service payment model by focusing on compensation per procedure code rather than overall focus on quality outcomes.

The proposal will have a significant impact on the private practice of medicine and local competition among providers.  This will reduce competition by providing an unfair advantage to large providers and health systems.  Such consolidation in local health markets has been shown to increase overall health care costs.

STATUS:

This legislation has been fast tracked by the Florida House and was voted off the floor of the Florida House. Fortunately, we were able to kill this proposal in the Florida Senate where such a radical approach was opposed by Senate leadership.

Increased Medicaid eligibility for pregnant woman (SB 1086 by Senator Flores and HB 447 by Representative Castor-Dentel)

This legislation would increase Medicaid eligibility for pregnant woman from 185% of poverty to 200%.

Although this is hard for our organization to lobby against this increase, we are using this as an opportunity to bring further attention to the fraud and abuse taking place when pregnant woman, who otherwise have private insurance and means to pay for their co-pays, are abusing the system and enrolling in Medicaid. We advocated and successfully passed legislation in 2011 to curtail this abuse, however, the fraud continues to increase.

STATUS:

Although this legislation failed to pass, we have asked the sponsors of the legislation to call a meeting with all interested parties over the summer to try to trace these abuses and urge the  Department of Health and Department of Children and Family Services to administratively  prohibit pregnant woman from dropping their insurance unless they meet the strict criteria.

Hepatitis C legislation (SB 824 by Senator Arthenia Joyner and HB 465 by Representative Mia Jones)

We opposed the legislation below because it is yet another legislative mandate on how to practice medicine. We worked with the House and Senate Leadership in opposing any vetting of this bill unless it was significantly amended.

 (2) A person born between January 1, 1945, and December 31,

30  1965, who receives health care services as an inpatient in a

31  general hospital as defined in s. 395.002, primary care services

32  in a hospital inpatient or outpatient setting, or primary care

33  services from a physician, physician assistant, or nurse

34  practitioner shall be offered a Hepatitis C screening test

35  unless the health care practitioner providing those services

36  reasonably believes that the person:

37         (a) Is being treated for a life-threatening emergency;

38         (b) Has previously been offered or has been the subject of

39  a Hepatitis C screening test; however, if the person's medical

40  condition indicates the need for additional testing, a test

41  shall be offered; or

42         (c) Lacks the capacity to consent to a Hepatitis C

43  screening test.

44         (3) If a person accepts the offer of a Hepatitis C

45  screening test and receives a positive test result, the health

46  care practitioner shall offer the person followup health care or

47  refer the person to a health care provider who can provide

48  followup health care. The followup health care must include a

49  Hepatitis C diagnostic test.

50         (4) The Department of Health shall adopt rules that provide

51  procedures for culturally and linguistically offering Hepatitis

52  C screening in accordance with this section.

53         (5) This section does not affect the scope of practice of a

54  health care practitioner or diminish the authority or legal or

55  professional obligation of any health care practitioner to offer

56  a Hepatitis C screening test or Hepatitis C diagnostic test or

57  to provide services or followup health care to the subject of a

58  Hepatitis C screening test or Hepatitis C diagnostic test.

59         (6) The State Surgeon General shall submit a report

60  evaluating the effectiveness of the Hepatitis C testing program

61  established in this section by January 1, 2016. The State

62  Surgeon General shall submit the report to the Governor, the

63  President of the Senate, the Speaker of the House of

64  Representatives, and the chairs of the appropriate substantive

65  committees of the Legislature.

66         Section 2. This act shall take effect July 1, 2014.

STATUS:

This legislation was killed due to opposition from our organization and others.

Telemedicine Proposals (SB 1646 by Senate Health Policy Committee and HB 751 by Representative Travis Cummings)

Legislation moved quickly through the process which would have significantly liberalized what can currently be done in the area of telemedicine utilizing out of State (non-Florida licensed physicians) which can be harmful to patients. Although the Senate bill was less offensive than the House bill, both bills were contrary to our primary objectives for an effective telehealth delivery system in Florida which should do the following:

(1) Only allow physicians licensed in the State of Florida to practice telemedicine;

(2) More narrowly define telemedicine which is very broad in both bills;

(3) Ensure proper training of physicians who wish to engage in telemedicine; and

(4) Ensure appropriate reimbursement for those services.  

STATUS:

 The House HHS chair wrapped this legislation into our C-section repeal bill and it was heard on the House floor with only 42 dissenting votes. The Senate Appropriations committee failed to hear the Senate bill, therefore the bill ultimately died.

Insurance Reform Package (HB 7157 by House Health and Human Services Committee)

ACOG, District XII had significant concerns with aspects of HB 7157, State Group Insurance Program that would have had a dramatic impact on the private practice of medicine in the State of Florida.  Portions of HB 7157 would have impacted contract negotiations between physicians and the State Employee Group Health Insurance Carrier.

We adamantly opposed this legislation and distributed the following talking points to the Legislature as follows:

  • HB 7157 requires the State Health Plan to publish CONTRACTED RATES for procedures that the State Health Plan negotiates with providers.  This public disclosure of contracted rates has never been done before. Typically all data made public is usual and customary charges, not negotiated contracted rates.  This will significantly impact the ability of physician practices to negotiate with the state health insurance plan.
  • The proposal requires the carrier to benchmark providers based on COST alone.  It does not take into consideration quality of care or outcomes.  It simply collects and reports on contracted rates.
  • The proposal would compensation patients directly on savings if they visit physicians that have agreed to lower contracted rates as compared to their colleagues.  This punishes practices that have invested in advanced technology, adequate staffing levels, or may have specialized training in their specialty. 
  • Publishing contracted rates will give a significant competitive advantage to hospital-employed groups and large multi-specialty group practices that have an easier time cost shifting loss leaders within the business to make sure for specific service lines that may not be profitable.  This will significantly expand the number of private practices being purchased by hospitals and health systems.

We support quality measures and evidenced-based medicine that focuses on improving patient outcomes.  We do not support comparing physicians on cost alone.  This proposal will drive medicine to the lowest cost providers without consideration of overall disease management, quality measurements, and outcomes data.  It would expand upon the limitations of the current fee for service payment model by focusing on compensation per procedure code rather than overall focus on quality outcomes.

The proposal will have a significant impact on the private practice of medicine and local competition among providers.  This will reduce competition by providing an unfair advantage to large providers and health systems.  Such consolidation in local health markets has been shown to increase overall health care costs.

STATUS:

Although this legislation was fast tracked by the Florida House and passed on the Floor of the House, we were able to convince the Florida Senate to oppose this radical approach to reform. We have been asked to participate in discussions on this issue during the summer months.

Insurance Reform (SB 1354 by Senator Denise Grimsley and HB 1001 by Representative Jason Brodeur)

We have been working during the summer and fall of last year with other medical specialties and the FMA to make important changes in the insurance statutes to correct problems with retroactive denials, step therapy mandates, prior authorization and bait and switch abuses with exchange products.

STATUS:

This bill was referred to four committees in the House and was only heard by one committee which stripped our most important provision relating to retroactive denial. The Senate heard the bill in its last committee stop today (April 22nd) and watered down the bill substantially due to strong opposition from the insurance lobby.

With many efforts by the Florida Medical Association, our organization and many others the bill failed passage this year. A summary of the proposal is below:

Current Situation

Physicians and their staff face a daunting landscape of red tape they are required to endure before patients can receive prescription drugs and certain medical procedures. Each different insurer can have dozens of different prior authorization forms doctors must complete depending on the type of insurance coverage the patient has. This means that doctor’s offices need to be proficient in potentially hundreds of different types of forms in order to be paid for treating patients.

Additionally, insurers can often take days or weeks to respond to a prior authorization request. Studies have shown that the burdensome prior authorization process is costing the health care system between $23-31 billion per year, which equates to about $85,000 per physician. These costs are ultimately passed along to consumers in the form of higher insurance premiums or out or pocket expenses.

In addition, physicians must deal with ill-advised cost containment measures adopted by the Medicaid program and a number of Florida health plans which force patients to try and fail on several different cheaper and often ineffective medications before they agree to cover the treatment originally prescribed by the patient’s doctor.

Physicians also face the possibility of providing a great deal of uncompensated care because of a provision in the Affordable Care Act that allows for patients to remain on insurance rolls even when they have not paid their premium. The ACA dictates that insurers will be allowed to deny claims even when they have verified that the patient is insured. This exacerbates an already untenable situation where a physician who provides care to a patient who the insurance company has represented as having coverage in effect often finds that the coverage did not really exist, and thus the physician either is not paid, or receives a claim for repayment from the insurance company.

Proposed Solution:

Prior Authorization:

  • Florida should join states we are competing with like Texas and California and reduce medical red tape by creating a standard prior authorization form for medical procedures and prescription drugs.
  • The form should be readily available for all physicians to download from the insurer’s website.
  • All insurance carriers should be required to accept this standard form for all claims that require prior authorization.
  • In order to ensure patient safety, insurers should be required to act on the request for prior authorization within 72 hours of receipt of the form, or the procedure is deemed approved.

Fail First Protocols:

  • Appropriate safeguards need to be put into place with any “fail first” system so that patients are not forced to endure weeks, if not months, without effective treatment. If a physician reasonably believes, based on sound medical judgment, that fail first protocol is likely to be ineffective or will likely cause an adverse reaction or physical harm, an override of the fail first restriction should be granted within 24 hours.
  • If a physician agrees that a fail first protocol is warranted, the duration should not be any longer than a period deemed appropriate by the physician.
  • If during the fail first period, the physician deems the treatment clinically ineffective, the patient should be able to receive the recommended course of therapy without requiring an override of the fail first protocol.

Retroactive Denials:

  • Finally, insurers should be required to pay all claims when they have told the physician or their staff that the patient has insurance coverage.

Bait and Switch:

  • Many individuals rely on the fact that their current physician is part of a preferred network in making a decision as to which health insurance product to purchase. Insurers should not be able to entice people to purchase their product by relying on long-outdated preferred provider lists that do not accurately reflect their current network. This bill will require insurers to maintain an accurate list on their website, and to make any changes within 24 hours.

C-section reporting repeal (SB 380 by Senator Aaron Bean and HB 373 by Representative Kathleen Peters)

As you are aware, one of our priorities this Session is to repeal the following statute which the Department of Health told us they want to implement soon. This is unnecessary regulation and we have filed legislation to repeal the following:

383.336 Provider hospitals; practice parameters; peer review board.—

(1) As used in this section, the term "provider hospital" means a hospital in which there annually occur 30 or more births that are paid for partly or fully by state funds or federal funds administered by the state.

(2) The Office of the State Surgeon General, in consultation with the Board of Medicine and the Florida Obstetric and Gynecologic Society, is directed to establish practice parameters to be followed by physicians in provider hospitals in performance of a caesarean section delivery when the delivery will be paid partly or fully by state funds or federal funds administered by the state. These parameters shall be directed to reduce the number of unnecessary caesarean section deliveries. These practice parameters shall address, at a minimum, the following: feasibility of attempting a vaginal delivery for each patient with a prior caesarean section; dystocia, including arrested dilation and prolonged deceleration phase; fetal distress; and fetal malposition. The Department of Health shall adopt rules to implement the provisions of this subsection.

(3) Each provider hospital shall establish a peer review board consisting of obstetric physicians and other persons having credentials within that hospital to perform deliveries by caesarean section. This board shall review, at least monthly, every caesarean section performed since the previous review and paid for by state funds or federal funds administered by the state. The board shall conduct its review pursuant to the parameters specified in the rule adopted by the Department of Health pursuant to this act and shall pay particular attention to electronic fetal monitoring records, umbilical cord gas results, and Apgar scores in determining if the caesarean section delivery was appropriate. The results of this periodic review must be shared with the attending physician. These reviews and the resultant reports must be considered a part of the hospital's quality assurance monitoring and peer review process established pursuant to s. 395.0193.

STATUS:

This bill was fast tracked on the Senate side with final action on the Senate floor on March 20th.

Unfortunately, since our bill was the only health bill with traction, the House HHS Chairman used it as the Health care train and wrapped ARNP expansion of scope issue, adverse telemedicine legislation, controversial trauma legislation and recovery center bills into our legislation. Therefore, we were placed in a position to lobby against our own bill…...and were successful!! The DOH has assured us that they support the repeal and will not implement the statute.

IMPORTANT UPDCOMING DATES

2014 Election Day Dates

  • Primary Election: August 26, 2014
  • General Election: November 4, 2014

2014 Early Voting Period (minimum mandatory 8 days beginning on the 10th day and ending on the 3rd day before Election Day)*

  • Primary Election: August 16, 2014 – August 23, 2014
  • General Election: October 25, 2014 – November 1, 2014

*Each county Supervisor of Elections may at his or her own discretion offer additional days of early voting on any or all days during the 15th through 11th day and the last Sunday before Election Day.

2015 SESSION DATES

August 1, 2014 Deadline for filing claim bills (Rule 4.81(2))

March 3, 2015 Regular Session convenes (Article III, section 3(b), Constitution)

March 3, 2015 12:00 noon, deadline for filing bills for introduction (Rule 3.7(1))

April 21, 2015 50th day—last day for regularly scheduled committee meetings (Rule 2.9(2))

April 27, 2015 All bills are immediately certified (Rule 6.8)

May 1, 2015 60th day—last day of Regular Session (Article III, section 3(d), Constitution)

Contact:

Colleen Filbert
Project Manager
cfilbert@acogdistrict12fl.org

ACOG District XII:
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