2016 Legislative Session – End of Regular Session Report

BALANCE BILLING

HB 221 by Representative Carlos Trujillo

SB 1442 by Senator Rene Garcia

PASSED

This legislation passed during the final hours of session and was considered a priority for Chief Financial Officer Jeff Atwater and his office of the Consumer Advocate to protect consumers.  This bill prohibits PPO insured patients from being balance billed by an out of network provider for emergency and elective services. It also includes a resolution process to resolve issues between the provider and the insurance company.  The President’s goal of adding language to the bill that mandates coverage of developmental disabilities passed in the last hours of Session.

 

Other issues in this bill included that insurers provide treatment coverage such as physical therapy and occupational therapy for the treatment of Down Syndrome.  This was a priority for Senate President Andy Gardiner who has a son with Down Syndrome. It also provided provisions for the use of a uniform prior authorization form.

 

SCOPE OF PRACTICE

HB 977 by Representative Kathleen Peters

SB 1250 by Senator Jack Latvala

PASSED

Of interest, this bill allows for psychiatric nurses to prescribe psychotropic controlled substances to treat mental illnesses under the established protocol of a psychiatrist.

 

HB 423 by Representative Cary Pigman

SB 676 by Senator Denise Grimsley

PASSED

HB 423/SB 676 allows for ARNPs (advanced registered nurse practitioners) and PAs (physician assistants) to prescribe controlled substances under the supervision of a physician.  There is a prescription limitation to a seven day supply, a prohibition of prescribing psychotropic drugs for children and clarification that ARNPs and PAs cannot prescribe controlled substances in a pain management clinic.

Other provisions of this bill requires health insurers and pharmacy benefit managers to use a standard prior authorization form and provides sovereign immunity protections for free clinics who receive state dollars or grants.

 

NURSE LICENSURE COMPACT

HB 1063 by Representative Cary Pigman

SB 1306 by Denise Grimsley

PASSED
This legislation enacts the multistate nurse licensure compact in Florida – an agreement between participating states that would allow nurses to practice in other compact participating states with a single multistate license. The nurse must comply with state laws where she is practicing or where the patient is located.

 

MEDICAL MARIJUANA

HB 307 by Representative Matt Gaetz

SB 460 by Senator Rob Bradley

PASSED

Of interest, this bill would add medical marijuana (manufactured and sold to a licensed dispensing organization) to the list of drugs that is allowed for use under the Right to Try Act.  The Right to Try Act passed during the 2015 Legislative Session and allows patients that are suffering from a terminal condition to use certain drugs that have not been approved by the US Food and Drug Administration.

 

PRACTICE OF PHARMACY

 HB 547 by Representative Ed Narain

SB 692 by Senator Denise Grimsley

DID NOT PASS

 These bills proposed expanding the scope of pharmacists to include medication management, patient health assessments and the ability to refer for health care services.  It would also allow them to initiate, modify, discontinue or administer drugs within the framework of a therapy order or protocol with other health care providers.  This legislation would also provided that pharmacist would be reimbursed for these healthcare services outside of the prescribing.  HB 547 was brought up in its first committee of reference but ultimately did not pass due to its controversial nature.  Senator Grimsley withdrew her version from consideration prior to any hearing in the Senate.

 

DRUGS, DEVICES AND COSMETICS

SB 1604 by Senator Denise Grimsley

HB 1211 by Representative Scott Plakon

PASSED

This bill makes several changes to the Florida Drug and Cosmetic Act.  Of interest, it increases the number of unit doses, from 5,000 to 7,500 unit doses, of a controlled substance that may be ordered during a one-month period before triggering an assessment by the wholesaler as to whether the purchase of that controlled substance is reasonable.

 

AMBULATORY SURGERY CENTERS/RECOVERY CARE CENTERS

HB 85 by Representative Heather Fitzenhagen

SB 212 by Senator Don Gaetz

DID NOT PASS
HB 85 and SB 212 would have allowed patients to stay past midnight at ambulatory surgery centers (ASC) and up to 24 hours. It also created a new category of a licensed facility known as a recovery care center (RCC), which would provide general nursing and rehabilitative services for up to three days. The Senate bill ultimately removed the RCC component from the bill and added provisions to the ASC language that would have required these facilities to provide care to Medicare/Medicaid patients as well as patients who qualify for charity care.  Also, it would have required ASC’s to comply with the same reporting requirements and safety codes as a hospital. This legislation (HB 85) ultimately became a heavy train of health care issues and died in Messages.

 

 PRESCRIPTION DRUG MONITORING PROGRAM

 SB 964 by Senator Denise Grimsley

HB 313 by Representative Ray Pilon

PASSED

SB 964/HB 313 exempts a rehabilitative hospital, assisted living facility, or nursing home that dispenses a dosage of a controlled substance to a patient from reporting to the PDMP.  It also allows a designee of a pharmacy, prescriber or dispenser to access the PDMP.  This legislation also included language that related to impaired practitioners.

 

Report presented by Johnson & Blanton, May 23, 2016

FSA Legislative Update

The FSA Board of Directors has been actively engaged in this year’s legislative session.  We have been kept abreast of relevant issues by our Tallahassee lobbyists Johnson & Blanton.  Issues that were most pertinent to the practice of anesthesiology were expansion of scope of practice of CNRAs, prohibition of balance billing, regulation of Pain Management Practices, and appropriate use of the title “doctor”.   Your FSA Board of Directors has strategically and assertively contacted legislators when needed to protect and advance the practice of anesthesiology here in Florida.The most critical piece of legislation for anesthesiologists this session was HB 305/SB 1450 filed by Representative Fresen (Miami) and Senator Christopher Smith (Ft. Lauderdale).  The bill entitled Certified Nurse Anesthetists “authorizes CRNAs to practice within a protocol established in collaboration with, rather than approval of, physicians and medical staff…”  This bill served no purpose other than to advance the independent practice of nurse anesthetists in this state.  Although this year’s session has a few weeks remaining, this bill is unlikely to advance.

The past several legislative sessions have seen a variety of bills which would have prohibited our ability to balance bill.  One version would have fined the hospital if a hospital based provider did not contract with all of the hospital’s insurance plans.  The FSA, along with the FMA, has stood firmly in opposition.  HB 1153/SB 1692 filed this year by Representative Stark (Weston) and Senator Gibson (Jacksonville) would have prohibited the ability of a hospital based physician practicing in a hospital that is contracted with an insurer to balance bill. These bills were never heard in a committee. However, we will continue to remain vigilant that this language is not amended onto another bill.

The FSA has been a leading advocate in the legislation to regulate the practice of Pain Management.  Readily available prescription narcotics here in Florida have contributed to 7 deaths per day and made us a travel destination for those seeking easy access.  SB 1192, Provision of Health Care with Controlled Substances, is back in front of the legislature and is being actively amended.  Some of the issues are how will the Prescription Drug Monitoring Program (PDMP) be funded, who has to access the PDMP, and who might be exempt from local ordinances that may exceed state regulations.  Our priority is the safe medical practice of Chronic Pain Management.

With multiple disciplines offering a doctorate degree and many health care providers trying to expand their scope of practice, patients need to have a clear understanding of who is providing their care.  A bill entitled Health Care Practitioners would establish grounds for discipline if “presenting oneself with the title of “Doctor”… without disclosing the licensee is not a medical doctor or osteopathic physician”.  HB 805 was filed by Representative Fitzenhagen (Fort Myers) and co-sponsored by Representatives Harrell (Port St. Lucie) and Fresen (Miami).  A senate version, SB 612, was filed by Senator Galvano (Bradenton).

Without the assistance of Johnson and Blanton in Tallahassee, the FSA would be rudderless.  Their vigilance and strong advocacy on behalf of Florida’s anesthesiologists, keeps us directed.  However, they can only do so much; ultimately, it is up to us, all of us, to ensure the safe practice of physician lead anesthesia here in Florida- Know the Issues, Meet Your Legislators,
Join the FSAPAC.

Kurt Markgraf MD
Chair, FSA Legislative Committee


FSAPAC

Contributions to the FSAPAC can come from your group practice. Your contribution can be made as a monthly pledge. Any amount will be welcomed.

Physician Anesthesia Is In Jeopardy Today

FSAPAC

A bill has been filed in the state legislature (HB 305) that would “authorize CRNAs to practice within a protocol established in collaboration with (emphasis mine) rather than the approval of, the physicians and medical staff…”

This seems like an innocuous change but let me reassure you, collaboration as used in this context will lead to the elimination of physician supervision of CRNAs in the state of Florida. The Colorado courts supported the CRNAs Opting Out of the Medicare Supervision rule because their practice was legally defined as “collaborative” and therefore a requirement of supervision was not valid.

Let me reassure you that FSA’s leadership has been aggressively pursuing this issue. Who is FSA’s leadership? We are anesthesiologists like you that volunteer our time to advance and support the practice of anesthesiology here in Florida.

What do you need to do? Now more than ever we need a strong FSAPAC. Access the link below and join the FSAPAC at the Circle of Distinction ($1000) or Chairman’s Council ($500) level. Entire groups like North Florida Anesthesia Consultants have been contributing at this level routinely for years. They are known and respected in Tallahassee.

Last year 100% of the FSA Board of Directors supported the FSAPAC. Less than 15% of our general membership did.

Kurt Markgraf, MD
Chair, FSA PAC

FSAPAC

Contributions to the FSAPAC can come from your group practice. Your contribution can be made as a monthly pledge. Any amount will be welcomed | PAC@fsahq.org

Notice of HB 305

HB 305, “An Act Relating to Certified Registered Nurse Anesthetists”, has been introduced in the Florida House of Representatives. Sponsored by Representative Erik Fresen, this bill aims to fundamentally alter the relationship between CRNA’s and physicians from one of “supervision” to that of “collaboration”. The explicit purpose of this bill is to lay the groundwork for CRNA practice independence. In fact the original version stated it would seek to revise their “authorized scope of practice”. We feel this would jeopardize patient safety and irreparably harm the authority of anesthesiologists to direct patient care.

As an FSA member, you can be confident that your leadership has already been in full gear for several weeks, coordinating with our Tallahassee strategists as well as contacts throughout Florida and nationwide to develop a political plan to kill HB305. Visits are being made to key policymakers who will continue to receive the undeniable message that this bill is bad for the safety of Floridians.

We will keep you informed of our efforts to derail 305 and to make sure legislators understand the importance of physician primacy over mid-level provider care. The legislative session begins March 5, and, at that time, the full FSA membership may need to be mobilized. Until then, we will keep you informed of any developments as they occur, and please feel free to contact myself or any member of the Board of Director via cell for questions or concerns.

Sincerely,

Charles J. Chase, DO
President, Florida Society of Anesthesiologists
Anesthesiologists of Greater Orlando Orlando, FL
407-947-1954 Cell
407-896-9500 Office
https://www.fsahq.org/