Christopher L. Nuland 
Lobbyist and General Counsel                      
Legislative Report Week 8
March 4, 2016 

With only one week left in the 2016 Legislative Session, considerable progress was made on a bevy of issues, not the least of which was the budget.  Conferences have ended, and it appears very likely that the final budget deal will be on the legislators’ desks by Tuesday, which will allow for an on-time “sine die” next Friday.

The House has effectively closed debate on its bills, as this week it sent to the Senate bills on Balance Billing, Direct Primary Care, PA and ARNP prescribing, the Department of Health package, Transparency in Health Care Pricing, and Telehealth.  The House also gave final passage to the long-delayed Needle-Exchange bill and a Medical Assistant Certification Bill.  As important as what the House passed, however, was what it did not, as its bills did NOT include independent practice for physician extenders or elimination of Open Heart standards, both of which had been proposed at the beginning of the Session.

The Senate has begun its deliberations on these issues and is likely to make adjustments in the coming days, at which time that chamber will either agree with the House, amend the House bills, or reject House ideas entirely.  This obviously will involve a significant amount of back-room dealings, but we look forward to being part of those discussions in the coming days.

Regardless of how the Session ends up, now is a time to thank everybody who has helped this Session.  We have done some great work, but we look forward to even better results over the next week.

Legislative Report Week 7
February 26, 2016

With only two weeks left in the 2016 Legislative Session, action was fast and furious this week, with legislators and lobbyists scurrying to find “vehicles” on which to attach their legislative priorities and to position bills for final passage. The most frantic action was in Thursday’s all-day Senate Appropriations Committee hearing, the last stop for most Senate bills before heading to the full floor. In the course of the day, a bill designed to allow 24 hour ASC operation was amended to severely restrict such operation, but also to include Direct Primary Care and significant managed care reforms. Also passing this committee were allowances for ARNP and PA controlled substance prescribing, as well as prohibitions on balance billing in an emergency setting. Two bills regarding health care technology also passed the Committee, one requiring hospitals and providers to provide transparency of their pricing and the other allowing telemedicine (but only for Florida licensed professionals). At this point, the issues are teed up for final actions on the House and Senate Floor, and we look forward to actually passing some meaningful legislation over the next two weeks. 
Legislative Report Week 6
February 18, 2016

While progress on many of the most important issues has been slow this Session, Week 6 saw an avalanche of legislative activity, including major action on several of our priority pieces of legislation.

For instance, The House Needle Exchange Bill escaped legislative purgatory and cleared it last committee of reference; it is now on the House calendar, while its Senate companion also is on the calendar.  Also making progress were Dental Access Bills, with both House and Senate versions now ready for Floor votes.  The same is now true for ARNP and PA prescribing.  Receiving final passage were bills raising awareness for Bladder Cancer and Brain Tumors.

Of interest to many of our members was the Senate Health Policy confirmation hearing of Surgeon General John Armstrong, M.D., FACS.  After a thorough examination, Dr. Armstrong received a favorable vote from the committee, although his nomination must still be acted upon by Ethics and Elections Committee and by the full Senate.

All is set up for an exciting final three weeks, and we look forward to sharing even better news in the days to come. 

Legislative Report Week 5
Feburary 12, 2016  

As the 2016 Legislative session roared past its midway point this week, several health care priorities pushed ever closer to their respective finish lines, while others languished and saw their chances of becoming law dwindle.

The Needle Exchange Bill, already on the Senate floor, finally passed the House Judiciary Committee this week and now need only pass the House Health Appropriations Committee to advance to the House Floor.  Meanwhile, bills to extend dental access in under-served communities advanced to the House floor and the Senate Appropriations Committee, respectively.

Although the House continues to dawdle on bills that would restrict formulary changes for stabilized patients, both SB 1084 and SB 1142   have advanced to the Appropriations Committee, having passed all of their “substantive” committees.  Meanwhile, consensus was achieved on the controversial ER Balance Billing, with a House compromise allowing non-contracted physicians to charge the insurance company the usual and customary amount for such services while holding the patient harmless.

The Legislature now takes four days off for the President’s Day recess, after which much of next week will be devoted to budget consideration, with hope being to have budget conferences next weekend.  That would be a good omen for an on-time departure in 2016.  Unfortunately, the current budget does not fill the current vacancies at DOH, an issue that will be discussed on Tuesday when the Senate Health Policy Committee is scheduled to meet and consider Dr. Armstrong’s nomination as Surgeon General. 

Legislative Report Week 4
February 6, 2016

As we approach the halfway point of the 2016 Legislative Session and the impending end of committee meetings, it is becoming increasingly clear which issues are likely to remain viable in the Session’s final weeks. For instance, it now appears likely that Nurse Practitioners and Physician Assistants will be allowed to prescribe controlled substances, albeit with restrictions and without independent practice. Prohibitions on balance billing emergency room patients will remain a hot issue, although the parties have been feverishly attempting to hammer out a compromise over the past week. Finally, it is apparent that the House of Representatives once again will pass legislation eliminating Certificate of Need Programs, while the Senate ponders less drastic legislation on this subject.

As for FPHA pet projects, SB 478 (which would increase state salaries) did pass the Senate Government Operations Committee, but its House companion has yet to be heard. Meanwhile, while the Needle Exchange Bill is on the Senate Floor, discussion of its House companion was postponed in the House Judiciary Committee. On a better note, the DOH “package” bill has moved in each chamber and is poised for final passage. As you can see, it was an eventful week, but we look forward to even bigger and better things next week! 

Legislative Report Week 3
January 29, 2016

The third week of the Legislative Session is traditionally a “set-up” week, as legislators and lobbyists determine which issues will be actively pursued in the final six weeks and which issues will be deferred for another year. 2016 is no different. While we saw physician extender prescribing rights advance to the House floor, several of its most important legislative priorities will be debated next week. Next Monday’s Senate Health Policy Committee will be the Super Bowl for health care, as that committee will debate bills on Direct Primary Care, Managed Care reforms, and prohibitions on ER Balance Billing. Later in the week, the Legislature will begin debating Appropriation issues that will affect not only Public Health but each and every citizen. We also hope that the Government Affairs Committee will once again consider a pay raise for state workers, as the Committee ran out of time this week before considering the bill. FPHA will be there each and every step of the way, and we look forward to providing an update on what is sure to be an eventful week.

Legislative Report Week 2
January 22, 2016

The second week of the 2016 Legislative Session maintained the frenetic pace of the first, as both the House and Senate continued to move forward several pieces of significant health care legislation. After years of wrangling, it appears that physicians, nurses, and physician assistants have agreed on a compromise that would allow extenders to prescribe controlled substances in certain circumstances but would not allow for independent practice. These bills have already cleared their House committees, and their senate companions are already scheduled for next week. Meanwhile, the Senate Banking and Insurance Committee passed SB 1084, which would guarantee that insureds be allowed to maintain their current medicines when they change plans, although the House has yet to act on a companion bill. In other good news, the IDEA (i.e., Needle Exchange Bill) is on the Senate Floor, while its House companion has passed two of its four required committees. Much of Public Health’s legislative agenda is dependent on the budget, and it is rumored that serious consideration of the respective budgets will begin in the next few days, with both chambers aiming to pass their plans by the middle of February. At that point priorities will be clear, and legislation with a financial impact will be considered. All in all, it was a good second week, but we are hoping for even better things in the weeks to come.
Committee Week 6 12/1/15

The Legislature just completed its sixth and final week of pre-Session Committee hearings, tackling several thorny issues and setting the stage for what likely will be an eventful Legislative Session.   

Tuesday started with a well-attended press conference on Texting and Driving, as today’s press coverage has been supportive of our efforts to make Texting and Driving a primary offense.  Later that day, the Senate Health Policy Committee, after last-minute bargaining between the parties,  passed a  bill (SB 422) that will allow hundreds of people in underserved areas receive basic dental hygiene services (the House companion, HB 595, passed the House Health Innovation Committee the next day).  During the same hearing, the Committee also passed legislation that would require insurance coverage for opioid antagonists to the same extent as the opioids themselves. 

Wednesday saw the postponement of the controversial ER Balance Billing bill that would eliminate balance billing for emergency room visits.  That bill will be reconsidered in January.  Meanwhile, we participated in efforts to ensure that patient medications could not be arbitrarily switched by insurance companies in the middle of a contract year, although no bill has, as yet, been filed. 

By Thursday the venue had shifted from Tallahassee to Jacksonville, where the Board of Medicine is meeting to discuss its legislative agenda and office surgery.  As always, we are there working for our members, and we will let you know of any exciting developments. 

As a reminder, there will not be a legislative conference call this week, but we will reconvene prior to the Start of the Legislative Session. 

Committee Week 5 11/20/15
It may have taken awhile, but the Florida Legislature this week began its legislative work in earnest, voting on several key pieces of legislation during its fifth week of Committee hearings.

For instance, the Senate Health Policy Committee passed a bill that would prohibit the use of tanning beds by minors, while the Government Operation Committee was the second committee to vote in favor of a Pediatric Cardiac Take Force.  Wednesday saw traditional opponents coming together, as doctors and nurses agreed on a bill that would allow ARNPs to order controlled substances in a hospital environment pursuant to physician orders, and dentists and dental assistants agreed on a bill that would expand dental care to underserved areas.  All parties in the Senate joined together to advance a needle Exchange bill, although the legislation faces an uphill battle in the House.

For physicians, the most important issue on Wednesday was the House Insurance and Banking Committee’s consideration of the issue of balance billing.  While HB 221, as filed, is not worthy of support, leaders appeared to recognize the subtleties of the issue, including the need to ensure network adequacy.  The actual bill, along with several proposed amendments, likely will be heard on December 2.  On a positive note, the House Select Committee on Access to Healthcare unanimously advanced its Direct Primary Care Bill that would allow physicians to contract directly with patients for services, as well as legislation that would allow ASC patients to stay in such facilities for a full 24 hours.

With only one more week of pre-Session Committee meetings, the pace in Tallahassee has increased substantially, and we look forward to a tumultuous but productive first week of December.

October 9, 2015 Committee Week 2
The calendar may say that it is only October, but the legislative season is in full swing, with the Florida Legislature just having completed the second of six scheduled “committee weeks” in advance of the 2016 Session.

While the actual committee hearings were uneventful, lobbyists and legislators alike were scurrying to form alliances, file bills, and obtain intelligence regarding likely initiatives.  For us, many of last year’s issues will re-emerge, as legislation has already been filed that would allow for Direct Primary Care, 24 hour ASC access, ARNP and PA prescribing, and the prohibition of most ER balance billing.  

One item of interest for many FPHA members are the presentation of the DOH Budget requests for the coming year.  Capital projects were a large item, and all parties emphasized that the cuts in FTE that were published were only a"worst-case scenario" that is currently unlikely,

Next week is an “off” week for the Legislature, after which a three week Special Session on Redistricting will be held.  Although the focus of the Special Session will be on congressional and state senate maps, the health care committees will be meeting throughout the period, so stay tuned for what should be an eventful 21 days!!

May 2015               

As the Special Session of the Legislature is winding down, Chris has submitted the following report.  Your Legislative Committee is still meeting and considering potential bills/amendments for the upcoming Session which will begin much earlier next year.  Committee hearings are just around the corner.  If you have ideas you want to suggest, please send them.  If you are interested in being on the committee, just let me know.  At any time your suggestions are welcome.  I want to also remind you that Advocacy for public health was the number one desire of the membership.  If FPHA is to continue this effort, we need your continued support.  That means remaining a member.  So when you are notified you membership dues are up for renewal, be sure to pay them.  It is also important to bring others into FPHA.  If you know of someone who is not a member, talk to them about joining.  Large numbers in an organization will get the attention of those who are making important decisions.  FPHA wants to be sure we are at the table ensuring the right decisions are made.  Help us continue to be there.


End of Special Session Report

Christopher L. Nuland, Esq.

After the abrupt end of the 2015 Legislative Session, hope was high that the June Special Session could yield not only a balanced budget, but also resolution on a series of health care issues, all of which were included in the “call” for the Session.

True to its promises, the Florida House of Representatives not only considered the Senate’s Medicaid expansion plan, but also passed its own Health Care Reform package, including Direct Primary Care, ARNP/PA Prescribing, Certificate of Need Elimination, 24 Hour Ambulatory Surgery Centers and the Establishment of Recovery Care Centers.  While these initiatives all passed with overwhelming support, the House’s decision not to accept the Senate’s Medicaid expansion (on a mostly party-line vote) seriously jeopardized the Senate’s willingness to accept any House proposals.

Senator Aaron Bean graciously agreed to hear these proposals in his Health Policy Committee, but after a workshop on these issues, the Chairman decided that these issues were complicated enough to merit a vetting greater than that available in a three week special session.  As a result, the proposals died in the Senate Health Policy Committee, although Chairman Bean called for special interim workshops to more fully evaluate the proposals.  They will all be back when the Legislature begins its Committee hearings this Fall.

Despite these disappointments, the Legislature did succeed in its two major missions, to pass a balanced budget and appropriate enough finds for LIP funding.  With the use of $450 million dollars from General Revenue, as well as a $1 billion grant from the federal government, the Legislature was able to ensure continuation of LIP funding for one more year, after which time the federal government will further reduce its share of the cost by another $400 million.

In addition to the actions of the Legislature, the Governor provided some good news for FPHA and its members when he signed several of FPHA’s Priority Bills during June, including bills to ease HIV testing requirements (HB 321), allow the DOH to respond appropriately to epidemic threats (HB 697), and allow practitioners to provide opioid overdose counter-measures.

Overall, it has been an eventful six month legislative season, and it all revs up again in September due to the early start of Session in 2016.  I, for one, cannot wait!

As always, it is a pleasure and honor to serve.


End of Session Report (April 29, 2015)

With the House of Representative’s premature departure, several health care issues including legislation on ARNP Scope of Practice, Needle Exchange, Laboratory Directors, Direct Primary Care, Health Care Clinics, and several other issues, died this week. but not before the Senate passed HB 751, which allows the emergency use of opioid reversal agents. Of course, the House’s departure meant that there was no resolution of the overarching issues of the Low Income Pool and Medicaid Expansion.  These issues have yet to be resolved and are destined to be addressed during an as yet unscheduled Special Session in June. Despite the lack of passage of many pieces of legislation during the last week, we should took pride in those pieces of legislation that we did pass this year, listed below:

SB 104            Spinal Cord Awareness

SB 178            American Stroke Month

HB 321           HIV Testing Facilitation

HB 332           Nursing Home Pneumonia Vaccinations

SB 450            Pain Clinic Regulation

SB 676            Contributions for Breast Cancer Research

HB 697           DOH Epidemic Response

HB 751           Use of Opioid Reversal Agents

SB 800            Bladder Cancer Awareness

SB 1068         Brain Injury Awareness

I would like to thank those members who contacted their legislators to ensure the success of our agenda. Until the Special Session in June,


Week 8 Legislative Update (April 24, 2015)

Although resolution of the Low Income Pool (LIP) and Medicaid Expansion have yet to be resolved, the Florida Legislature did address many of our issues during this penultimate week of the 2015 Legislative Session.   SB 332, which facilitates the provision of pneumonia vaccines in nursing homes, passed both the House and Senate and is on its way to the Governor, as is SB 450, which renews regulations on pain clinics.  Breast Cancer Funding will be enhanced by SB 676, which allows for voluntary donations to such research when renewing one’s license.  Meanwhile, HB 697 (the DOH Epidemic Response Bill) took an extra couple of days but also is headed to Governor Scott’s desk. 

While funding issues do not appear as promising as the above, all appearances are that FPHA will be able to look back on 2015 as a stellar legislative year.   Until next week….


April 22, 2015 

The House just sent SB 332 (Pneumonia Vaccinations), SB 676 (Breast Cancer Funding) and SB 450 (Pain Clinics) to the Governor!!  It also passed HB 697 (DOH Epidemic Response), which is already on Special Order in the Senate.

A great day for FPHA!!

LIP Service-Week 7 Legislative Update (April 17, 2015 report)

While progress was made on several bills this week, the main topic of conversation is the relationship between the Low Income Pool (LIP), Medicaid Expansion, and our legislative agenda.

In a nutshell, CMS has indicated that it will no longer provide the State with almost $3 billion in LIP funding (which pays hospitals for uncompensated care) unless the State agrees to expand Medicaid eligibility (which, the feds argue, would lessen the need for LIP funding because there would be fewer uninsured Floridians).  The House is adamant that it will not expand Medicaid and therefore does not include LIP funding in its budget, while the Senate wants to expand Medicaid and therefore has included LIP in its budget.  The difference (after factoring costs of expansion, etc.) is approximately a $4 billion budget difference, and neither side is relenting. 

Until the chambers can agree on a final budget amount, any bill with a fiscal impact is stalled, as it is unclear as to whether there will be sufficient funds in the budget.  That fact, combined with the House’s desire to pass “disruptive” health care legislation (Scope of Practice Expansion, Balance Billing Prohibitions, Direct Primary Care, 24 hour ASCs, etc.). 

How bad has it gotten?  With two weeks left, the sides are not even talking, and the House and Senate are taking a four day weekend.  While hope springs eternal, legislators and lobbyists alike are planning on an extended or Special Session. 

With all of that being said, however, we still have bills in play.  A summary of our pending major legislation: 

HB 281           ARNP/PA Prescribing                                   Floor

HB 321           HIV Testing                                                    Floor

SB 332           Pneumonia Vaccines in Nursing Homes             Passed Senate; now in House

HB 411           Pneumonia Vaccines in Nursing Homes     Floor

SB 450           Pain Clinic Regulation                                   Passed Senate, in House

SB 478          Telemedicine                                                 Appropriations

SB 532           Hospital Prescribing                                     Finance and Tax

HB 547           ARNP Independent Practice                         Floor

SB 614            ARNP/PA  Prescribing                                  Rules

HB 697           DOH Epidemic Response                              Floor

HB 751           Emergency Opioid Coverage                       Senate

SB 950            DOH Epidemic Response                              Special Order

SB 1040         Needle Exchange                                          Floor

HB 4017         Pain Clinic Regulation                                   Floor

SB 7044         Medicaid Expansion                                     Floor

Week 6 (4/10/2015 report)

With the House concluding its committee meetings for the Session, the House Health and Human Services Committee took the opportunity to advance several pieces of controversial legislation. 

The good news is that the Committee did pass HB 7047, which will allow many physicians to contract privately with patients for an annualized price without having to procure and insurance license.  As a special bonus, the bill was amended to include a Medical Tourism component that will promote Florida medical expertise outside of the Sunshine State.  This bill now mirrors SB 7084, which passed the Senate Health Policy Committee this week. 

For its part, the Senate Health Policy Committee’s meeting was notable for NOT approving the nomination of John Armstrong, M.D., FACS.  While all indications are that the Committee’s delay was not aimed at Dr. Armstrong, but rather at a Governor who this week publicly opposed the Committee’s Medicaid Expansion Bill, Dr. Armstrong was placed in the unfortunate role of scapegoat. 

Meanwhile, the Senate Appropriations Committee on Health and Human Services passed SB 950, which addresses the Department’s ability to respond to epidemics, as well as SB 512, which eases the bureaucracy of HIV Testing paperwork. 

With scores of bills still in play, the deal-making now begins, as leaders of the House and Senate will seek to cobble together packages with their respective priorities.  Get ready for a bumpy ride for the next three weeks.  

Week 5 Legislative Update (4/3/2015 report)

As in most years, Week Five was devoted to further narrowing the range of bills that will be considered in the upcoming weeks.  While significant action was taken on many of our priorities, other legislation lagged and is now in danger of “dying” in the respective committees of reference.

On a positive front, two of FPHA’s major priorities, the Reauthorization of Pain Clinic Regulation and the Administration of Pneumonia Vaccines in Nursing Homes, both passed the full Senate and are now headed to the House, where the companion bills are already on the Floor.  Meanwhile, bills raising awareness of Strokes, Bladder Cancer, and Brain Injuries all passed the Senate and have become law. 

In less favorable news, despite some action on Texting/Driving legislation in the Senate, the House has indicated that it will not address the subject this Session.  Likewise, the House has indicated its reluctance to address Medicaid expansion, although the Senate has made clear its intention to do just that; because of the budget implications, this issue will go down to the wire.

Below is a summary of the actions taken on FPHA Legislation this week:

SB 104             Spinal Cord Awareness              Passed
SB 192             Texting as Primary Offense        Passed CEPU
SB 332             Pneumonia Vaccines                 Passed Senate; on House Floor
SB 450             Pain Clinic Regulation                Passed Senate; on House Floor
SB 800             Bladder Cancer Awareness       Passed
SB 1068           Brain Injury Awareness              Passed  

Week 4 Legislative Update (March 27, 2015 report)

Four weeks of the 2015 Legislative Session are now in the books.  With House Subcommittee meetings having now ended, and it becoming clearer where the major issues will arise during the final days of the Session.

In Public Health news, the Nursing Home Vaccination and Pain Clinic Regulation bills cleared Second Reading in the Senate and are poised for final passage next Wednesday.  Meanwhile, the Senate Health Policy Committee passed legislation that would facilitate the treatment of opiate overdoses, as well as the Needle Exchange Bill.  In the House, we were pleased to see the House Criminal Justice Committee pass a bill to regulate the recreational drug, Kratom.  Next week is likely also to be eventful, as a series of bills will be heard that would decrease the deadly combination of texting and driving.

With the Session approaching its halfway point, it looks like it is going to be a wild ride for the last 30 days.

Week Three Legislative Update

It was quite a week for FPHA.   Rather than providing a daily update, below are some of the notable events for the week.

*            SB 450, which preserves pain clinic regulations, passed its last committee of reference and is now on the Senate Floor and is on Special Order for March 24.  Its House companion, HB 4017, also is on the floor awaiting a final vote.

*            SB 1068, which promotes Brain Injury Awareness, received final passage by the Florida Senate.

*            HB 321, which eases the burden of obtaining consent for HIV Testing, passed its last Committee of reference and is now on the House floor.

*            SB 332, which facilitates the provision of pneumonia vaccines in nursing homes, passed its last committee of reference and is now on the Senate Floor, as did its House companion, HB 411.

Below is the current FPHA List of Bills being followed by FPHA and the Committee Status:

2015 FPHA Bills of Interest

#                  Subject                                                                        Sponsor                                    Committees Remaining

9                  Wireless Devices                                    Slosberg                  JA; APP                 

104                  Spinal Cord Awareness                        Hukill                                                                                         

178                  American Stroke Month                       Hukill                                                                                         

192                  Texting as Primary                               Altman                   CEPU; TA                                   

201                  Diabetes Awareness                             Narain                    CJ;JA;J                                                     

287                  Kratom                                                  Jacobs                    CJ; JA; Jud                                   

321                  HIV Testing                                         Avila                       Floor

332`                  Pneumonia in NH                              Grimsley                Floor

376                  Tanning                                                 Sobel                     HP; CJ; Rules                                   

411                  Pneumonia vaccine NH                       Miller                    Floor

4 50                  Pain Clinics                                         Benaquisto            Floor

460                  Traffic Safety                                        Flores                     CEPU; T; TEDA                                   

475                  Needle Exchange                                 Edwards                 GO; J; HHSC

478                  Telemedicine                                        Bean                       HHSA

486                  Health Care Clinic                                Sobel                       HP; HHSA                 

545                  Telehealth                                            Jones/Cummings    HQ; HCA; HHSC 

550                  Malnutrition Awareness                       Joyner                                                                                         

676                  Breast Cancer                                      Benaquisto              TEDA;

681                  ER Balance Billing                             Trujillo                    App; HHSA

697                  Epidemic Public Health                      Gonzales                 Floor

764                  Kratom                                                 Evers                       App; HHSA

800                  Bladder Cancer                                    Richter                                                                                         

950                  Epidemic Public Health                     Hukill                      HHSA; FP

996                  Home Medical Exemption                 Richter                     HHSA; FP

1040                  Needle Exchange                               Braynon                  HP; HA; FP

1068                  Brain Injury Awareness                   Bean                        Floor

1438                  Hep C testing                                    Joyner                        HP; HHSA; App                                   

4017                  Pain Clinic Regulation                                                       Floor                                                     

7047                  Direct Primary Care                        HI                             HHSC

7044                  Medicaid Expansion                        HP                            Floor


XXXX= bill has passed at least one committee

All in all, it was an exhausting week, but we cannot wait to get back into the battle on Monday!!

 Legislative Update- Week 2


The momentum from the opening week did not abate in Week 2, as legislators addressed a series of our issues in a series of often contentious debates.


In the most publicized action, the Senate Health Policy Committee passed SPB 7044, which would effectively expand Medicaid access to 138% of poverty and draw down billion of dollars in federal funds.  While the House will be reluctant to accept any such plan, the Senate has made its position clear, and this issue likely will be one debated in the final hours of the Session.


As for FPHA issues, bills empowering the Surgeon General to both quarantine and isolate those who have had contact with significant infectious diseases (such as Ebola) passed both the Senate Health Committee and the House


Telemedicine continues to be a hot topic, with bills requiring Florida licensure and a maintenance of the existing standard of care having passed the Senate Health Policy (SB 478) and House Health Quality Committee (HB 545).  Likewise, bills to facilitate the administration of pneumonia vaccines to nursing home residents have passed both House and senate committees.


As eventful as this week, however, next week is likely to be even more contentious.  On Tuesday the Senate Health Policy Committee will debate a bill to allow ARNPs to prescribe controlled substances, and on Wednesday the House Insurance and Banking Committee likely will hear a bill that would prevent ER physicians from balance billing patients beyond what is paid by insurance.


As always, feel free to contact me with any questions you may have.


Legislative Session Week One
And away we go!!!


The 2015 Legislative Session began on Tuesday with the traditional State of the State speech by Governor Scott.  Instead of a full day of pleasantries, however, the House of Representatives immediately began its business in earnest, with the House Health Appropriations Committee quickly passing HB 411, which should better enable nursing homes to administer pneumonia vaccines.  Later that same afternoon, the House Innovation Committee heard testimony on  Direct Primary Care bill and opted to introduce it as HB 7047 later that day.


Wednesday was a day of immense activity, with the Senate Banking and Insurance Committee unanimously passing senator Don Gaetz’ Step Therapy Bill (SB 784), while the House Health Quality Committee was passing the Needle Exchange Pilot Program (HB 475), Increased Authority for the Surgeon General to Respond to Public Health Threats (HB 497), and Reauthorization of the State’s Pain Clinic Law (HB 4017).


Next week already is filling up with major issues.  On Tuesday the Senate Health Policy Committee will consider the Senate version of the Epidemic Response Bill (SB 950), as well as legislation to provide sovereign immunity to those providers serving the State.


As you can tell, it has been and will be a busy Session . Thank you to all for your support and, (with apologies to Governor Scott), “Let’s Get to Work.”


Final Pre-Session Update


By all accounts, this past week was an eventful one for Medicine in Tallahassee.  Not only was action taken on several meaningful bills, but lawmakers also scrambled to file several pieces of legislation before the filing deadline.


In actual Bill action, the Senate Health Policy Committee passed a Telemedicine Bill (SB 478) that, while lacking some enhancements we would have liked, does require a Florida license and no alteration from the existing standard of care.  We also were heartened to see that that same Committee passed legislation to continue regulation of pain clinics (SB 450).  Meanwhile, the Senate Health Appropriations Committee passed an update to the Nursing Home Pneumonia Vaccination Bill (SB 332), pushing that good piece of legislation one step closer to final passage.


Despite the good Committee work, the real excitement was in seeing what bills were filed.  For Public Health, that includes bills on Epidemic Response (HB 697 and SB 950), Brain Injury Awareness ((SB 1068), and regulation of Kratom as a Schedule I drug (SB 764 and HB287). 


Although lobbyists and legislators have been hard at work for two months, the legislative preseason is now over, and all stakeholders now turn their attention to the official start of the Legislative Session, which begins on March 3. 

The Week that was

The calendar may only say February, but the 2015 Florida Legislature is already in full swing, using the past week to introduce a myriad of bills that would have profound impacts on medicine and actively debating bills that had already been filed.


In Committee action, the House Health Quality Committee passed HB 321, which would update current Florida laws with regard to HIV Testing.  We were also pleased to witness the passage of HB 9 out of the House Criminal Justice Committee, as this bill would elevate the act of driving and texting from a secondary to primary offense. 


Recently filed bills of note include HB 287 and SB 764, both which would place the recreational drug Kratom on the Schedule I list of controlled substances, as well as SB 800, which would increase awareness of Bladder Cancer.

Next week (the last of the official legislative pre-season), promises to be eventful, as the Senate Health Policy Committee will consider legislation to extend the regulation of pain clinics (SB 450) and expand the use of Telemedicine (SB 478).  On the latter issue, we have been meeting with Committee Chairman Aaron Bean to ensure that Telemedicine is used a supplement to, and not a replacement for, the actual presence of a Florida-licensed health care provider.

Next Week's Update will include a full listing of the bills on which FPHA is working this year.


Legislative Update

While this week in Tallahassee was shortened by the MLK holiday, it did not lack for emerging issues. 

Not only have a myriad of driving safety bills been filed (most dealing with minors texting and driving), but I am pleased to report that Senator Eleanor Sibel’s staff has indicated that they will champion the FPHA initiative to seek a 7% pay raise for state workers.  Thank you, Senator Sobel!!

Bills also have been filed to allow for the more expedited treatment of opioid overdoses,  restrict tanning bed use by minors, and increase awareness for public health issues such as strokes and diabetes.  These are but a fraction of the bills that will eventually be filed, and we look forward to an eventful session.                  



When Senate leaders refused to consider a final House health care counter offer at 8:30 on the 60thday of Session, chances for meaningful health care legislation evaporated. The House had gambled that the Senate would not walk away from a bill that included the Department of Health legislative package, a controversial trauma system reform, and our Health Care Clinic Act, but the Senate effectively called the House’s bluff by refusing to even consider the last-minute House offer, leaving the legislation to die when the Legislature adjourned “sine die” (without date).

Notwithstanding the last-minute implosion, here were also some notable bills passed. Legislation allowing for schools and other institutions to stock and administer emergency allergy treatment is on its way to the Governor, as is legislation to raise the age at which children must still utilize booster seats. This latter legislation has taken over a decade to pass. While a bill that would have required primary care physicians to offer Hepatitis C tests to all new patients died on the floor, money for an awareness campaign and increased testing was included in the budget. We also were successful in preventing efforts to eliminate red light cameras, which have been shown to reduce the severity (if not frequency) of intersection accidents. Finally, while FPHA was not a player in the debate, a bill allowing the compassionate use of low-TDC marijuana passed and is on its way to Governor Scott.

I would like to thank each and every member who took the time out of their schedule to contact even a single legislator. Our victories this year were by narrow margins, and each and every contact was vital in our legislative efforts,

As always, it is a pleasure and an honor to serve. 



With only one week left in the 2014 Legislative Session, battle lines have formed in both the House and Senate on the major health related issues.

The House of Representatives yesterday amended its single Health Care Bill (HB 7013) to include ARNP Independent Practice, Telemedicine (where out of state physicians are subject to revocable registration, but not required to obtain a Florida license), easing of Physician Assistant supervision requirements, and Trauma legislation.

The Senate, on the other hand, has not allowed any of those issues (other than Trauma) to advance to the Floor, but will consider Medicine’s Managed Care reform (SB 1354) on Monday, as well as our Health Care Clinic Act, which passed the Senate Appropriations Committee on Thursday. As a result, the stage is being set for an ultimate showdown in which all major healthcare legislation may be imperiled if negotiators do not reach a compromise. This compromise is unlikely to involve the entire chambers, as neither chamber is likely to pass the other’s bill; rather, these negotiations likely will include the respective health committee chairmen (Senator Aaron Bean and Representative Richard Corcoran) and a few other leaders.

While the attention was on the above legislation, FPHA quietly had a very good week. Booster Seat legislation passed the House and advanced to the Senate floor; ultimate passage is not assured, but is quite possible after five years of efforts. Needle exchange legislation is on the floor of both chambers. A Spinal Cord Injury Awareness passed the Florida Senate., and a good DOH “glitch bill” is on the floor of both chambers.

We will keep you updated in what surely will be a wild final week.


With last week being the last opportunity for non-Appropriation committee meetings, there was a flurry of activity as bills were advanced, left for dead, and/or combined to make huge health care “trains.”

Without doubt, the most notable activity was the House Health and Human Services Committee combining its Telemedicine, ARNP Independent Practice, and Trauma legislation into one bill (HB 7113). Of note is that this bill would allow independent practice for ARNPs and would not require out of state telemedicine providers to possess a Florida license.

By contrast, amendments made to the Senate Telemedicine Bill, SB 1646, would require Florida licensure, while the Senate legislation on ARNPs, SB 1352, would only allow for ARNPs to prescribe controlled substances (it should be noted that SB 1352 still has two more committee stops.

In other public health action, the Infectious Disease Elimination Acts passed their respective last substantive committees in both chambers and are now ripe for final passage. In a similar vein, child booster seat legislation (SB 518) is now in Appropriations in the Senate but, more importantly, is already on the House floor. Finally, legislation to increase the availability of HIV/AIDS testing (HB 1225) is on the House Floor, although its Senate companion (SB 1470) continues to languish in Judiciary.  On the other hand, other Senate action was favorable to public health, as the Health Care Clinic Act passed yet another committee and is now in Appropriations..

There will be no report this Friday, as both chambers are taking this week off in observance of the Passover/Easter holidays, but next week will begin with an all day Senate Appropriations meeting on Tuesday, when most of our legislation will hopefully be heard. Stay tuned for an eventful final two weeks.

The 2014 Florida Legislative Session hurled through its midpoint this week, with significant progress on several of FPHA’s targeted issues.


The IDEA (Infectious Disease Elimination Act) has advanced to the Senate Floor, while its House counterpart is in its third House Committee today.  Meanwhile, booster seat legislation for years struggling even to have a hearing in the House, this week passed its first committee.  In administrative news, the House DOH Bill (HB 819) passed its last committee as is headed for a floor vote.  Also now ready for a Floor vote is HB 1131, which would ease the restriction on the use of epi-pens; its Senate companion (SB 1122) passed its final committee on Wednesday.

While no bills have officially “died,” bills that have received no action to date will have difficulty passing.  Below is a list of bills that, as of today and in my opinion, are still very much alive:

2013 Bills of Interest

As of  4/4/13

#          Subject                                     Sponsor              Committees                 

144       Red Light Cameras                    Brandes           T; TA; App                               

342       Fl. Indoor Clean Air                    Bradley            RI; CA; CJ                                           

408       Needle Exchange                      Braynon           Floor                                   

465       Hepatitis C                                 Jones               HQ; HCA; HHSC                       

430       Spinal Cord Awareness             Hukill   

491       Needle exchange (IDEA)           Pafford             HQ; GO; Jud; HHSC

518       Booster Seats                            Flores               App

746      Health Care Clinic Inspection     Sobel                HP; CJ; CA; App

751       Telemedicine                             Cummings        Select; HCA; HHSC

819       DOH                                      Pigman            Floor

1122     Emergency Allergy              Bean                Floor

1131     Emergency Allergy              Hudson           Floor

7028     Telemedicine                       Health Policy  Appropriations


March 28, 2014

The week of March 24 was an eventful one for Public Health.  Hepatitis C testing legislation advanced in the House, as did needle Exchange Programs in both the House and Senate.  With FPHA’s help, bans on minors using tanning booths advanced in the Florida Senate, as did proposed laws that would require inspections of virtually all health care clinics.

Infectious disease control bills passed both the House and Senate committees, notwithstanding FPHA concerns regarding finding that hopefully will be addressed in the respective Appropriations Committees.

While this week’s report may appear short, please rest assured that much work was done behind the scenes.  Next week’s report will include a complete rundown of the status of FPHA’s targeted bills.


March 21, 2014

After a couple of relatively slow weeks, this past five days have been the busiest of the 2014 Florida Legislative Session, with the promise of an even busier week to come....

The week began on Monday with a three hour hearing on the pending Medical Malpractice Crisis created by the Supreme Court’s invalidation of caps on non-economic damages. We spoke at the hearing, emphasizing that any solution must center on the patient while eliminating the need for costly defensive medicine.

Bills requiring physicians to offer the Hepatitis C test to virtually all baby Boomers passed committees in both the House and Senate (HB 465 and SB 824). While we publicly supported the test itself, we are working hard with the sponsors to find common ground on the issue of a physician mandate. Also passing were bills to promote the early treatment of Alzheimer’s Disease .

I am also pleased to announce that Surgeon General John Armstrong, M.D., FACS cleared yet another committee in his quest to receive official confirmation, with a final hearing scheduled for next week.

All of that activity pales in relation to the schedule for next week. On Monday afternoon the House Health Appropriations Subcommittee will consider bills on Graduate Medical Education, Telemedicine, and Trauma, after which the Senate Criminal Justice Committee will consider the Health Care Clinic Act.

Tuesday will start at 8:30 a.m. with consideration of the FMA’s Insurance Reform package by the House Insurance and Banking Committee, and finally this year’s “Super Bowl” of a Senate Health Policy Committee, where bills on Trauma, ARNP Prescribing, Tanning, and the Senate version of the FMA Insurance Package all will be considered.


March 7, 2014

The first week of the 2014 Legislative Session included the usual pomp and circumstance, but otherwise was dominated by actions in both the House and Senate on the respective Telemedicine bills, with public health bills being largely postponed for a week..

On Monday, the House Select Committee on Healthcare Workforce Innovation passed its Telemedicine Committee Bill. While the bill did include a provision stating the Telemedicine’s standard of care must be the same as in-person services, the bill omitted a much-needed requirement that out-of-state providers be licensed by the State of Florida. Such a requirement is not about “turf protection;” rather it is a patient safety initiative designed to ensure that all Florida patients receive the benefits of patient protection laws that we have passed on the past decade, such as pill mill legislation. I am pleased to report that both House sponsors have acknowledged this concern to me and have pledged to address it in upcoming drafts.

The Senate version was introduced and amended by the Senate Health Policy Committee on Wednesday. Again, the Senate bill did not include a requirement for Florida licensure, although Senator Eleanor Sobel did introduce and pass a late-filed amendment that at least required out of state physicians to comply with Florida laws and be subject to discipline by the Board of Medicine. We thank her for her sensitivity to this issue.

Next week represents the first full week of the Session, and the health committees already are looking at bills to regulate non-physician-owned medspas and continue debate on ARNP scope expansion and Telemedicine.

Stay tuned. 

February 21, 2014

The final week of pre-session committee meetings was an eventful one.

Hundreds of bills filed in an attempt to meet the impending March 4 deadline, including a good KidCare eligibility bill by Representative Gayle Harrell, a DOH “glitch bill” by Representative Cary Pigman, M.D., and a measure to preserve and strengthen the Prescription Drug Monitoring Program.

The most ferocious battle of the week, however, was the consideration of the ARNP Scope of Practice expansion bill in the House Select Committee for Health Care Workforce Innovation.  Despite vocal opposition from a series of physician groups, the Committee voted 13-2 to allow ARNPs independent practice. 

This does not mean that unlimited ARNP independent practice is a certainty, as amendments are likely both in future House committees and in the Senate.

While we continue to work behind the scenes on the various Telemedicine bills, consideration of SB 7028 was postponed by the Senate Health Policy Committee on Tuesday.  It is scheduled to be debated at the March 5 meeting of the Senate Health Policy Committee, as well as by the Select Committee on Health Workforce Innovation on Monday, March 3.  While supporting the use of telemedicine, we are seeking to ensure the safety of both the systems and those who use them.

We also have been actively engaged in promotion of a Hepatitis C Prevention and Awareness Bill, seeking to overcome objections from the physician community that the mandatory offering of a Hepatitis C test to those in the target population (born from 1945-1965) is an overly onerous burden on physicians..

The 2014 Legislative season is already in full swing, and we truly appreciate those members that are already fully engaged in our efforts.  It is going to be a wild Session!


P.S.      There will be no legislative alert next week, as Legislature is taking the week off before the official start of Session.  I will, however, be distributing a final list of those bill on which FPHA is engaged.

February 21, 2014

While hundreds of bills were filed during the penultimate week of pre-session committee hearings, the primary focus remained on Telemedicine and ARNP Independent Practice.

With regard to Telemedicine, the Senate Health Policy held a second hearing on its proposed Telemedicine Bill, SB 7028.  While all parties appear to agree that Telemedicine should not alter the standard of care and should not be used to prescribe controlled substances for the treatment of chronic pain (issues on which we testified), differences do still exist as to whether insurance companies should be required to pay at the same level as in-person visits, and whether out-of-state Telemedicine providers must be licensed in Florida. 

The more contentious issue, however, was the release and debate on the House ARNP Independent Practice Bill.  As written, this bill would essentially grant to the newly designated Independent Practice Registered Nurse the full medical privileges, including the right to prescribe controlled substances, without even a collaborative agreement with a physician.  A final committee vote on this bill will be held next week.

Of course, these were not the only events of the week, as bills were filed to ensure the safety of health care clinics (SB 746), promote Hepatitis C testing (SB 824), and further discourage the use of wireless devices in motor vehicles (SB 988).  Below is a more thorough list of the bills were are currently “working” in the Legislature.

2013 Bills of Interest


As of  2/14/13

HB          937

SB           1060


#              Subject                                          Sponsor                              Committees                         


5           Minors driving/cell phones                   Slosberg                                T; TEDA; HHSC                                   

70         Telemedicine                                     Joyner                                    HP; BI; HHSA; App          

144       Red Light Cameras                             Brandes                                  T; TA; App                                   

167       Telemedicine                                     Jones                                      HI; BI; App; RA                 

309       FL Indoor Clean Air                            Edwards                                  HQ; LF; HHSC                                                     

322         Texting as Primary Offense               Sachs                                     T; CEPU; CJ                        

341       Smoking w/ Minor                              McBurney                               T; TEDA; EA                    

342       Fl. Indoor Clean Air                            Bradley                                   RI; CA; CJ                                  

352       Minor wireless driving                        Abruzzo                                 T; CEPU; Jud                      

408        Needle Exchange                              Braynon                                 HP; CJ; HHSA; App                      

454         Booster Seats                                 Altman                                   T; CF; Jud; App

430         Spinal Cord Awareness                   Hukill                    

518         Booster Seats                                Flores                                     T; TEDA

594         Smoking and Driving                      Bean                                        T; RI

746       Health Care Clinic Inspection            Sobel                                      HP; CJ; CA; App

751         Telemedicine                                Cummings                               Select; HCA; HHSC

917       Kidcare presumptive Eligibility           Harrell                 

988       Wireless Driving Near School            Margolis                                                                       

4009     Red Light Repeal                              Artiles                                     EAF; App

7028     Telemedicine                                   Health Policy       

And, just because you asked, here is a list of the various marijuana bills that have been filed to date (the FPHA is not taking a position on any of these bills at this time)

843         Representative Gaetz

962         Senator Clemens

1030       Senator Bradley


February 7, 2014

The calendar may say that Session is still three weeks away, but that did not stop the Florida Legislature from using its Committee Weeks to take significant action on several key issues.

Legislatively, Telemedicine and Scope of Practice continue to dominate the legislative discussion.  The latest Telemedicine Bill, SB 7028 by Senate Health Policy, incorporates our core concerns that Telemedicine NOT alter the standard of care and NOT be used as a method of prescribing controlled substances for the treatment of non-malignant pain (these issues also were incorporated in the final Board of Medicine rule, which is poised for final approval).  Two issues not related to Public Health have yet to be resolved legislatively is whether an out-of –state “certificate for non-Florida physicians is sufficient (the proposal tracks the Expert  Witness certificate of a few years ago) and whether insurers must pay for Telemedicine services at the same rate as in-office services.  This proposal will be further debated on Tuesday during the Senate Health Policy Committee.

With regard to Scope of Practice, the House Select Committee on Health Workforce Innovation released its draft ARNP Bill on Wednesday evening.  The bill would allow ARNPs to practice without physician supervision and to prescribe controlled substances.  Of note, however, is that the bill does not otherwise significantly expand what ARNPs can do,  and independent ARNPs would be subject to many of the restrictions (self-referral, adverse incident reporting, etc.) that currently apply to physicians.  This bill will be debated on Monday at the Committee hearing.

Both of the above bills are designed to address the upcoming shortage of physicians in Florida by allowing increased access to health care through new technologies and newly "liberated" providers.

Other issues gaining attention are promoting testing for Hepatitis C, which now has sponsors in both chambers (e.g., SB 824 by Joyner), and a pilot Needle Exchange Project in Miami-Dade, the latter of which passed the Senate Health Committee tis past week.

As the above shows, we certainly are already in full swing.  Should you have any questions, or if I may be of further assistance, please feel free to contact me.

Until next week…Chris


2014 Bills of Interest  As of  12/2/13
HB          353
SB          458

#             Subject                                                   Sponsor                 Committees                         

5             Minors driving/cell phones                  Slosberg                T; TEDA; HHSCz
70           Telemedicine                                      Joyner                    HP; BI; HHSA; App
144         Red Light Cameras                             Brandes                 T; TA; App
167         Telemedicine                                       Jones                    HI; BI; App; RA
309         FL Indoor Clean Air                             Edwards   
322         Texting as Primary Offense                Sachs                    T; CEPU; CJ
341         Smoking w/ Minor                               McBurney  
342         Fl. Indoor Clean Air                             Bradley                 RI; CA; CJ  
352         Minor wireless driving                         Abruzzo                 T; CEPU; Jud 
408         Needle Exchange                               Braynon 
458         Booster Seats                                     Altman 
430         Spinal Cord Awareness                      Hukill  
4009       Red Light Repeal                                Artiles                    EAF; App              


Week ending November 7, 2013

The third week of Committee meetings for the 2014 Legislative Session laid the groundwork for what are shaping up to be the two major issues of the Session- Scope of Practice and Telemedicine.

As the House Select Committee on House Healthcare Workforce Innovation heard voluminous reports that Florida’s demographic trends indicate that the combination of an aging population will increase demand for health care services, and that this demand must be met enabling health care providers to see more patients,  This may be accomplished either by utilizing new technologies (e.g., telemedicine) or  by increasing the number of providers available to treat patients (which may well increase in increase in the scope of practice of some professions).  In both cases, FPHA is adamant that patient safety AND increased accessibility to health care both be guiding principles during the upcoming debate.  Despite much discussion, no bills have yet been filed.

These themes also will be echoed next week, when special committees of the Board of Medicine and Osteopathic Medicine will again meet in Tampa to discuss Office Surgery and Telemedicine.  Again, balancing access with patient safety will be the challenge, with our goal being to err on the side of safety whenever possible. 

While only a few hundred bills have already been filed, only a handful address FPHA concerns, and those include bills to make texting and driving a primary offense (especially for minors) and allowing municipalities to enact tough clear air laws.  The FPHA will be supporting all such bills.

As always, your thoughts and comments are welcome.  Please feel free to contact me an nulandlaw@aol.com with comments, suggestions, and questions you may have.             

Week 9 Legislative Report-May 2013             
To quote the famous philosopher, Yogi Berra, “It ain’t over til it’s over.” Such was the case in the final week of the 2013 Florida Legislative Session, as debate, backroom deals, and parliamentary maneuvers kept legislators and lobbyists alike on their toes until the final gavel fell and the Legislature officially adjourned “sine day” (Latin for “without day”).

Almost immune from the intrigue was the one issue that the Florida Constitution requires the Legislature tackle each and every year- the passing of a budget. With a resurgent economy producing more state revenue, state employees received a modest increase, and health programs escaped the cuts that had plagued them for the past several years.

The penultimate week also saw the passage of legislation that will allow health professionals to earn continuing education credit for volunteer services; we worked especially hard on this latter bill, which will encourage the provision of health services at no cost to the State and rewards those who volunteer their time and talents.

Despite the resolution of the above issues, the final week saw its usual flurry of activity. By Wednesday physician assistants had won the right to prescribe in hospitals pursuant to a physician orders (a practice that had become commonplace but lacked legal authority), and schools were allowed to stock epi-pens for use in emergencies.

Perhaps most rewarding from a personal standpoint was the passage of a bill banning the combination of texting a driving, an issue that FPHA has pursued for four years. Likewise, a bill designed to make oral cancer agents more accessible was amended in the House, requiring the Senate to pass the same bill twice. Both of these FPHA-supported measures eventually passed and are on their way to the Governor.

One issue that did not survive the internal in-fighting was additional coverage for the poor and uninsured. While both chambers opted to not expand traditional Medicaid, even with the $51 billion over ten years promised by ObamaCare, the Senate passed a plan that would utilize federal funds to find non-Medicaid coverage for those making up to 138% of poverty (the same number used by ObamaCare). The House, however, refused to allow any federal funds to be used, and the Session ended with the competing sides unable to resolve their differences. A Special Session on this issue is still a possibility.

None of the above machinations, however, even held a candle to the backroom dealings of SB 966/HB 1159, a bill that originally addressed only hospital credentialing. After 59 (that is not a typo) amendments that included such issues as Telemedicine and the Credentialing of surgical Assistants, as well as three days of postponements, the Senate finally opted not even to address SB 966 and instead made HB 1159 its Omnibus Health Care package. The Senate amended HB 1159 to allow additional Level II Trauma facilities (although a week of lobbying prevented the complete deregulation of the trauma systems). The House then tackled the bill in its final moments, adding the Oral Cancer Medication parity issue, and PDMP funding. The Senate then opted not to add additional amendments before passing the final product in the Session’s waning moments.

As the above demonstrates, 2013 was an eventful Session that was largely successful because of the efforts of our members and allies. Special thanks go to those members who contacted their legislators and visited the Capitol, as well as to the FMA and other specialty societies with which we regularly partner.

But most of all, I thank each and every one of you for allowing me the privilege and honor to serve.

Sine die…


Week 8 Review - 4/26/13
As with every session, the number of bills “in play” during the last few weeks diminishes, although parliamentary moves and backroom deals abound. That being said, we are in a good position going into the Session’s final week.
Much of the discussion next week will center on the ongoing issue of whether to accept federal dollars to expand Medicaid. The Senate is opting for a plan that would accept $51 billion over ten years, while the House plan would forego those funds and thereby provide coverage for far fewer patients. I expect some resolution of this, as all legislators have a political interest in passing this. However, the time taken to resolve such a contentious issue may not allow sufficient time to address all of the remaining bills.
HB 1093 is on its way to the Governor!! This bill would allow health care providers to earn CMEs for providing volunteer services. This will increase the availability of health care at no cost to the state.
Overall, on health issues it appears that the House is waiting to consider Senate language, as many health-related bills have passed the Senate but are still awaiting action in the House. As of next week, the House will be unable to take up its own bills that have not yet passed Second Reading. Among those bills are:
SB 52 Texting/Driving (Passed Senate, House Bill on Floor)
SB 284 Epi-Pens in Schools (Passed Senate, House Bill on Floor)
SB 398 Physician Assistant Prescribing in Hospitals (Passed senate, House Bill on Floor)
SB 422 Oral Cancer Treatment (Passed Senate, House Bill on Floor)
SB 1192 Physician Consultation with PDMP (Special Order in Senate, on Floor in House)
SB 1302 Temporary Licenses for Visiting Physicians (Passed senate, House Bill on Floor)

Anybody notice a trend?

As you can see, it should be an eventful final weeks, and I will be providing leadership with updates on a regular basis.


Week Seven Legislative Report - 4-19-13

Week Seven was the last week of Committee hearings, and any bill that has not passed each of its assigned committees is now officially removed from further consideration (exceptions do occur, but are rare). As a result, there was a flurry of last-minute activity, as exemplified by the Senate Appropriations Committee passing 67 bills in an eight hour session on Thursday. The result of this activity were generally positive for public health.

After years of effort, the Florida House will consider a bill that bans the combination of texting and lobbying, as HB 13 has passed all of its committees; for its part, the Florida Senate has done its work, as it has already passed and sent to the House its version of the ban as SB 52. Likewise, the Senate has already passed legislation to allow schools to maintain and store epi-pens, while the House companion bill has passed each of its committees and is now awaiting final action on the House floor. The same is true for bills that would make oral cancer drugs more readily available.

In addition to these positive developments, it should be noted that bills to raise awareness of bladder and esophogeal cancer have both received final approval.

While this week's developments were positive, much work still needs to be done over what promises to be a hectic final two weeks.


Week Six Legislative Report - 4/12/13

Christopher L. Nuland, Esq.
Lobbyist and General Counsel

Week Six of the 2013 Legislative Session saw lawmakers making significant progress on key issues and the budget, while scores of other bills appeared destined to be abandoned until 2014.

In good news, both the House and Senate passed budgets that increase salaries for state workers (3.0-3.4%) and preserve pension benefits for those currently in the system. In substantive bills, HB 369, which allows schools to stock epi-pens, passed the House Education Committee and now is on the House Floor. Likewise, bills to ban the combination of driving and texting have advanced to the floors of both chambers (with the Senate Bill on Special Order for Tuesday), and bills to provide incentives for health professionals to provide volunteer health services passed Appropriations committees in both chambers.

Next week is that last week for committee hearings, and the House PPACA Committee debating a Republican Plan to provide insurance access to approximately 115,000 additional Floridians with no federal funds. On Tuesday the Health and Human Services Committee is expected to take up an as yet unseen bill by Representative Corcoran that would allow a degree of independent practice to ARNPs.

Until next week


Week Five Report - 4/5/13
Christopher L. Nuland, Esq.
Lobbyist and General Counsel

The 2013 Legislative Session passed the midway point this week with a flurry of positive activity for Public Health.

For instance, the Senate passed SB 284, which will allow auto-injectors (AKA "epi-pens") in public schools, with the House having moved the companion bill to the Floor. Meanwhile, SB 422, which would ease the way for oral cancer drugs, advanced to Third Reading in the Senate, with the House bill already having passed that chamber. The FPHA has worked hard on both of these bills throughout the Session.

Meanwhile, bills that would ban the combination of texting and driving are on the verge of passage after ten years of effort. HB 13 passed the Economic Affairs Committee and is now headed to the House Floor, while its Senate companion, SB 52, has its final committee of reference on Monday.

For those working in governmental public health jobs, preliminary budgets in both chambers point to modest raises this year, with work on health care and pension benefits not likely to adversely affect current state workers.

Keep an eye out for Votervoice alerts in the coming weeks, as legislators need to hear your voices on these and other critical issues.


Week 4 Legislative Report (3/28/13)

Week Four was that last week of meetings for House subcommittees, meaning that bills that have not passed at least one subcommittee will require a two-thirds vote of the entire House in order to be considered further. In reality, the lack of consideration by now is paramount to a death sentence for such bills.

While the Passover and Easter holidays curtailed legislative action this week, what action did take place was very favorable, as the House Health Committee passed several bills of interest to Public Health.

With Wednesday being its final meeting, the Committee passed, HB 731 (which would create a pilot Needle and Syringe Exchange Program in Dade County. Especially noteworthy was the passage of HB 1093, which would enable physicians to obtain CME credit for providing volunteer services through a DOH-recognized program, thereby increasing health care access to Florida's underserved population. This bill has now passed committees in both chambers and appears poised to make a strong run on passage in the Session’s final weeks.

Also on Wednesday, the House Criminal Justice Committee passed Representative Berman’s HB 1041, which would make both HGH and hcG Class III controlled substances and hopefully curb the abuse of these two drugs. Meanwhile, the Senate moved one step closer to making oral cancer agents more accessible, moving HB 422 to its Third and final reading.

In separate but important news to many of our members, negotiators in the House and Senate appear closer to giving state workers their first raise in several years. While likely not the seven percent increase advocated by House Democrats, the raise should be significant.

Although this week was slow, the lack of activity may be seen as a temporary “cease-fire,” which is sure to expire when the Legislature returns to action next week.
Legislative Update-Week Three (3/24/13)
With the third wek of the 2013 Legislative Session now in the books, several issues have emerged as priority items for lawmakers, and our lobbying efforts appear to be reaping benefits.
For instance, we were successful in passing amendments that will allow ep-pens in public schools, as well as a Senate Bill that would make both hcG and HGH Schedule III drugs and hopefully reduce instances of their abuse.  We also have our texting bills in position to move to the Floor over the next few weeks, and further disruption to DOH seems to be a more remore threat.
Of course, no week this year would be complete without a Medicaid development.  This week’s news is that Senate Budget Chairman Jo Negron is proposing legislation that would allow those making up to 138% of poverty participate in the Healthy Florida program, using federal funds that otherwise would have been available under Obamacare.  The House is skeptical of this proposal but has not dismissed it.
Next week is likely to be a slow week, due to the Jewish and Christian holidays.  Nevertheless, the House Health Quality Committee will hold its final meeting, and we are expecting the unexpected on Thursday.

Legislative Update-Week Two

It is not every week that a Lieutenant Governor resigns in a scandal, but Tallahassee did its best to avoid discussion of the issue, with Governor Scott going so far as to state that he will not even consider a successor until after the conclusion of the Legislative Session. In my mind, this is an outstanding political move, as would-be candidates (almost all of whom are current legislators) must spend the rest of the Session currying favor with Governor Scott in order to be considered for the job.
In other news, Week Two of the Legislative Session was again dominated by Medicaid debate, with the Senate Select Committee on PPACA echoing the vote of its House companion by opting (on a purely party line vote) not to expand Medicaid. Nevertheless, both the House and Senate Committees will continue to meet as they continue to examine ways in which to implement those portions of Obamacare for which the State has no discretion.
The House and Senate Committees did address some substantive issues this week. After years of not even receiving a hearing in any House committees, HB 13, which would ban texting and driving, passed its second committee and needs only to pass one more committee before going to the House floor; its Senate companion also passed its second committee this week. Also, both the House and Senate committees passed bills to ensure that oral cancer medications are paid by managed care organizations to the same extent as IV infusion services.
Next week should be a full one in Tallahassee, as both the House and Senate strive to build momentum on hundreds of bill before an anticipated Holy Week break the following week. 

Legislative Update-Week One (3/9/13)
The first official week of the 2013 Legislative Session was again dominated by Medicaid discussions, with the House select Committee voting 10-5 along party lines not to expand Medicaid eligibility. While this vote does not doom the possibilities of expansion, it does show that Governor Scott faces an uphill battle convincing his Republican colleagues in the House that expansion would be good for the State of Florida.

That is not to say that Medicaid was the only issue discussed this week. In an unusually strong week for FPHA issues, the House Transportation Committee voted to ban texting and driving, an issue for which FPHA has lobbied for several years. Meanwhile, the Senate Health Policy Committee voted to allow municipalities to create Indoor Clean Air Acts that go beyond what is mandated by state law.

Final Pre-Session Legislative Update (2/22/13)

Any discussion of the legislative events of the past week must start with the shocking decision of Governor Rick Scott to expand the state’s Medicaid eligibility to those making less than 138% of poverty. By all estimates, such an expansion would add at least one million Floridians to the Medicaid rolls, making Medicaid by far and away the largest payor of health services in the State.

Always an opponent of big government, Governor Scott did not come to this decision lightly, having announced his support only after the federal government agreed in principle to the Florida Medicaid Managed Care law passed by the legislature last year. It should also be noted that Governor Scott has only committed to the expansion for three years, during which time the federal government has committed to paying 100% of the cost of insuring the additional Floridians. It should also be noted that Governor Scott’s decision in not binding on the Florida Legislature, which must also approve the expansion before it can go into effect in January of 2014.

With this week’s flurry of activity, the legislative “pre-season” is officially over, and lawmakers and lobbyists alike are preparing for the annual 60 day madhouse known as the official Legislative Session, which will begin on March 5, 2013.

Battles Lines Forming as Legislative Season Heats Up (2/15/13)

Christopher L. Nuland, Esq.
Lobbyist and General Counsel
After weeks of merely discussing issues without moving on particular legislation, the Florida House and Senate this week both began work on specific legislation, much of it controversial, that will soon be debated in the Capitol.

For instance, a bill to ban texting and driving has already passed its first committee in the Senate, where such bills have passed in each of the passed few years, but this week I received confirmation from House Transportation Committee Chairman Dan Davis that he will hear a texting bill for the first time this Session. We thank Chairman Davis for allowing debate on this important public health issue.

Moreover, while hearings continue to be held on the progress of last year's DOH reorganization, the tone of those hearings is much less combative, and the hope is that the worst of that political crisis may be behind us. In fact, Governor Scott's proposed budget does not target the Department to the extent of last year, and there were no calls for further cuts during the Senate's initial consideration of that budget.

As the above indicates, the Legislative Season is now in full swing, and we urge you to stay involved throughout the Session by contacting our office and the offices of your local legislators. We can assure you that your voices will be heard!

2013 Session Report (2/8/13)

The Florida House and Senate just completed the fourth of six weeks of pre-session committee hearings. While work continued on the various aspects of implementing the Affordable Care Act, legislators began taking action on some notable bills.

For instance, the FPHA-supported ban on texting and driving (SB 52) unanimously passed the Senate Transportation Committee on Wednesday and now has only two more committees to pass before it reaches the floor. Other legislative work has centered on budget issues, with DOH and AHCA both making multiple presentations to the various Appropriations Committees.

From an internal perspective, the FPHA is well-positioned for the upcoming session, having held a Legislative Committee meeting on Monday and presenting a report to the full Board on Thursday. 2013 will be another year of challenges, but the FPHA, as ever, remains committed to preserving the health of Florida's citizens.

2013 Session Off to Busy Start (1/24/13)
Although the official start of the 2013 Legislative Session is not until March 5, the Florida House and Senate just completed the third of six weeks of pre-session committee hearings. While actual votes were few, both chambers spent much of their time debating the various aspects of implementing the Affordable Care Act, as the State must soon decide whether it wants to establish its own Health Care Exchange and whether it wants to expand its Medicaid coverage to those making up to 133% of poverty. Early indications are that the State will decline on both counts.
In addition to the hearings, legislators have already begun filing bills, with over 200 bills having been filed in each chamber. Of particular interest are FPHA-supported bills to reduce the incidence of texting and driving, require booster seats for children, increase bladder cancer awareness, and further reduce indoor smoking. Of course, DOH reorganization continues to be a discussion, and we have made overtures to allow the Department to continue to "focus like a laser beam" on its core mission without unnecessary further legislative interference.

Please allow me to thank in advance those who contact their legislators on these important issues. Legislators are eager to hear from you, and your voice does matter.



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