Christopher L. Nuland
FPHA Lobbyist and General Counsel
February 17, 2017
This past week was a momentous one for the Florida public health,
both in the courts and in the legislature.
Florida House Moves Major Legislation
The Florida Senate this week addressed budgetary items, including
the DOH budget. The Governor’s proposed
budget adds about $52 million to DOH coffers and holds the number of employees
In the House Quality Committee, the Committee voted to move
forward with a bill that would allow certain ARNPs to practice without
physician supervision and would allow out-of-state Telemedicine providers to
practice without being held accountable to the Florida Boards. Discussions continue on those two points of
The same Committee also advanced legislation that would allow the
responsible use of a single opiate during Level I office procedures if (and
only if) emergency medications were available.
The Senate Health Policy Committee will address the same issue next
11th Circuit Rules Ban on Physician Free Speech re Guns
In a major decision for all professional free speech, the full 11th
Circuit Court of Appeals yesterday ruled that Florida’s ban on physician’s
speaking to their patients regarding guns was a violation of the physician’s
First Amendment Right to Free Speech.
While the Court did uphold a portion of the law that prohibits
discrimination based upon a patient’s gun ownership (a point that was not
disputed by the plaintiffs), all but one judge agreed that restrictions on what
a physician and patients discuss are a violation of the First Amendment.
As of press time, the Scott administration is considering whether
to appeal the ruling to the U.S. Supreme Court.
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.
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!!