2015 Legislative Review

Florida State CapitolThe 2015 Legislative Session has been regarded as one of the least productive regular sessions in recent memory. Three and a half days ahead of the scheduled Friday, May 1 conclusion of the Session, the House abruptly ended its Session and went home, which is the first time that the House and Senate have adjourned on separate days since at least 1971, when state records on adjournment times began. This acrimonious meltdown was precipitated by weeks of unproductive budget talks between House and Senate leadership to resolve a $5 billion discrepancy between the Chambers’ budget proposals. At issue is the proposed expansion of the Florida Medicaid program to cover an additional 800,000 uninsured, low-income Floridians under the federal Affordable Care Act, which the Senate supports and the House does not. The disparity between the Chambers’ proposed budgets is the result of the expiration of a federal program that provides hospitals a mechanism to receive $2.2 billion in supplemental funds to offset care provided to the uninsured, known as the Low Income Pool. The federal government has been reluctant to extend this temporary program and has encouraged the state to come up with an alternative plan for caring for its uninsured population. The Senate has put forward a proposal, modeled after the federal Affordable Care Act, which would draw down significant federal dollars to provide coverage in the private marketplace for the uninsured. However, this plan has been met with considerable opposition by the House and, absent further direction and assurance from the federal government that the Senate’s plan would be approved, the House and Senate remain at impasse, despite the looming end of the state fiscal year on June 30. Typically, major policy issues and bills that have an effect on the budget are reserved for the last week of the Session. The House’s early withdrawal from the Regular Session had the effect of killing a significant number of bills and priorities of both Chambers. In addition to the constitutionally mandated balanced budget, other leadership priorities were left on the table, including the Governor’ s $673 million tax cut plan, establishing a comprehensive state water policy, reforming Florida’s troubled prison system, regulating hydraulic fracturing in oil and gas exploration, and providing funding for economic development.

There were also a number of health care-related bills considered this Session, described as follows:

Bills that passed

Health Care Surrogate for Medical Treatment
House bill 889 by Representative John Wood changes the health care surrogate law to designate a health care surrogate who would be authorized to review confidential medical information and to make health care decisions in the place of the principal, which is not conditioned upon the incapacity of the principal. The bill sponsor said the legislation is meant to address situations when an elderly person may vacillate in and out of capacity, to allow a health care surrogate to act at any time, including while an adult is still competent and able to make their own decisions. The bill allows for a minor ‘s health information to be shared with the surrogate prior to incapacity. The bill also allows the parents, legal custodian or legal guardian of a minor to name a health care surrogate to act for a minor if the parents, legal custodian or legal guardian cannot be timely contacted to make medical decisions for the minor. Under the bill, the definition of “medical care and treatment” includes dental examination and treatment. If signed by the governor, the bill will go into effect October 1, 2015.

Florida Right to Try Act
House bill 269 by Representative Ray Pilon creates the “Right to Try Act,” which will allow terminally ill patients to try experimental treatments after other medications have failed. The bill establishes a framework in which a manufacturer may provide an investigational drug, biological product, or device to an eligible patient with a terminal condition and provides liability protection for manufacturers, persons, and entities involved in the use of the investigational drug, biological product, or device. The bill also provides liability protection for manufacturers, persons and entities involved in the use of these drugs and devices. If signed by the governor, the bill will become effective on July 1, 2015.

Emergency Treatment for Opioid Overdose
House bill 751 by Representative Julio Gonzalez attempts to address the problem of accidental deaths caused by overdose related to the use of narcotic pain relievers. Opioid antagonists have proven successful in reversing some opioid-related drug overdoses when administered in a timely manner. The bill authorizes health care practitioners to prescribe and dispense opioid antagonists to patients, caregivers and first responders. A health care practitioner is defined as a licensed practitioner authorized by the laws of Florida to prescribe drugs. The bill gives health care practitioners, pharmacists and first responders who prescribe, administer or store an opioid antagonist civil liability protection. Further, a health care practitioner acting in good faith is not subject to discipline and also is immune from civil or criminal liability for prescribing or dispensing an opioid antagonist. The bill will take effect upon the governor’s signature.

Public Health Emergencies
House bill 697 by Representative Julio Gonzalez allows the State Health Officer to isolate an individual who has a communicable disease that has a significant morbidity or mortality rate and presents a severe danger to the public health. The legislation also authorizes law enforcement officers to immediately enforce orders by the Department of Health, which relate to the isolation or quarantine of persons, animals or premises when controlling communicable diseases or providing protection from unsafe conditions that pose a threat to public health. Violation of an isolation order can result in a second degree misdemeanor. If signed by the governor, the bill will take effect July 1,2015.

HIV Testing
House bill 321 by Representative Bryan Avila revises the HIV testing requirements for health care settings to eliminate the informed consent requirement in an effort to increase the incidence of individuals who submit to the testing. The bill also provides that a person’s signature on a general consent form suffices as consent to an HIV test. If signed by the governor, the bill will take effect July 1, 2015.

Bills that failed

Dental Care Access Account
This was FDA’s priority issue (SB 606 by Senator Don Gaetz and HB 657 by Representative Travis Cummings) that would have created a dental care access account that could be used to repay dental student loans if the dentist worked in a public health program. The bills would have also allowed dentists to use the funds to invest in property and dental equipment or to open a private practice in an underserved area. We anticipate that FDA will re-file the bill again next Session.

Direct Primary Care
In an effort to provide a more cost-effective model for providing health services, Representative Fred Costello and Senator Aaron Bean filed HB 7047 and SB 7084, respectively, to create a direct primary care (DPC) model in Florida that eliminates third-party payers from the primary care provider-patient relationship. Through a contractual agreement, which is exempted from regulation under the insurance code, a patient pays a monthly fee, usually between $50 and $100 per individual, to the primary care provider for defined primary care services. This DPC model is anticipated to eliminate practice overhead costs associated with filing claims, coding, re-filing claims , write-offs, appealing denials , and employing billing staff. The cost and time savings are expected to be reinvested in the practice, allowing more time with patients to address their primary care needs. The legislation failed to pass this Session, but we anticipate that it will be re-filed again next year.

Scope of Practice Expansion
Over the last few Sessions, there have been multiple attempts to expand the scope of practice for registered nurses, which have been bolstered by reports indicating that Florida has a shortage of primary care physicians. The Florida Medical Association and similar medical groups have opposed these proposals on the basis of the potential harm to the public from inadequate education and training. This Session, there were multiple bills filed that would have created an independent advanced practice registered nurse (IAPRN) and expanded the scope of practice for advanced registered nurse practitioners (ARNP) and physician assistants (PA) to prescribe controlled substances – HB 547 and HB 281 by Representative Cary Pigman and SB 614 by Senator Denise Grimsley. Each of these bills died this Session, however we anticipate they will be re-filed again for the 2016 Session.

On a date yet to be determined, the Legislature will return in June to convene in Special Session for the purpose of passing the state budget, which must be in effect before July 1, the beginning of the state fiscal year. Unlike Regular Session, the Special Session will likely be limited to the state budget, as well as legislation that is tied to the budget. We understand that the FDA will continue to pursue two of its Session priorities of funding for Donated Dental Services ($150,000 for two full-time coordinators) and community water fluoridation ($1 million).