Capitol Update March 10 2014

FPTA Advocacy Over Concerns with AT Legislation WORKS!

APRN Scope of Practice
Telemedicine Proposal
Physical Therapist Licensure
Athletic Trainers
Patient Lifting
Assisted Living Facility Reform
Unaccompanied Youth Bill
Managed Care Plans
Supervision of PAs
No Movement This Week
Personal Injury Protection (PIP)
Concealed Weapons

The FPTA is proud to report that our members’ hard work in communicating with Florida Legislators about concerns with HB 669, relating to Athletic Trainers, was successful. House and Senate sponsors of the legislation are withdrawing the bills from further consideration during the 2014 Session. See the Athletic Trainer summary in this edition for details on the bill. 

The excellent response to FPTA and APTA membership alerts on HB 669, member and student personal visits with legislators during the FPTA State Advocacy Days, and FPTA lobbying team efforts of Metz, Husband & Daughton highlighted serious concerns about the legislation.

This is a classic example of why advocacy makes a difference, especially when we work together educating legislators and public policy makers about the profession and the role physical therapists have in the healthcare delivery system.

Please remain diligent reading weekly FPTA Capitol Updates, responding to alerts and requests to join Florida Physical Therapy – Political Action Committee (FPT-PAC).

Week 1 of 2014 Legislative Session

Tallahassee welcomed the first week of the Legislative Session with rallies, speeches, legislation and yes, politics. The week started with rivaling rallies. The first was “Moral Monday” which featured citizens supporting Medicaid expansion, income equality, voting rights and a repeal of the Stand Your Ground Law. The counter rally was sponsored by Americans for Prosperity, a more right-leaning group, which opposes Medicaid expansion, supports tax cut proposals and an overhaul of the state pension system. And this was just the first day!

On Tuesday Governor Scott delivered his State of the State Address featuring familiar messages about jobs and Florida’s economic turnaround, as well as the Governor’s budget priorities.  He also highlighted a $500 million dollar tax reduction. As he heads into re-election the Governor used the opportunity to contrast these issues, especially the state of the economy and job creation, with their status from the prior four years under Governor Crist. The speech helped set the tone for what expects to be a very close election battle in November.  

The remainder of the week saw the legislature take action on bills clarifying the residency requirements of legislators and toughening sexual predator laws.  Senate President Don Gaetz and Speaker Will Weatherford promised quick action on both of these issues.  Also, legislative committees were in full-swing addressing issues ranging from gaming to student privacy to medical marijuana, school vouchers and telemedicine.

Issues of importance to the FPTA

Advanced Practice Registered Nurse Scope of Practice Debate

HB 7071, as passed by the Select Committee on Workforce Innovation, significantly broadens nurses’ scope of practice by expanding the role of an advanced registered nurse practitioner (now titled advanced practice registered nurse or APRN) and also creating the new provider category, the independent advanced practice registered nurse. Specifically, the select committee’s bill:

  • Allows an advance practice registered nurses (APRN) and an Independent APRN to administer, dispense, and prescribe medicinal drugs including controlled substances and narcotics.
  • Allows the Independent APRN to practice advanced or specialized nursing independently and without the supervision of a physician or protocol.
  • Allows an Independent APRN to admit a patient to a hospital, long-term care hospital, skilled nursing facility, hospice, or intermediate care facility for the developmentally disabled. The independent APRN can manage this care, and discharge the patient from the facility.
  •  Allows an independent APRN to provide a signature, certification, stamp, verification, affidavit, or other endorsement that is otherwise required by law to be provided by a physician.  
  •  Allows an APRN and an independent APRN to sign a death certificate.
  •  Allows an independent APRN and certain APRNs to initiate and release from a Baker Act.

SB 1352 by Senator Denise Grimsley (R-Sebring) was recently filed. The bill allows an advanced practice registered nurse to prescribe, dispense, administer, or order prescription drugs in accordance with a specified formulary. In addition, the bill redefines the term “psychiatric nurse” and allows such a nurse to initiate and release under the Baker Act.

Senate and House Telehealth Proposals Passed This Week

On March 5th, the Senate Health Policy Committee chaired by Senator Aaron Bean (R-Jacksonville) voted 7 to 2 to pass a telemedicine bill.  The Senate proposal establishes guidelines and requirements for health providers who want to treat patients remotely through the use of Internet and telecommunications technology. The amended version of the bill limits the practice of telemedicine to physicians and osteopathic physicians. Chair Bean and Senator Bill Galvano cautioned that the Senate bill has a long way to go and will likely face further changes as the legislative session progresses.  Several health care providers, physician groups, business groups, and the health insurance industry testified on the proposed bill. Specifically, the Florida Medical Association recommended that telemedicine should only be performed by a Florida-licensed physician. 

On the House side, the House’s version of telehealth, HB 751 by Rep. Travis Cummings (R-Orange Park), passed the Select Committee on Health Care Workforce Innovation by a vote of 15 to 0 on March 4th. The House bill provides for the maintenance of health records, standards of care and scope of practice for telehealth providers, however, the House version offers less regulation than the Senate’s proposal and does not limit the practice of telehealth to only physicians.

SB 70 by Senator Arthenia Joyner (D-Tampa) and HB 167 by Rep. Mia Jones (D-(Jacksonville) pertaining to telehealth have also been filed. 

Physical Therapist Licensure

SB 930 by Senator Wilton Simpson increases from 5 to 10 the number of times an applicant for licensure as a physical therapist or physical therapist assistant may take the license examination. No House companion has been filed yet.

Athletic Trainers (withdrawn)

HB 669 by Rep. Bruce Antone (D-Orlando) revised athletic trainer licensure requirements and authorized certain out-of-state persons to practice athletic training in Florida without a license for 30 days or less. The bill also required out-of-state athletic trainers to apply for a temporary license to practice in the state for more than 30 days.  Further, the bill deleted the provisions establishing an athletic trainer examination fee, revised the responsibilities of athletic trainers, prohibited the use of certain titles or abbreviations by persons who are not licensed as an athletic trainer and provided that an athletic trainer's failure to include his or her credentials in advertising would be grounds for disciplinary action. As reported in this edition of the Capitol Update, this bill was withdrawn by House and Senate sponsors.

Patient Lifting

SB 554 by Senator Geraldine Thompson (D-Orlando) and HB 289 by Rep. David Richardson (D-Miami Beach) require hospitals to establish a protocol concerning the lifting and associated handling of patients by hospital employees. Further, the legislation requires that the protocol be developed by a committee comprised of an appropriate mix of management and non-management employees, including registered nurses engaged in direct patient care. The bills outline the factors for the committee to consider in developing the protocol and establish a continuous assessment and evaluation of such protocol.

Assisted Living Facility Reform – Senate Bill Debated Next Week by Full Senate

SB 248 filed by the Senate Children, Families & Elder Affairs Committee and HB 573 by Rep. Larry Ahern (R-Seminole) strengthen the enforcement of current regulations for assisted living facilities (ALFs) by revising fines imposed for licensure violations, clarifying existing enforcement tools, and requiring an additional inspection for facilities having significant violations.  Among other provisions, the Senate proposal:

  • Clarifies the criteria under which the Agency for Health Care Administration (AHCA) must revoke or deny a facility’s license;
  • Adds certain responsible parties and AHCA personnel to the list of people who must report abuse or neglect to the Department of Children and Families’ central abuse hotline;
  • Requires a study to determine the consistency with which the AHCA applies regulations to facilities; and
  • Requires the AHCA to implement an ALF rating system by March 1, 2015, and to add certain content to its website by November 1, 2014, to help consumers select an ALF.

The Senate bill is estimated to have a $1.1 million positive fiscal impact on the AHCA’s Health Care Trust Fund. SB 248 has cleared all of its Senate committees and is slated to be heard on the Senate floor on March 11.  HB 573 passed the Health Innovation Subcommittee by a vote of 11 to 0 and is now in the Health Care Appropriations Subcommittee.

Unaccompanied Youth Senate Bill Clears All Committees

On March 4th, SB 260 by Senator Jack Latvala (R-Tampa) passed the Judiciary Committee. That is its last stop before possible Senate floor consideration. On March 5th, HB 203 by Rep. Dan Raulerson (R-Plant City) cleared its first committee, the Civil Justice Subcommittee, by a vote of 13 to 0.  The legislation establishes the legal authority for an unaccompanied homeless youth to consent to certain medical procedures and care or consent to a forensic medical examination without a parent’s permission. To qualify as an unaccompanied homeless youth, the youth must be:

  • At least 16 or 17 years old;
  • Found by a school district’s liaison for homeless children and youths to be an unaccompanied homeless youth eligible for services pursuant to certain federal standards; or believed to qualify as an unaccompanied homeless youth, as defined in certain federal legislation, by an individual in one of five specified categories.

Once qualified as an unaccompanied homeless youth, the youth must be given a written certificate by the individual who makes the finding on his or her official letterhead stationery noting that status. The unaccompanied homeless youth may then present that certificate to the healthcare professional from whom he or she is seeking service as proof of the minor’s authority to consent. The legislation provides that such consent does not affect the Parental Notice of Abortion Act requirements.  

Managed Care Plans

Health care provider groups, including FPTA, are spearheading an effort to change and/or codify requirements for managed care programs, health insurers and HMOs in their interactions with patients, especially in the pharmaceutical area.  SB 1354 and HB 1001 were recently filed by Senator Denise Grimsley (R-Sebring) and Rep. Jason Brodeur (R-Sanford).  The bills have yet to receive a committee hearing. Specific provisions of the bills include requirements that:

  • Health insurers cannot deny a claim retroactively if the insured provides an identification card at the time of treatment or if the insurer verified eligibility at the time of treatment. 
  • The Financial Services Commission adopt a standardized prior authorization form and prescribes use of the form by health insurers, managed care plans and health maintenance organizations after January 1, 2015.
  • Any insurer issuing a policy of health insurance in this state, which insurance includes coverage for the services of a preferred provider, to post a link to the list of preferred providers on the home page of the insurer’s website. (Any changes made to this list must be updated within 24 hours). 
  • All health insurers offer a “broad range of therapeutic options” consistent with the needs of the state’s outpatient population. Furthermore, whenever “feasible” the formulary or preferred drug list should include at least two products in a therapeutic class. 
  • All new drugs approved by the FDA be covered by Medicaid providers through the prior authorization standards set out in this bill until the Medicaid Pharmaceutical and Therapeutics Committee conducts its normal review. 
  • Patients may remain on a certain drugs removed from a plan’s formulary if the “provider submits a written request that demonstrates that the drug is medically necessary” and the patient meets clinical criteria to continue. 
  • All health insurers use, after January 1, 2015, the standardized prior authorization form adopted by the Financial Services Commission. 
  • All prior authorization requests submitted to health insurers be approved or denied within 2 business days of being submitted or they will have been deemed to be approved. 
  • When health insurers have a step-therapy or fail-first protocol, the prescribing provider has the ability to override said step-therapy or fail-first protocol within 24 hours. 
  • Step-therapy or fail-first protocols cannot exceed a period of time deemed appropriate by the prescribing provider. 

Supervision of Physician Assistants

SB 1230 by Senator Alan Hays (R-Umatilla) increases the number of licensed physician assistants that a physician may supervise at any one time from four to eight. The bill revises the circumstances under which a physician assistant is authorized to prescribe or dispense medication and revises the application requirements for licensure as a physician assistant and license renewal. The identical House companion measure was withdrawn prior to the start of the session.

HB 1275 by Rep. Larry Ahern (R-Seminole) revises the circumstances under which a physician assistant is authorized to prescribe or dispense medications and revises the application requirements for licensure and licensure renewal as physician assistant.

SB 1420 by Senator Rene Garcia (R-Miami) exempts certain physicians prescribing controlled substances for the treatment of pain associated with sickle cell disease from the standards of practice for prescribing controlled substances, removes the cap on the number of physician assistants a physician may supervise and specifies the drugs to be included on the formulary that a physician assistant may not prescribe.

These bills have not been heard in committee yet in either the House or Senate.

The following bills had no movement this week:

Personal Injury Protection

HB 267 by Rep. Carlos Trujillo (R-Doral) would replace the state's current "no-fault" auto insurance coverage with bodily injury coverage. The proposal comes less than two years after legislators passed auto insurance system reforms attempting to rid the system of fraud. The House measure replicates a draft committee bill being discussed in the Senate’s Banking and Insurance Committee chaired by Senator David Simmons (R-Altamonte Springs). The Personal Insurance Federation of Florida, a three-year-old trade association which includes Allstate, Progressive and State Farm Insurance, and the Property Casualty Insurers Association of America, contend that the Legislature should continue to see if the 2012 reforms work by decreasing fraudulent claims. Chair Simmons has said publicly that he does not plan to advance any measures that would replace no-fault insurance with a bodily-injury coverage requirement during the legislative session until there is a greater consensus among both the stakeholders and legislators.

Concealed Weapons and Firearms

SB 580 by Senator Gwen Margolis (D-Miami) and HB 577 by Rep. Sharon Pritchett (D-Miramar) prohibit persons from openly carrying a handgun, concealed weapon or firearm into a hospital, mental health facility, or nursing home, unless they are a security guard employed by the hospital, mental health facility, or hospital, or a law enforcement officer.

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