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OCMS/SCMS Final Look at 2017 Regular Legislative Session

The 2017 Legislative Session came to a dramatic conclusion on Friday night with many health policy issues remaining undecided and failing to advance. The Legislature is due to return to Tallahassee Monday to approve the final budget, but it is not anticipated that they will address any policy issues. After several months of hearings and debate the failure to act means it is status quo for most of our priority issues. Below is a quick list of those bills that the OCMS and SCMS was monitoring that either passed and failed. And I have attached a more formal summary document below.

Bills we monitored that passed:
HB 557 - Controlled Substance Prescribing - this legislation shortens the timeframe in which a dispenser of a controlled substance (typically the pharmacy) must report dispensing from seven days to the end of the next business day. It also requires the dispenser to submit required reporting information via an electronic system approved by the Department of Health. In addition, the bill expands access to the PDMP database now to healthcare employees of the U.S. Veterans' Administration to assist with their patient's treatment. The bill was amended on the last day to exclude a requirement for any doctor with a DEA number to complete an additional two hour CME course.

Bills we supported that failed:
Maintenance of Certification
Direct Primary Care
Ambulatory Surgery Centers/Recovery Care Services
Retroactive Denials
Fail First/Prior Authorization
Patient Protection from Formulary Changes
HMO Accountability

Bills we opposed that failed:
Personal Injury Protection Repeal
Scope of Practice expansions for ARNPs, Optometrists, and Pharmacists

Bills we monitored that failed:
Medical Marijuana
Workers Compensation
Patient Shared Savings
Summary of Bills that Passed

Rights & Responsibility of Patients

HB 1253 adds to the Patient's Bill of Rights and Responsibilities, to allow a patient to bring any person of his or her choosing to patient-accessible areas of a health care facility or a health care provider's office to accompany the patient while the patient is receiving inpatient or outpatient treatment or is consulting with his or her health care provider. The bill allows the facility or provider to prohibit patients from exercising this right if doing so would risk the safety or health of the patient, other patients, or staff of the facility or office or cannot be reasonably accommodated.

Prescription Drug Monitoring Data Base

HB 5203 permits the use of state funds appropriated in the General Appropriations Act to administer the prescription drug monitoring program (PDMP). Removes requirement relating to implementation of the PDMP being contingent on receipt of nonstate funding.

Regulation of Health Care Practitioners

HB 543, Department of Health Agency bill makes numerous technical changes to statute. New to statute is the requires an ARNP to maintain a copy of his or her protocol at the location the ARNP practices and if the ARNP works with multiple supervising physicians in a group practice, the ARNP has to enter into a protocol with at least one physician vs all the physicians

The bill expands the pain management clinic registration requirement to include those that are exempt from registration under current law. However, these entities will be exempt from registration and inspection fees and other regulatory requirements. Registration of all pain management clinics will assist DOH with its regulation of pain clinics that are not registered and operating in violation of state law.

HB 229 also was a Department of Health bill mainly making changes to the Impaired Practitioner Program. In addition to the PPP, the bill authorizes DOH to issue or renew licenses of individuals who were convicted of or entered a plea of guilty or nolo contendere to a disqualifying offense before July 1, 2009, when the licensure disqualification law was enacted. The bill authorizes DOH to issue or renew the license of an individual who is convicted of or enters a plea of guilty or nolo contendere to a disqualifying felony if the applicant successfully completes a pretrial diversion program and the plea has been withdrawn or the charges have been dismissed.

Summary of Bills that Were Monitored

Supported Bills:

Ambulatory Surgery Centers - (SB 222 & HB 145)

Summary: Bill extends length of stay in an ASC to 24 hours from the start of the procedure. Creates licensure and regulations for Recovery Care Centers that enable patients to stay up to 72 hours.

Outcome: Bill passed the House but passed only one committee in the Senate. Was withdrawn from consideration.

Retroactive Denials - (SB 102 and HB 579)

Summary: Bill prohibits insurance carriers from denying claims for patient ineligibility if they have provided a treatment authorization to the physician.

Outcome: Passed the Senate. Passed only one committee in the House. Withdrawn from consideration.

Workers Compensation - (SB 1582 and HB 7085)

Summary: The Legislature is being asked to address the 14.5% increase in workers compensation premiums that took effect last fall based on two Supreme Court rulings that addressed attorney fees and duration of benefits. The FMA is championing decreased litigation through increased access to care and patient choice of treating physician and ancillary services. Our efforts to increase access to care include prior authorization reform and increases in physician expert witness fees and the physician fee schedule.

Outcome: Different versions of the bill were passed by both chambers. They could not agree on final language. The bill was withdrawn from consideration.

Maintenance of Certification - (SB 1354 and HB 723)

Summary: This legislation will prohibit hospitals from requiring physicians to participate in MOC in order to maintain staff privileges. The bill also prohibits insurance companies from requiring MOC in order to participate in their networks. The bill differentiates between original Board Certification and MOC, so hospitals and insurers can still require initial certification.

Outcome: Passed one committee in both chambers. Withdrawn from consideration.

Right Medicine, Right Time - Fail First - (SB 530 & HB 877)

Summary: This legislation will provide pathways for physicians to bypass fail first protocols implemented by insurance carriers under certain circumstances. The bill also requires more transparency and advanced notification from insurance carriers that want to implement such protocols.

Outcome: Passed all committees in the Senate. Passed one committee in the House. Withdrawn from consideration.

HMO Accountability: (SB 262 & HB 675)

Summary: This legislation will eliminate immunity of HMOs for being sued for medical negligence. Currently HMOs are protected from liability when making decisions on medical necessity.

Developments: The bill failed to pass all of its committees of reference.

Direct Primary Care: (SB 240 & HB 161)

Summary: The bill clarifies that a subscription style relationship between a patient and physician for the provision of a menu of primary care services each month is not an Insurance Policy and therefore not subject to insurance regulations.

Developments: Passed both the House and Senate but Laid on the Table. No final action taken.

Patient Protection from Formulary Changes - (SB 182 & HB 95)

Summary: The bill prohibits an insurance company from changing the drug formulary in the middle of a patient's contract year.

Developments: The bill passed the Senate but was not taken up by the House. Withdrawn from consideration.

Controlled Substance Prescribing (SB 840 and HB 557)

Summary: revises requirements for reporting dispensing of controlled substances; limits exception to reporting requirements for certain facilities dispensing controlled substances; authorizes certain employees of U.S. Department of Veterans Affairs to access certain information in program's database; specifies when revised reporting requirement takes effect.

Outcome: Passed both Chambers and Sent to the Governor.

Opposed Bills:

PIP Repeal - (SB 156 & HB 1063)

Summary: Legislation has been filed to eliminate PIP which is the automobile no-fault insurance coverage that provides $10K in benefit regardless of who is at fault in an accident. The House bill filed does not replace PIP with any other form of mandated Med-Pay to cover emergency care. The only Mandated Coverage would be Bodily Injury that covers the cost of injuries you do to others when your fault is established. Motorists will have the option to purchase Med Pay and Uninsured Motorist coverage. The Senate Bill does create Mandatory Emergency MedPay. We support the Senate version of the bill since it does mandate MedPay.

Outcome: The bill passed the House but only passed one committee in the Senate. Withdrawn from consideration.

Telehealth and Independent Practice for Advanced Registered Nurse Practitioners and Physician Assistants - (HB 7011)

Summary: The bill establishes a regulatory and oversight process for Telehealth services. The bill expands the independent scope of practice for ARNPs and PAs.

Outcome: Passed the House but never taken up in the Senate. Withdrawn from consideration.

Optometry Scope of Practice (HB 1037 and SB 1168)

Summary: Allows optometrists to perform laser surgery.

Outcome: Passed one committee in the House. Withdrawn from consideration.

Pharmacy Scope of Practice Expansion (SB 1180 and HB 7011)

Summary: Expanded scope of practice to include ordering and interpreting clinical labs.

Outcome: Passed several committees in the House. Did not move in Senate. Withdrawn from consideration.

Monitored Bills:

Patient Shared Savings - (SB 528 & HB 449)

Summary: The bill requires insurance companies to provide web access to contracted rates for certain "shoppable procedures and services" for their various providers in the community as well as the average price paid for those same services as noted in the all claims database the state is creating. The bill requires insurance carriers to share 50% of the savings achieved if a patient receives any of these shoppable services from a lower cost provider. The bill enables the patient to have access to the same incentives for utilizing out of network providers.

Developments: The bill failed to pass either chamber and was withdrawn from consideration.

Medical Marijuana - (HB 1397 and SB 406)

Summary: The legislation would implement the constitutional amendment passed by the voters in the fall 2016.

Outcome: Versions of the bill passed both chambers but they could not agree on final language. The bill was withdrawn from consideration.

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