Seven Big Health Care Issues To Watch
As the end of the 2020 legislative session nears, the Florida House and Senate need to resolve key health-care policy and budget issues. Here are seven big issues to watch:
--- NURSES: House Speaker Jose Oliva has made clear that his top priority is allowing advanced practice registered nurses to practice independently of physicians. The Senate is poised to offer a compromise that would allow the nurses to provide primary care and for certified nurse midwives to work autonomously. To qualify, advanced practice registered nurses would have to take at least 3,000 clinical practice hours in the five years before practicing autonomously. It’s a scaled-back version of what the speaker wanted but more than what the Senate initially offered.
Why it’s in play… Persistence. Oliva, R-Miami Lakes, never faltered in his push for independent practice. It’s one of the few issues Oliva didn’t get passed in 2019, and he is determined to get it done this year.
--- PHARMACISTS: In addition to giving more autonomy to nurses, Oliva has moved to broadly expand the scope of practice for pharmacists. Toward the end of the session, the House amended a proposal that initially would have allowed pharmacists to test and treat patients for the flu and strep throat and broadened it to allow pharmacists to treat people for chronic medical conditions. The Senate approved an amendment Tuesday and could send the bill back to the House as soon as Wednesday.
Why it’s in play … This is one of a number of proposals that Oliva has championed during his tenure as House speaker, maintaining they will help lower health-care costs for the uninsured and keep people out of emergency rooms. Oliva has opposed expanding Medicaid coverage for uninsured people.
--- PEOPLE WITH DISABILITIES: Senate President Bill Galvano, R-Bradenton, was determined to increase funding for Medicaid services for people with developmental and intellectual disabilities. He has worked to increase funding for the Agency for Persons with Disabilities by $128 million in recurring general revenue in the upcoming fiscal year. The 2020-2021 budget also is expected to include $241 million to wipe out deficits the APD has accrued over the last two years. Galvano also would like to see passage of a bill (SB 82) that would make administrative changes in the iBudget program, which provides services that help people with disabilities remain in their homes and communities. Galvano hopes that will shore up the iBudget program and put to rest rumblings that it should be transitioned to managed care.
Why it’s in play … Galvano told reporters in December that he has a “real heart for this population.”
--- GENETIC TESTING: The Senate inched closer Tuesday to passing a bill that would block life insurers and long-term care insurers from using genetic testing information when pricing policies. Before teeing up the bill (HB 1189) for a vote, the Senate approved an amendment that makes clear insurers could consider medical diagnoses included in medical records, even if the diagnoses were based on the results of genetic tests.
Why it’s in play … The genetic testing issue has been a priority of incoming House Speaker Chris Sprowls, a Palm Harbor Republican who is a cancer survivor. It’s unusual for incoming House speakers to file bills; they usually have other members to take on that task.
--- HOSPITAL FUNDING: The Senate has a plan to redirect money currently used to provide supplemental payments to hospitals that care for large number of low-income patients. The money would be targeted toward increasing base Medicaid rates for all hospitals. Hospital Corporation of America is leading the charge, arguing the change would allow Medicaid money to “follow the patient” and not the facility. The Safety Net Hospital Alliance of Florida has dubbed the supplemental payments the “critical care fund,” noting that the dollars are spent on 28 hospitals that provide the most charity care.
Why it’s in play … This could be a take-home issue for Senate Appropriations Chairman Rob Bradley, a Fleming Island Republican who faces term limits this year. Bradley last year was successful at chipping away at the amount of supplemental hospital payments and wants more this year.
--- MEDICAID MANDATES: Florida administers its Medicaid program mostly through contracts with managed care plans after competitive bidding. The House wants to change Medicaid laws to require medical faculty plans and essential hospital providers to contract with all managed care plans or lose hundreds of millions of dollars in Medicaid funding.
Why it’s in play … The issue stems from a contract dispute between Centene Health Plan, which operates in the Medicaid program as Sunshine Health Plan, and UF Shands Hospital in Gainesville, UF Health Jacksonville Hospital and physicians in the health system’s network. The contract dispute has been settled, but the House speaker’s office doesn’t want a repeat.
--- MEDICAID MANAGED CARE ENROLLMENT: The House also wants changes about automatic assignment of Medicaid beneficiaries to managed care plans. Such automatic assignment happens when beneficiaries don’t choose plans. Potential changes include requiring the Agency for Health Care Administration secretary to certify that the state’s auto-assignment policy won’t prevent managed-care plans from reaching enrollment levels necessary for sustainable operations.
Why it’s in play … The changes would help Lighthouse Health Plan in the Panhandle, Vivida Health in Southwest Florida and Miami Children’s Health Plan in Southeast Florida, which are “provider-sponsored networks” that signed five-year contracts with the state in 2018. AHCA’s current policy, the provider-sponsored networks argue, impedes their expansion in the market and benefits legacy managed-care plans.