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Medicaid bill packed with other health goodies

For months, Florida Senate leaders have talked about shifting Medicaid recipients into managed care. But a mammoth bill they released Thursday does more than that -- much more.

From physician payment rates to smoking cessation and psychotropic drugs, the 202-page bill is filled with changes to the health-care system.

Here are thumbnail descriptions of some of the proposals:

Doctor payments: Many physicians don't want to serve Medicaid patients because the state pays too little. But beginning in 2013, the bill would require that they get paid the same for treating Medicaid patients as they do Medicare patients --- a rate that is nearly twice as high.

Senate Health and Human Services Appropriations Chairman Joe Negron, R-Stuart, said Thursday he didn't have a exact cost for the move. Also it was not immediately clear how the state could afford it, though Negron said lawmakers would have to look for cuts in other areas of the budget.

But one clue might be in last year's federal health overhaul, which calls for primary-care physicians to be paid at Medicare rates when they treat Medicaid patients in 2013 and 2014. At least initially, the federal government would finance the increase.

That federal funding, however, might not be available if Florida and other states are successful in challenging the constitutionality of the health overhaul. Republican Senate leaders are vocal critics of the law.

Lawsuit limits: The Senate bill also would give a boost to doctors and other types of medical providers by helping shield them from costly malpractice lawsuits.

One oft-discussed proposal would give legal protections to doctors when they treat Medicaid patients, which supporters say could help encourage physicians to take part in the system. In most cases, a doctor's potential liability would be limited to $300,000.

But the bill goes far beyond helping Medicaid doctors. It also includes new lawsuit limits for nursing homes and community-based organizations that run large parts of the state's foster-care system.

Trial lawyers likely will fight these proposals, contending that they would take away the rights of people who are injured by malpractice or wrongdoing. But Gov. Rick Scott and many Republican legislative leaders have vowed to rein in lawsuits.

Illegal aliens: In rolling out the bill this week, Negron made a point of emphasizing that it would bar Medicaid from covering the health costs of undocumented aliens.

The provision appears to largely mirror current restrictions that only allow emergency coverage for most illegal immigrants. But despite those restrictions, Negron said the Medicaid system often improperly pays for services.

One point of contention between government regulators and the hospital industry, however, is how to draw the line at when services stop being needed for emergency purposes. At least part of the question is when patients become stabilized enough that they are not considered in emergency situations.

Drugs, smoking and obesity: Ever since the 2009 hanging death of a 7-year-old foster child in Broward County, Sen. Ronda Storms, R-Valrico, has tried to crack down on the use of psychotropic drugs in the foster-care system.

The bill includes a series of legal changes that would help Storms' effort. As an example, the bill would bar court approval of such drugs for any foster child under age 11 unless it could be shown that there is a "compelling governmental interest.''

Senators also would target other specific groups in the bill, including smokers and obese people who are on Medicaid.

The measure would require smokers to participate in in smoking-cessation classes and "morbidly obese" people to participate in weight-loss programs. Such requirements are aimed at preventing higher-cost medical problems, such as diabetes.

Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at