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House Eyes Health Care Deregulation Ideas

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Jupiter Images
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Touting the possibility of more choices for patients, a House committee Thursday began a renewed effort to revamp regulations in the health-care industry.

The House Select Committee on Affordable Healthcare Access approved three bills, including a long-debated idea about eliminating what is known as the "certificate of need" process for hospitals. That regulatory process, which often spurs legal fights, requires the state to sign off before hospitals can be built or expanded or before certain programs can be added.

The hospital industry's focus on the issue was evident during Thursday's meeting. A coalition of public and teaching hospitals raised concerns about eliminating certificates of need, while the for-profit HCA hospital chain endorsed the proposal (HB 437).

Mark Delegal, general counsel of the Safety Net Hospital Alliance of Florida, said public and teaching hospitals provide specialty services and care for large numbers of patients who are indigent or who are covered by Medicaid and Medicare. If the certificate-of-need process is eliminated, Delegal expressed concern that profitable, privately insured patients could be drawn away to new facilities in affluent areas.

"We have to be able to find a way to take some of the commercial business and make some profit on that in order to sustain some of the uninsured obligations that our safety-net hospitals have,'' he said.

But Steve Ecenia, an attorney for HCA, said deregulation of the certificate-of-need process will not reduce access to care, increase costs or "change the matrix of services" that are provided.

"We believe that certificate-of-need deregulation is a concept whose time has come,'' Ecenia said.

The Republican-dominated committee voted 10-4 along party lines to approve the certificate-of-need bill, which is sponsored by Rep. Chris Sprowls, R-Palm Harbor.

House leaders have focused heavily during the past year on trying to revamp parts of the health-care system in ways they argue would reduce costs and give more options to patients. That effort also dovetails with a push by Gov. Rick Scott to make health-care changes.

All three of the bills approved by the committee mirror legislation that the House passed during a special session in June. The Senate did not take up the issues during that session.

Along with the proposal to eliminate hospital certificates of need, the committee also voted 10-4 along party lines to approve a measure (HB 85) that would allow patients to stay at ambulatory-surgical centers for up to 24 hours. The proposal, sponsored by Rep. Heather Fitzenhagen, R-Fort Myers, would eliminate a regulation that currently prevents overnight stays.

Also, the bill would allow the creation of "recovery care centers," where patients could stay for up to 72 hours after surgery. Florida does not currently issue licenses to such recovery facilities.

The third bill (HB 37), filed by Rep. Fred Costello, R-Ormond Beach, is aimed at increasing the use of "direct primary care" agreements between patients and doctors. Under the agreements, which remove the role of insurers in making payments, patients pay monthly fees for services such as annual physicals, routine laboratory tests and vaccinations and then get the services without additional charges. They also buy catastrophic insurance policies for potentially expensive health problems.

The bill, at least in part, would make clear that direct primary-care agreements are not subject to regulation under state insurance laws. The committee voted 13-1 to approve the measure, with only Jacksonville Democrat Mia Jones opposed.