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News & Press: FAPA

2018 Florida Legislative Session Update, by Corinne Mixon

Wednesday, March 21, 2018   (0 Comments)
Posted by: Courtney Miller

Florida Academy of Physician Assistants

2018 Florida Legislative Session Update, by Corinne Mixon

Summary

The 2018 Florida Legislative Session came to a dramatic close on Sunday evening. The 60-day window for policy making was one of the most gut-wrenching terms in Florida’s history. The rear impact of Hurricane Irma, which seemed to dominate the Florida’s interim committee weeks in the fall, fell to a distant second place as a matter of importance as Florida’s legislators and executive cabinet scrambled to respond to the shooting of 17 innocent people at Marjory Stoneman Douglas High School.

 

The timing of the event was surreal in its opportunism, as the Legislature was about halfway through its annual policy-making process. If the shooting would have occurred 20 days later, Florida’s Legislature would have shepherded in the 2018-2019 fiscal year with $68 million fewer dollars to address the mental health of students and an A-rating from the National Rifle Association (NRA) to match its “near perfect” prior rating.

 

In addition, dozens (possibly hundreds) more bills may have passed. Instead, the Florida Legislature had just enough time file public safety legislation, debate it and amend its state budget to accommodate the measure known as SB 7026, An Act Relating to Public Safety. That budget passed on Sunday evening after the Legislature was forced to extend session by two days.

 

Changes to Florida’s gun laws would not have passed if the shooting hadn’t occurred. However, the Legislature and Governor Rick Scott had been mulling-over the possibility of increasing mental health spending prior to the massacre. Governor Rick Scott’s initial budget recommendation, for instance, recommended an additional $53 million for combatting the opioid crisis and $21.7 million for community mental health, community action teams and child protective investigators. An initial education proposal by the Senate also proposed an additional $40 million to be earmarked for student mental health services.

 

Guns and mental health funding aside, the Legislature also considered several proposals addressing health care and insurance. Most of these policies did not pass this session. In fact, a record high 3,250 bills were filed during the 2018 session; whereas, a record low 200 bills actually passed. That’s about 5-6% compared to the average 10-14% that pass in a typical year.


Detailed Bill Information

Below you’ll find a list of bills that may be of interest to you and your practice. If you have specific questions on any legislation, please feel free to contact us. FAPA will be preparing its agenda for the next legislative session, which begins in March 2019, in the near future. Please provide feedback to your FAPA leaders.

 

Worker’s Compensation Reform – Mental Health Reform for First Responders

The passage of SB 376 (Sen. Book) and HB 227 (Rep. Willhite) means that first responders diagnosed with PTSD are eligible for workers’ compensation benefits for the first time ever.

 

 

Prior to passage of these measures, Florida law did not allow workers comp benefits to be paid to first responders diagnosed with PTSD unless a physical injury had occurred.

 

After the Pulse Nightclub tragedy, many firefighters and first responders were unable to return to their jobs based on the horror they experienced. Rather than taking time off to address their (emotional) wounds, as they would have with a physical ailment, many first responders were forced to return to work because they could not afford to take time off without engaging their workers’ compensation policy. Dozens of wives, husbands and children testified about their family members (first responders) committing suicide following the Pulse event and other traumatic experiences which are regularly associated with these difficult careers. Another family member testified about the death of her husband who took his own life after responding to a traffic accident in which he found his brother pinned lifeless under a minivan.

 

This legislation faced early opposition from the Florida League of Cities due to the potential of increased cost. However, Sen. Book and Rep. Willhite were able to reinvigorate the policy after the Marjory Stoneman Douglas High School shooting.

 

As a result of these efforts, workers comp benefits are now available to first responders with PTSD arising from murders, suicides, mass casualties or other incidents involving a death.

 

The Marjory Stoneman Douglas High School Public Safety Act

 

In 2018 alone, there have been at least 14 school shootings in the US. This legislation passed in direct response to the mass shooting at Marjory Stoneman Douglas in Parkland, FL. The appropriation includes more than $69 million for mental health assistance in schools. The bill became law immediately following Governor Rick Scott’s approval on March 9. Much of the money appropriated in the legislation will be available to school districts through DOE grants. However, per Section 36 of the bill, the increase of $69 million in mental health student funding associated with the Safe Schools allocation will be available through the Florida Education Finance Program (FEFP). In Section 37 of the bill, $6.7 million is appropriated to youth mental health training.

 

FAPA will assist in any way it can with the implementation of several components of this $400 million bill. 

 

Opioid Legislation and Funding

 

The $54 million opioid bill Gov. Rick Scott first unveiled last September to combat Florida's deadly drug epidemic remained consistent with the Governor’s original plan. The bill, which includes the funding component, passed in the final days of the legislative session.


That funding discussion became contentious at the end of session. State House budget chairman Carlos Trujillo accused state Senate President Joe Negron of essentially holding the legislation hostage by requiring Vivitrol get a recurring line-item dollar amount of $5.3 million a year. This medication-assisted treatment would have been specifically named in law giving this particular pharmaceutical company a distinct advantage. Ultimately, this provision was stripped from the bill, allowing it to pass.

 

The bill also requires that all prescribers of opioids take a 2-hour course in the safe prescribing of controlled substances. The other two major tenets of the legislation are: limiting prescriptions of opioids to a maximum of three to seven days for the treatment of acute pain (an exception will be made for trauma patients), and expanding the use of the Prescription Drug Monitoring Program. That program will receive much-needed technological upgrades as a result of the bill.

 

Notably, several versions of the bill/amendments required that an additional 2-hour course be taken by PAs/ARNPs and that the course taken by PAs/ARNPs be offered only by the Florida Medical Association or Florida Osteopathic Medical Association.

 

Ultimately, FAPA helped ensure that the legislation allowed PAs to meet the requirement by taking the course required by the original controlled substance prescribing legislation which passed in 2016 (for instance, the PPACE course, taken by many FAPA members, will remain sufficient). Doctors will be required to take a new prescribing course if they have not already done so.

 

PA licensure issues

 

AUA—

Over the past two years, two attempts at creating alternative means to PA licensure have been filed and beaten by FAPA. One attempt stemmed from the American University of Antigua (AUA). AUA requested to be considered for accreditation by ARC-PA; however, ARC-PA does not accredit off-shore programs unless they are tethered to an ARC-PA accredited school. AUA is not. The school has attempted to file amendments to Florida Law that would permit its graduates to become licensed as PAs by the State of Florida without having graduated from an accredited program. FAPA was able to ward off the filing of such legislation this year by convincing AUA that we would beat them.

 

DMS—

Another topic which was kept at bay this year would create an advanced PA license for Doctors of Medical Sciences. If passed, these bills would have permitted some PAs (PA, DMS) to practice to a higher scope than the everyday PA. FAPA was strongly opposed to this legislation when it was filed last session and the bills never received a hearing.

 

Retroactive Denial Bills

 

Despite unanimous support from the Senate, bills reforming Florida’s health insurance protocols were unable to push through House committees. 

 

One measure, by Sen. Steube, would have prevented insurance companies from retroactively denying health insurance claims if customer eligibility was confirmed during the time of treatment. 

Another bill, SB 98, also by Sen. Steube, aimed to create requirements for insurers responding to prior authorization requests. This legislation cleared the Senate floor in late January. Its House counterpart, HB 199 by Rep. Shawn Harrison, failed to clear its last committee.

 

Perinatal Mental Health

These bills require that the Department of Health (DOH) offer perinatal mental health care information through the Family Health Line toll-free hotline accessible to the general public.

 

Further, the bills revise components included in postpartum evaluation and follow-up care provided by birth centers to include mental health screening and information about postpartum depression. These bills, HB 937/SB 138, passed and will be implemented in July.

 

Personal Injury Protection Legislation (PIP) – Motor Vehicle Insurance

 

Bills that would have overhauled the PIP system of insurance did not pass the legislative process.

 

This House bill would have repealed the PIP law altogether. In its place, Floridians would be required to purchase more Bodily Injury (BI) coverage.

 

The Senate version would have provided some medical payments (MedPay) coverage, leaving in place what some were referring to as a “PIP lite” system. The bill also would have allowed for a $5,000 death benefit.

 

Late in session, the Senate bill, which was presumed dead, re-emerged. An amendment was added that wouldn’t have allowed services provided by PAs to be reimbursed by MedPay (current law treats PAs the same as doctors). FAPA worked with the bill sponsor, Sen. Lee and Banking and Insurance Committee staff to amend PAs into the legislation. This amendment was crucial at the time.

 

However, in the end, the PIP refinement bills did not pass. These proposals are expected to return.

 

Department of Health Legislative Package

 

FAPA filed an amendment to a large legislative package (initially crafted by DOH) that would have removed the requirement to report changes to all supervising physicians within the supervision data form within 30 days. This amendment cut out unnecessary paperwork for PAs working in large group practices and keep PAs from being repeatedly slapped with this minor offense. The underlying bill died due to unrelated opposition.

 

Nurses Legislation

 

A bill was passed that changes the title of ARNPs to APRN.

 

Laser Hair Removal

 

If this bill would have passed it would have eliminated the Electrolysis Council under the Board of Medicine and its oversight of the practice of electrology. Instead, it would have required licensed electrologists to maintain a nationally recognized certification to use laser or pulsed-light devises. At one point in the legislative session, the bill was amended to require that all people performing electrology services be under the direct supervision of a doctor, but it ultimately died.

 

 

Susan Salahshor, PhD, PA-C, DFAAPA

FAPA President July 2017 to June 2018


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