News from Tallahassee for 4/16/14

Fla lawmakers look to expand, regulate telehealth posted on 4/8/14

by kelli kennedy | AP

MIAMI — The calls may come in the middle of the night and from hospitals more than an hour away. Someone is having a stroke and is en route an emergency room in the Florida Keys, but there aren't any neurologists on call.

Within 15 minutes, a University of Miami neurologist pops onto a computer screen and can order an IV drug that should be given within three hours. It's that sort of potentially life-saving technology that some lawmakers say will drive down health care costs, while also addressing serious doctor shortages around the state.

A Senate bill would increase the use of telemedicine in Florida and establish requirements for health providers who treat patients remotely. A companion bill is also making its way through the House, but that bill doesn't require doctors to have a Florida license — only that they be licensed in their home state and registered in Florida.

"If we didn't have an access problem we wouldn't be here today ... everyone would rather see the doctor face to face, but when your mother is having a stroke in rural Florida and the choice is having a doctor via telehealth versus having no doctor," said Rep. Cary Pigman, an emergency room physician who supports the bill.

The Senate bill requires doctors providing telemedicine services to patients within the state to be licensed in Florida or meet an alternative requirement. For example, an insurer using a doctor that's in-network in another state would also be allowed to treat a Florida patient. The bill recently passed a Senate committee, but has two more stops before it's heard on the floor. Dozens of other states have passed legislation supporting telemedicine.

The Senate bill also would require Medicaid to reimburse for telemedicine services and allow doctors to negotiate payment rates with insurers. The House bill doesn't address payments.

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As lawmakers pass session’s halfway point, here’s where big issues stand posted on 4/7/14

by News Service of Florida

FL Capitol BldgTHE CAPITAL, TALLAHASSEE -- Florida lawmakers have crossed the mid-point in their 60-day march to craft new laws, amend existing ones and agree on a roughly $75 billion budget for the next fiscal year.

And they've done so mostly without controversy.

A day at the Capitol was blown out to honor the Florida State University football team for winning the national championship, and another day was seemingly devoted to lawmakers taking "selfies" with retired British soccer star David Beckham, who wants to build a soccer stadium in Miami.

With the two chambers working in tandem on most issues, Gov. Rick Scott was able to sign a series of bills into law this week. They included a bill, dubbed the "Florida GI Bill," aimed at making the state more military friendly; a package of bills aimed at keeping sexually violent predators locked up; and a bill that will roll back motor-vehicle registration fees.

Meanwhile, the vast majority of the 1,826 bills, resolutions and memorials filed by members and committees as of Friday morning had already died with barely a murmur.

Here's a look at where a dozen major issues stand as lawmakers head toward the homestretch of the 2014 session:

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Health Items in Senate, House Budgets posted on 4/4/14

by staff | Health News Florida

The Florida Senate and the Florida House have passed their budgets for the 2014 legislative session.

From a Florida Senate news release, here is a look at the health funding in the Senate’s $74.9 billion budget:

Health and Human Services

The budget includes funding to transition wait list individuals to the home and community-based services waiver (approximately 1,400 individuals) through $8.1 million GR (general revenue), $11.9 million TF (trust funds) and funding to serve additional clients in the long-term care managed care program (approximately 1,136 individuals), $6.6 million GR; $9.7 million TF...

The budget will provide substance abuse services for pregnant women, $10 million GR; children’s mental health Community Action Teams, $8.1 million GR; adult community mental health funding, $4 million GR; domestic violence services, $4 million GR; and adult/children community substance abuse funding, $3.6 million GR.

The budget also doubles the personal needs allowance (currently $35 per month) for Medicaid patients living in nursing homes, $9.1 million GR; $10.9 million TF; provides for the phase one construction of new state veterans’ nursing home, $11 million TF; and funds ongoing maintenance and repair of state veterans’ nursing homes and other domiciliary, $7.8 million TF.

From a Florida House news release, here is a look at the health funding in the House’s $75.3 billion budget:

Healthcare

The Health Care Appropriations Subcommittee overall proposed budget totals $30.7 Billion ($8.2 billion from General Revenue and $22.5 billion from Trust Funds). This total includes funding for 32,943 authorized positions.

Highlights

• Medicaid Price Level and Workload Adjustment - ($600.4) M, $260.0 M GR - Funding for Medicaid caseloads and price level adjustments as agreed upon by the February 2014 Social Service Estimating Conference for an anticipated 3.7 million Medicaid beneficiaries. No category of Medicaid eligibility is eliminated or reduced. No provider rates are reduced.

• Long Term Care Waitlist Reductions - $19.8 M, $8.0 M GR - Funding to reduce waitlist clients for the Elderly Long Term Care Medicaid Waiver to serve approximately 1,295 additional individuals.

• Florida Kid Care Enrollment - ($36.3) M, ($12.7) M GR – Fully funds the KidCare program for the 2014-15 Fiscal Year to serve approximately 269,778 children.

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As final budget talks near, Scott administration meets with feds over 1b holding up health care budget posted on 4/2/14

by MATT DIXON | Scripps/Tribune Capital Bureau

With the clock ticking on this year’s legislative session, top officials from Gov. Rick Scott’s administration met Tuesday with federal regulators in Baltimore to discuss a $1 billion pot of money holding lawmaker’s proposed health care budget hostage.

In 2005, the Centers for Medicare and Medicaid Services (CMS) approved a waiver allowing Florida to implement a “Low Income Pool.” That money can be used for things like uncompensated care, care for those without insurance and Medicaid services.

The current waiver, which has a $1 billion cap in place, is set to expire June 30. Officials with the Agency for Health Care Administration, which Scott oversees, were initially seeking $4.5 billion for LIP and related programs designed to supplement hospital payments. That’s roughly $1.2 billion over current levels.

After it became clear that additional federal officials would not green-light the increase, AHCA turned its focus to consolidating the handful of programs related to LIP into one roughly $3.3 billion fund.  If CMS does not approve that plan, another option is to sign-off on a one-year extension at the current $1 billion cap.

The issue has forced heartburn for health-care budget writers because it’s unclear what direction is going to come down from federal officials.

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Senate TeleHealth Bill Extends To Out-Of-State Docs, Nurses And Pharmacists posted on 4/2/14

by Lynn Hatter | WFSU

Florida lawmakers have been weighing how to regulate telemedicine—generating debate between doctors’ groups and other healthcare providers. The House has been moving its telehealth proposal along, but the Senate version (SB 1646) of the bill had its first hearing Tuesday.

There are several different bills on telemedicine for lawmakers to consider, but when it comes to the Senate’s plans, only one proposal is finding widespread support from various physician groups, at least so far. That’s because an amendment to the bill singles out nurses, pharmacists and others who are engaged in their own fight in this year’s session.

“ARNP’s, PA’s and Pharmacists, will be able to practice telemedicine just as they do under their existing scope of practice," says Rep. Rene Garcia (R-Hialeah) who sponsored the amendment. "We want to make sure we’re very clear this doesn’t expand the scope of practice for any of these professions.”

That means, for example, advanced registered nurse practitioners, or ARNPs, would still have to work under the supervision of a doctor. It’s a group of people lobbying for more freedom to practice on their own.

The Florida Medical Association, the powerful doctor-lobby group, has pushed to limit telemedicine to doctors in Florida. It won that concession in another Senate telemedicine bill. But Phillis Oeters, a lobbyist for the non-profit South Florida hospital chain Baptist Health worries restricting telemedicine to Florida-registered doctors will hurt the industry:

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