By William P. Dillon and Kristen Plyler*
March 31, 2009
The Florida Legislature began its sixty-day legislative session on March 3, 2009, and will conclude on May 1, 2009. Policy meetings are concluding in both the House and Senate, with a limited number of exceptions, as both chambers move the focus to the FY2009-10 budget. Given Florida's continuing revenue issues, or lack-of-revenue issues, legislative proposals that have a significant fiscal impact will face a difficult path. Despite Florida's budgetary woes, healthcare reform remains a significant concern for the Legislature.
The recent passage of the American Recovery and Reinvestment Act of 2009 (ARRA) appears to have allowed the Florida Medicaid Program, administered by the Florida Agency for Health Care Administration (AHCA), to escape potential budget cuts that would have reduced the availability of certain services for Medicaid beneficiaries. By increasing the Federal Medical Assistance Percentage (FMAP) from 55.4% to 67.6%, the Florida Medicaid program could receive up to $4.2 billon for its Medicaid Program over the next twenty-seven months.1 Florida initiated its first draw of $363 million in ARRA stimulus funds on March 24, 2009.
The initial legislative budget proposal related to the Medicaid program is contained in SB 1658 and will address
- Mandatory provisions of Children's Health Insurance Reauthorization Act of 2009,
- Medicaid fraud and abuse provisions,
- Extending the sunset of medically needy and the Medicaid for Aged or Disabled demonstration project,
- Providing for the administration of certain Medicaid waivers in the Department of Elder Affairs,
- Updating the disproportionate Share Hospital (DSH) language,
- Revising the nursing home quality assessment language,
- Revising Medicaid reimbursement language to require increases in unit costs to be specifically appropriated for certain providers, and
- Extending the conversion of fee-for-service/shared cost savings requirements for provider service networks in the Medicaid managed care pilot program.
Also of note are proposed changes to the Florida Medicaid Program's Low Income Pool (LIP) and more specifically to the LIP Council. The LIP program, along with Florida's DSH program, provides supplemental Medicaid payments to provide access to Medicaid beneficiaries for hospital inpatient services, specialty care, and primary care services. Both the LIP and DSH programs are eligible for FMAP. While not authorized to appropriate or expend funds, the LIP Council, pursuant to 409.911(9), F.S., serves as an advisory body making recommendations to AHCA regarding the distribution of LIP and DSH funds. Under current law, the LIP Council is largely composed of representatives from the hospital industry. Both SB 556 and HB 285 seek to modify the composition of the LIP Council by requiring that three members be appointed by the Speaker of the House and three members appointed by the President of the Senate. None of the Speaker's or the President's appointees would be allowed to be employed by any entity receiving funds from the LIP pool.
Access to Healthcare
SB 702 and HB 185 both deal with access to healthcare and are moving forward in both chambers. Specifically, the proposed bills deal with the Florida Healthy Kids Corporation; Prepaid Limited Health Service Organizations (PLHSO), and the Access to Health Care Act.
The Florida Healthy Kids Corporation, a component of Florida Kidcare Program (Florida's SCHIP program), was established to provide access to managed care plans for children that were not Medicaid eligible. The legislation proposed to increase the Florida Healthy Kids Corporation Board of Directors from eleven to twelve members, with one of the members coming from a nominee of the Florida Dental Association.
The proposed legislation, as it relates to PLHSOs, seeks to prohibit PLHSOs from restricting the ability of providers to enter into or renew contracts with other PLHSOs. The bills also limits the ability of PLHSOs to require providers to accept the contract terms of other PLHSos that are under common management and control.
Finally, the proposed legislation seeks to modify Florida's Access to Health Care Act. Under the Act, which can be found at 766.1115, F.S., sovereign immunity is made available to healthcare providers who volunteer and provide uncompensated healthcare to eligible low-income individuals. Currently, providers that provide at least eighty hours of services a year are eligible for a waiver of their biennial professional license renewal fee and fulfillment of up to twenty-five hours of their continuing education hours. The proposed bills allow the providers' service time to be accumulated during the term of the biennial license renewal period rather than annually.
Electronic Health Records
There are several similar bills currently proposed that deal with electronic health records (EHRs) and the exchange of electronic health information. The bill that seems to have progressed the furthest at this time is CS/SB 162, entitled the Florida Electronic Health Records Exchange Act (FEHRA). FEHRA would do the following, among other things:
- Create new definitions related to EHRs and the exchange of such records,
- Authorize the emergency release of a patient health record to a treating provider without the patient's written consent,
- Require AHCA to develop a universal but voluntary patient authorization form, and
- Modification of both Florida's hospital and clinical lab statutes to allow treating providers the ability to access patient records without the patient's written consent.
1 March 24, 2009, Press Release from the Florida Office of Economic Recovery.
*AHLA wishes to thank William P. Dillon, Esquire (Messer Caparello & Self PA, Tallahassee, FL) and Kristen Plyler, Legislative Assistant (Messer Caparello & Self PA, Tallahassee, FL) for writing this email alert.