Big changes expected from healthcare session
Florida lawmakers are about to make big decisions about your healthcare.
When the 2023 Legislative Session convenes on Tuesday, state legislators will tackle topics such as the type of healthcare you can get over the phone, how much power a physician’s assistant has to prescribe medication, and possibly even whether women in the state will be further restricted on how many weeks they legally can get an abortion.
A lot is at stake during a year when most of the COVID public health emergency benefits will disappear.
Behind the scenes, lobbyists for hospitals, long-term care facilities, pharmacy chains, and grassroots health and senior care organizations are working to protect their interests. These stakeholders will jockey for their share of funding in the state budget and propose new areas of spending. At the same time, lawmakers will debate new bills that affect your health costs and care.
These are 10 key areas to watch:
Abortion
One of the most explosive issues legislators could take on this session is abortion.
Gov. Ron DeSantis signed off on a new law to enact a 15-week ban on abortion last year. Now, some Republican legislative leaders say they are open to advancing more limits on abortion in 2023. House Minority Leader Fentrice Driskell and other pro-choice advocates say they are closely monitoring for proposed legislation and will fight against it.
Currently, Florida’s 15-week ban is being challenged in the Florida Supreme Court. Abortion providers urged the Florida Supreme Court on Monday to reinstate a block on the law, arguing it violates the state constitution. The providers said their patients are suffering irreparable harm while the law is in effect. It’s unclear whether the Legislature would propose further restrictions before the court issues an opinion.
Physician-assisted death
In what is considered an emotionally complex area of healthcare, Democratic Sen.
Lauren Book has introduced the Death with Dignity Act (SB 864). The bill comes less than a month after a Daytona Beach woman shot and killed her terminally ill husband.
If passed, this law would allow doctors to prescribe lethal medication to dying patients who want to end their lives. The fatal diagnosis would need to be confirmed by a second, consulting doctor.
Telehealth
The pandemic paved the way for doctors, therapists and other medical professionals to treat patients via smartphones and computer screens. This session, there are several bills that clarify and expand on the type of services can be provided via telehealth.
Here’s what the various proposals would do:
■ Redefine telehealth. If a proposed law passes, telehealth visits could include audio-only calls, which had previously been excluded in Florida.
■ Include genetic counselors. Genetic counselors work with patients to assess risks for certain genetic conditions they have or could pass on to their children and then provide counseling and education. A proposed bill would allow genetic counselors to see patients via telehealth. The bill also would allow genetic counselors licensed outside of Florida to operate in the state via telehealth.
■ Allow medical marijuana re-certification. Two Republican lawmakers have filed bills that would allow physicians to use telehealth to
re-certify medical marijuana patients, making it easier and less costly for cardholders to continue to have access.
Allow more prescriptions. If approved, a new law would allow a telehealth provider to prescribe certain controlled substances for health conditions such as cancer, psychiatric disorders or a terminal illness.
Medical duties
With staffing shortages plaguing the medical profession, various proposed bills would expand the abilities of certain professionals — particularly when it comes to prescribing or giving out medication.
Here’s what the proposed laws would do:
Give CNAs more authority. Certified Nursing Assistants with at least one year of experience and additional training could pass out medications to nursing home residents and home health agency patients. The long-term care industry supports this bill, and AARP agrees it would be beneficial for Florida seniors.
Give physicians assistants more authority. Republican Rep. Lauren Melo of Naples wants to give physicians assistants more authority by allowing them to prescribe or dispense drugs, without needing a physician’s supervision.
Give pharmacists more ability to screen for HIV. Another proposed bill allows certified pharmacists to screen for HIV exposure, and order and dispense HIV pre-exposure and post-exposure prophylaxis drugs without a prescription under certain circumstances.
Give home health aides a bigger role. Home Health Aides for Medically Fragile Children could see their medical authority extended if a proposed law gets approved that would allow them to administer medications under specific circumstances.
Create training requirements for Alzheimer’s caregivers. If approved as law, the Department of Elderly Affairs would offer education about Alzheimer’s disease and related forms of dementia to the general public and there would be minimum requirements for the training of caregivers.
Prescription drug coverage, costs
Most Floridians are frustrated with medication costs.
Two proposed bills seek to address the frustration. Bill SB 746 requires health insurers to provide notice of prescription drug formulary changes within a certain timeframe and in a specific manner so patients know about cost increases. A formulary is a drug list that include brand names and generics that are covered by an insurer. The bill also would require insurers to submit a report on formulary changes annually.
For Floridians whose insurers partner with a pharmacy benefit manager such as Express Scripts, another proposed bill (SB 46) would require any payments for drugs be applied towards the insured person’s cost-sharing requirements such as deductibles and co-pays. The change would provide cost-saving benefits to the insured and require more transparency from pharmacy benefit managers.
Advertising
There are so many different types of healthcare professionals that it has become confusing to patients to know who is treating them.
To provide some clarity, HB583/SB230 would create a statute laying out the titles and designations that healthcare providers may call themselves, use in advertising and use in a medical setting. Patients would more easily know if they are being treated by a nurse practitioner, licensed medical doctor or a doctor of osteopathic medicine.
The proposed law also would require certain healthcare practitioners to prominently display a copy of their license in a conspicuous area of their practice that is easily visible to patients.
Mental health
Florida suffers from so many gaps when it comes to mental health. This session could bring some improvements.
A bill now being debated would allow Medicaid beneficiaries with serious mental illness to bypass requirements that they try less expensive options before “stepping up” to drugs that cost more. Advocates believe it will go a long way to help women with postpartum depression and people with depressive disorders. The new measures would apply only to the state’s Medicaid-managed care plans and not to commercial health policies or policies sold in the state group insurance program.
Mary Mayhew, president and CEO of the Florida Hospital Association, said her group also is supporting a funding increase for community-based mental health services. “We know when people get timely access to community-based behavioral health services, it reduces preventable highcost utilization of emergency rooms, along with hospital admissions and readmissions.”
Transgender care
The Florida Board of Medicine and the Florida Board of Osteopathic Medicine approved rules last fall that prohibited gender-affirming surgery and puberty blocking hormones for minors.
Now two House Republicans have filed a proposal, and a companion Senate bill was filed, to make it illegal for doctors to provide treatments such as puberty blockers, hormone therapy and and gender-affirming surgery to transgender minors. Doctors could lose their licenses if they commit violations.
An effort also is underway in the Legislature with the name “Reverse Woke Act” to force Florida employers to pay for de-transitions. The “Reverse Woke Act,” (SB 952) would force businesses that cover gender-affirming care to be financially responsible for subsequent de-transitions, even for employees who no longer work for the company. It would apply to any employer that funds out-of-state travel for workers to access gender-affirming care.
Opponents say the bill is intended to dissuade businesses from supporting their trans workers.
Vaccination
DeSantis has come out strong during the pandemic against vaccine mandates.
Now, a bill titled Protection of Medical Freedom (SB 222) would prohibit Florida’s Department of Health from requiring enrollment in the state’s immunization registry. It also would prohibit businesses and governments from requiring individuals to provide proof of vaccination after recovery from any disease. A business also could not refuse someone employment, or discharge, discipline or demote an individual solely on the basis of whether or not they are vaccinated for a disease.
Covered medical services
With costs rising, healthcare is no exception. A few proposed bills would help Floridians by extending or requiring insurers to cover certain healthcare costs.
Skin cancer screenings.
Republican Sen. Gayle Harrell of Stuart wants to make it mandatory that health insurers fully cover the cost of skin cancer screenings by licensed dermatologists.
Biomarker testing. Biomarkers are an increasingly useful way to test for presence of a disease, infection, or environmental exposure. Republican Sen. Tom A. Wright of Volusia and Brevard counties wants to require the Agency for Health Care Administration to pay for biomarker testing under the state Medicaid program and require individual health insurance and group policies to provide coverage for biomarker testing under specific circumstances.
Glucose monitoring. Three proposed bills would extend Medicaid coverage for specific healthcare needs, including continuous glucose monitors for diabetes, home healthcare nursing under certain circumstances, and potentially more sickle cell disease treatments.
Transparency of coverage. Dubbed the “Health Care Transparency and Accessibility Act,” a proposed law would require health plans and providers to submit to the state’s Department of Health a notice and complete list of its refused medical services and provide that list with its application if applying for state grants or contracts.