South Florida Hospital News
Tuesday July 16, 2019
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June 2019 - Volume 15 - Issue 12

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Legislative Update

The following is a summary of the regulatory bills that have been passed so far this year by the Florida Legislature, and that are of particular interest to hospitals. All bills become effective July 1, 2019, with one exception, which is noted:

The Canadian Prescription Drug Importation Program charges the AHCA to engage with vendors to develop a Wholesale Prescription Drug Importation List, as well as to identify Canadian suppliers that comply with both the federal Drug Quality and Security Act, and Canadian federal and provincial laws and regulations.
 
The Certificate of Need bill repeals CON and revises certain requirements for hospital licensure.
The Telehealth bill permits out-of-state telehealth providers to register in Florida, but only to perform services within the range of their practice. They may also make evaluations via telehealth, and may prescribe controlled substances in certain settings and for certain disorders. Additionally, new language in the state's health insurance and MCO laws declares that reimbursement contracts are voluntary between providers and insurers, with both sides agreeing to acceptable rates or methods of payment for services.
 
Nonemergency Transportation Services for Medicaid Enrollees authorizes those receiving Medicaid to be provided nonemergency transportation services by certain transportation network companies or brokers that comply with specific requirements.
 
Non-opioid Directives instructs the Florida Department of Health to publish an educational pamphlet on its website that focuses on using non-opioid options for treating pain. The bill also requires health care practitioners to: present the pamphlet to patients before treating them with anesthesia, or dispensing or prescribing a schedule II-controlled substance; inform them of alternative treatment methods; and record the suggested alternatives in the patient's record.
 
Carrying of Firearms by Tactical Medical Professionals. The bill describes "tactical medical professionals" as physicians or paramedics who have been appointed to provide services to a tactical law enforcement unit, and allows them to carry a firearm in like manner as an officer, while actively supporting a law enforcement operation. Additionally, it provides the same criminal and civil immunity as a law enforcement officer would receive to those acting within their sanctioned range of duties.
 
Office Surgery Centers, which have been refined into three categories, are banned from performing procedures that require deep sedation with general anesthesia, or spinal, regional, or epidural anesthesia.
 
Electronic Prescribing requires health care practitioners who prescribe medicinal drugs to do so upon licensure renewal, or by July 1, 2021, whichever is earlier. In addition, the bill defines specific conditions when a written prescription is permitted, such as a short-lived technological or electrical failure that the prescribing practitioner cannot reasonably control, and when such failure is documented in the patient record. This bill goes into effect January 1, 2020.
 
The Stroke Centers Classifications & National Accreditation bill adds a new class, thrombectomy-capable stroke center, to the current law-list. It requires that hospitals be certified by a nationally recognized accrediting organization, and eliminates the authentication-by-affidavit process to verify that a hospital meets the proper requirements.
 
In addition, the OMNIBUS Healthcare Bill, which also goes into effect July 1, 2019, has highlights that include:
 
The Ambulatory Surgical Centers 24 Hours bill permits 24-hour patient stays for adults beginning July 1, 2019, and directs AHCA to adopt rules for ambulatory surgical care to children kept past midnight. Once those rules are in place, the law will then allow 24-hour ACS stays for children.
 
The New Hospital Patient Notice/Information Requirements include several directives, among them:
 
• New Hospital Quality Patient Information Requirement, obliging hospitals to provide specific data to all patients or their representatives, upon scheduling nonemergency care, either within 24 hours of stabilization or at discharge, whichever is first. The report is to comprise the most recent year's hospital and statewide average for hospital-acquired infections; the overall rating of the Hospital Consumer Assessment of Healthcare Providers Survey; and the 15-day readmission rate.
 
• New Hospital Primary Care Physician Notice Requirement, insisting that hospitals notify a patient's primary care physician or specialist with 24 hours of the patient's admission and discharge, to permit the PCP or specialist to have a hand in developing the patient's plan of care. Hospitals would be required to provide a copy of the discharge summary with seven days.
 
• New Hospital Patient Notice Requirement re Observation Status, requiring hospitals to immediately provide written notice to patients when they are placed on observation status.
 
New Hospital Regulations include two components:
 
• Non-Complete Clauses that void such clauses or restricted covenants, and consider them to be unenforceable where one entity employs or enters into contracts with all physicians who practice a particular specialty in one county. The restrictive covenant would continue to be void and unenforceable until three years following the date on which a second entity that employs or contracts with the particularly specialty starts serving patients in that county. (The language of the bill needs to be clarified as it is not clear if the three-year period commences when the second entity begins to offer services, or when it actually sees its first patient.)
 
• Unannounced Site Visits by Pediatric Cardiac Technical Advisory Panel has its authority and duties revised. The AHCA would be authorized to ask panel members to conduct announced or unannounced site visits to any existing pediatric cardiac facility, or a facility seeking such a license, as a way to safeguard regulatory compliance.
 
Likewise, New Physician and Practitioner Regulations include two components:
 
• Direct Health Care (Primary Care) Agreements Expansion – direct care agreements are expanded to include not only physicians, but also practitioners (within the limits of their competency and training), chiropractors, advanced practice nurses, physician assistants, dentists, and primary care practice groups.
 
• Drug Step-Therapy Protocols prohibit insurers, HMOs, and Medicaid managed care plans from requiring step-therapy protocol under the policy, contract, or plan for covered prescription drugs, if the patient has been previously approved to receive the drug by completing a step-therapy protocol. The bill specifies that a health insurer is not required to add a drug to its prescription drug formulary, or to cover one that would not otherwise be covered.
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