Legislative Issues and updates...

April 18, 2008

ARNP Legislative Report
Allison Carvajal, FNPN Lobbyist

Please Read!

The last few weeks of each legislative session is when, traditionally, we see what has really been ‘up the sleeve’ of organizations. What are some of the things they really want and what do they think they can really get?

ARNPs and other health care providers got a taste of that today. Lobbyists discovered that Sen. Mike Fasano was offering a ‘strike everything amendment’ (where the amendment eliminates the current language and inserts new language) on behalf of the Florida Medical Association through the Department of Health. The strike everything amendment is drafted to a bill that is important to the pharmaceutical industry.

In this instance, a bill that originally was intended to be a clean up bill for one industry, would result in making it almost impossible for anyone other than a fully licensed physician to order pharmaceuticals for the clinic practice from a wholesaler.

Your lobbyist and lobbyists for physician’s assistants and other professionals and health care clinics immediately met to review and analyze the legislation. At the same time they were meeting they scheduled an appointment with the Fl Department of Health Pharmacy Director who is the front for this amendment.

The DOH Pharmacy Director’s issue: The DOH believes that there are numerous persons who are not medical doctors currently ordering wholesale medications/drugs for their clinic (clinic is not defined in the amendment) or their practice.

ARNP lobbyist response: Then enforce the current law. There are clear laws regarding who may purchase medications/drugs from wholesalers, how it should be done, and who is responsible. If, as DOH contends, those laws are not being followed, enforce them. If DOH cannot enforce current laws, how does adding more laws fix the problem?

Review of this legislation by the lobbyists determined that should this bill passevery health care clinic (no definition so it could include a private practice) would have to have a qualifying practitioner who obtains a special permit to order from a pharmaceutical wholesaler.

A qualifying practitioner"means a licensed health care practitioner defined in s. 456.001 or a veterinarian
licensed under chapter 474, who is authorized under the
appropriate practice act to prescribe and administer a 1775
prescription drug without supervision or a protocol.1776

Some of the requirements the health care clinic would have to meet:
… healthcare clinic establishment must employ a qualifying practitioner who practices full-time at the establishment

….health care clinic establishment may not purchase a controlled substance as defined under chapter 893.1803
… Administration of prescription drugs purchased by the health care clinic establishment is prohibited during any period of time when the establishment does not comply with this paragraph. (i.e. if the ‘qualifying practitioner’ goes to lunch or on vacation).

Lobbyists met with the Department of Health representative this morning and discussed the fact that this alters the scope of practice for many practitioners and that this language needs to be eliminated and or re-written to address the concerns of the professions. It was made clear to the DOH representative that if the DOH does not address this (as it is the DOH who brought this to the Senator), amendments will be made by other Senators and the entire bill could be in jeopardy.

The House version has passed the House and is in Senate messages. The Senate Judiciary Committee is scheduled to take up this bill on Monday.

BILLS MOVING THIS WEEK

The HIV/AIDS Educational Requirements bill (HB153/SB646) are ‘on the verge’ of becoming law. It should have its final vote early next week.

Clinical Nurse Specialist bills ( HB285/SB736) revising the requirements for obtaining certification as a CNS. As earlier reported the Senate passed their bill and sent it to the House where it has been waiting House action. This week the House Healthcare Council withdrew the bill from its last committee and had it placed on the Calendar of the House. The House bill and the Senate bill are now in a position for the entire House to take action and send the bill on to the governor. Note: During the final three weeks of session bills that are scheduled to move begin to move more rapidly. The biggest issue is someone ‘forgetting’ them. Your ARNP lobbyist and the FNA lobbyist are spending a great deal of ‘reminding’ time on this bill.

Clinical Nurse Specialist bills ( HB285/SB736) revising the requirements for obtaining certification as a CNS. The House has heard the bill and should vote on final passage early next week. The bill will then be ready to be presented to the Governor.

BILLS AWAITING ACTION

Relating to reimbursement of Medicaid Providers (HB329/SB 1410) which would change (increase) reimbursement for physicians and dentists based on certain levels and rates

Access to Care (HB 515/SB 792) bill relating to ARNPs serving in underserved areas. The Senate is having its final scheduled committee meetings next week. This bill is not on an agenda. As new leadership takes over in House and Senate and many new members and new committee arrangements happen in the fall, we will begin to look for sponsors who can get this through.

 

ARNP Legislative Report
April 4, 2008
By Allison Carvajal, FNPN Lobbyist

"The ultimate measure of a man is not where he stands in moments of comfort and convenience but where he stands at times of challenge and controversy." Rev. Martin Luther King, Jr.

The challenge to create a budget to protect the citizens of Florida seems overwhelming this legislative session. The approximately $700million of proposed cuts in health care to poor women, children and hospice, is the almost the same amount the Legislature is considering giving to CSX Railroad to improve that private profit-making business. The comfort of funding a potential campaign contributor overrides the courage to support those in need in our state.

Each house is finalizing their budgets this week so they can begin the conference committee (the committee comprised of members from the Senate and the House who will negotiate between the budget differences) process.


Bills Moving
The HIV/AIDS Educational Requirements bill (HB 153/SB 646) took a step closer to becoming law this week. The House Policy and Budget Council passed the House bill out of their Council on Monday. The House bill is now on the Calendar and the Senate bill is also in the House. Both await action in the House.

The Center for Nursing Trust Fund bill (HB 5025/SB2116) has now passed through the House and Senate will be forwarded to the Governor for signing.

Clarification: There may be some confusion because of the new omnibus bill that the House Health Care Policy Council released this week which included a provision eliminating the Center entirely. This new bill would go along with the Appropriations bill in the House that eliminates all funding for the Center.

The bills that have now passed through the House and Senate leave the Center hanging on by a thread, but still there. The Center, under the bills that passed, would be rolled into the bigger Dept of Health Trust fund with a number of other Trust Funds. The voluntary contributions to the Center from nurses would remain as would the goals of the Center. The Senate budget reflects this bill.

It is pretty clear that this will be an issue worked out in conference. HOWEVER, it would be (un)safe to say that if the NEW House bill does not pass, then most probably, the House budget option for elimination of the Center would also not pass. Logical but not necessarily reality.


The Clinical Nurse Specialist bill (HB 285/SB736) passed through the House Health Care Council this week. The Senate version, which passed the Senate mid-March) is in the House, waiting for action. Like the HIV/AIDS bill the House can choose to take up their own version of the bill or the Senate version.

Bills still working through process
The Clinical Laboratory bill (HB595/SB716) which requires clinical laboratories to accept human specimens submitted by advanced registered nurse practitioners, although passed by the Senate, is still waiting to be heard by the House Health Care Council.
I have met with Council staff and spoke with the Chairman twice this week urging him to place this bill on the agenda or to withdraw it so the full House can vote on the bill. In addition, we are looking for a Senate bill so we can send it over again in the House.

The Access to Care bill (HB515/SB972) still has a fleeting chance of a hearing in the Senate. The Senate has two more weeks of committee meetings and we continue to lobby to have the bill. With the House not taking any action and committee meetings ended on that side, it is more difficult for the Senate to want to take the bill up.

Anna Small (FNA) is working on the language for the interim study. We should have that over the weekend.

The Patient Lifting bill (HB471/SB508) still awaiting action by the House Healthcare Council. As you will recall, the Senate bill passed the Senate and was sent to the House.

Of interest: Senator Deutch's bill that would require that school districts providing age appropriate sexuality education to make sure that the information is medically accurate, passed the Senate Pre-K thru 12 Education Committee this week. It is not expected to go much further and the House has made no move to hear the bill. But it is a step to agreeing that medically accurate information is important.

 National Provider Identifier (NPI) Deadline Approaching

If you bill for services, you probably need National Provider Identifier (NPI). If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is free. The first step is to get your NPI. Once you obtain your NPI, it is estimated that it will take 120 days to do the remaining work to use it. This includes working on your internal billing systems, coordinating with billing services, vendors, and clearinghouses and testing with payers. As outlined in the federal regulation, implementing the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you must also share their NPI with other providers, health plans, clearinghouses and any entity that may need it for billing purposes.

If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well. Providers have until May 23, 2007, before you are required to submit claims with only an NPI. Information available on the CMS website: If you are not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found at the Centers for Medicare and Medicaid Services (CMS) NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. In addition, a new Special Edition MLN Matters article is now posted on the (CMS) website with important information for Medicare providers, as well as information that may be helpful for all health care providers. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.