2008 Pre-Session Update

Week in Review at the Legislature - Legislators were in town for committee meetings this week. The pace has been ratcheted up as lawmakers prepare for the regular session which begins on March 4. Action was taken on a number of bills we are tracking. In addition, a few issues of interest to FAHSA were also discussed. Read on for details.

Home Health Regulation/Cap on Newly Licensed Agencies (SB 7012) - The Senate Health Regulation Committee, adopted a strike all amendment to a proposed home health agency regulatory bill (SB 7012) that incorporated ideas from a previous meeting. The new version of the bill, which passed unanimously, does the following:

·         Limits the number of approved newly-licensed home heath agencies per quarter to five for each geographic area in service areas 1 through 9, four for area 10, and three for area 11. The cap would slow the growth in home health agencies that has occurred since the certificate of need requirement was repealed in 2000.  (Associated Home Health Industries of Florida would prefer a total moratorium and intends to pursue it in the House.)

·         Directs AHCA to use a lottery system to select from the applications that are submitted for HHAs each quarter. Provides an exemption from the limits for HHAs opened by retirement communities for the sole purpose of serving their own residents. (This provision was incorporated in the bill for FAHSA.)

·         Requires new HHAs to submit a surety bond of $50,000 or an equivalent means of security.

·         Creates fines for various fraudulent activities.

·         Prohibits remuneration for staffing services to another HHA or health service pool with which the HHA has formal or informal patient-referral transaction arrangements. (This change is intended to stop kick-backs.)

·         Prohibits a HHA from staffing an ALF if the HHA does not receive fair market value remuneration. (This change is also intended to stop kick-backs.)

·         Limits the number of HHAs an administrator or director of nursing can manage or direct nursing services to one, except that the administrator or DON may manage or direct nursing services for up to five HHAs if all five have identical controlling interests and are located within one agency geographic service area or within an immediate contiguous county. If an HHA is part of a retirement community that provides multiple levels of care, the administrator or DON may manage or direct nursing services for up to a maximum of four entities licensed under Ch. 400 or Ch. 429, F.S.

·         Requires the HHA and DON to notify AHCA within 10 business days after the termination of the DON's services.

·         Directs AHCA to review the process and procedures for prior authorization of authorized HHA visits in excess of 60 over the lifetime of a Medicaid recipient.

·         The bill would take effect on 7/1/08.

There is no House companion, but we expect that there will be. HHA fraud is a hot topic. The Senate and AHCA are committed to stopping it.

Treatment Program for Impaired Practitioners -- HB 341 by Rep. Doug Holder passed out of the Health Quality Committee. The bill authorizes DOH to contract with impaired practitioner consultants to provide services to students enrolled in health care licensed training such as nursing, physicians and nursing home administrators; provides immunity to the schools from civil actions for referral of a student to an impaired practitioner consultant; and specifies contractual conditions in order for sovereign immunity to be granted. The bill as drafted may raise constitutional issues related to access to court (Article I, section 21) since it creates a barrier for health care practitioners to recover in a civil suit against a school providing training for health care practitioners. It also has a significant negative impact on the medical quality assurance trust fund.

Pharmacists and Pharmacy Technicians -- SB 334 by Senator Burt Saunders was temporarily postponed in the Senate Health Regulations Committee. The bill revises provisions governing licensure by endorsement of pharmacists; provides for the registration of pharmacy technicians and revises applicable general regulatory provisions; and requires the Board of Pharmacy to maintain a current directory of registered pharmacy technicians which must be published on the Internet.

Hospitalized Patients/Safe Lifting -- SB 508 by Senator Mike Fasano passed out of enate Health Regulation. The bill requires that hospitals, ambulatory surgical centers, and mobile surgical facilities establish a policy concerning the safe lifting of patients by their employees. By December of 2008, each hospital must establish a policy addressing safe lifting and associated handlingof patients by hospital employees which minimize the risk of injuries to patients and employees.

Automated External Defibrillators (AED) -- HB 243 by Rep. Anderson passed the House Committee on Health Quality this week with one technical amendment. The bill is intended to reduce the civil liability of having on AED available at a business. As proposed, this bill will:

·         Broaden the scope of individuals required to receive training in the use of an AED;

·         require any "person or entity in possession" of an AED to properly maintain and test the device and provide training to anyone who is expected to be a potential user of the AED. A related technical amendment passed that removed references to named association such as American Heart Association or the American Red Cross, as the only training standard of cardiopulmonary resuscitation and automated external defibrillator proficiency.

·         encourage persons who possess an AED to notify, rather than register with, the local emergency medical services director of the location of the device; and

·         broaden the civil immunity provided under the Cardiac Arrest Survival Act for harm resulting from the use of an AED by removing several provisions which specify instances when a person and an acquirer of the device are not immune from civil liability.

Although the bill passed the committee unanimously, there were many questions. The Florida Trial Bar testified in opposition.

DOH Reports to Legislature on Status of CE Broker - This week Lucy Gee, Dept. of Health Medical Quality Assurance Division Director, presented a status report to the House Health Quality Committee on CE Broker Tracking for health care licensees.  Ms. Gee reported that currently there are over 67,000 licensee subscribers to the system with 4,180 CE Providers who have submitted over 153,000 CE courses to CE Broker.  Almost five million completed course credits have been posted.

She further reported that DOH conducts random continuing education audits. If the audit reveals that the licensee does not have the required courses in CE Broker, the licensee will receive an audit letter requesting copies of certificates of completion.  Licensees are then given six weeks to respond. If the licensee does not respond within six weeks, a certified letter is sent giving them three weeks to respond to the second letter.  At the end of nine weeks, all incomplete files are determined non-compliant and are forwarded to Consumer Services for further action. Ms. Gee reported that the CE broker contract expires in  July of 2009 and requests for bids are expected to occur in July of 2008.

Elevator Safety/Generator Bill Proposes an Extension of Deadline for Compliance by High Rise Residential Buildings - This week, a new bill, SB550/HB253, sponsored by Senator Dennis L. Jones, (R-13), and Representative Jim Frishe (R-54), respectively, would extend the deadline from December 31, 2006, to December 31, 2010, for residential multifamily dwellings at least 75 feet in height to operate at least one elevator on an alternate generated power source.  In addition, the bill extends enforcement action, fines or other penalties from December 31, 2007 to December 31, 2011.

Current law requires that residential multifamily dwellings that are at least 75 feet in height and have a public elevator must be capable of operating at least one elevator on alternate generated power or to provide to the local building inspection agency verification of engineering plans for alternate generated power.  The elevator must be able to operate for an unspecified number of hours each day for a period of five days after a disaster or emergency resulting in an electrical power outage. 

In 2006, FAHSA was instrumental in passing legislation for multistory affordable residential dwellings for persons age 62 and older that are financed or insured by the United States Department of Housing and Urban Development that requires owners who could not comply with the requirements to make every effort to obtain grant funding from the federal government or the Florida Housing Finance Corporation (FHFC) to comply with this subsection.  FAHSA sent a letter to FHFC Executive Director, Steve Auger, requesting grant funding, either through an already established program or through the development of a new program. 

If an owner of such a residential dwelling cannot comply with the requirements of this subsection, the owner must develop a plan with the local emergency management agency to ensure that residents are evacuated to a place of safety in the event of a power outage resulting from a natural or manmade disaster or other emergency situation that disrupts the normal supply of electricity for an extended period of time. A place of safety may include, but is not limited to, relocation to an alternative site within the building or evacuation to a local shelter.