Title: Summary of the state legislature's impact on Florida's healthcare environment
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Title: Summary of the state legislature's impact on Florida's healthcare environment
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Creator: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Publisher: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
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Rlonda Crtter for Medicaid and the Urmiumed

2004 Legislative

Session Update

August 2004


Robert C Frank, Ph.D.

Allyson Hall, Ph.iD

leather Steingraber, MAC (ART)

lianyi Zhang, Ph.D.

Tinao Poilt
Heather lenderson

Eleit I)imoulas, M.S.
Fred Sheriff
Amanda Bhikhari, MiHA

A summary of the State

Legislature's impact on

Florida's Healthcare Environment

This year's legislative session concluded on Friday, April 30. Ihe
session ended with a flurry of bills passed at the last minute by
both chambers, and with reports of an unusually large amount
of "unfinished business" this year. The session was described
as 'disappointing" by both parties; numerous bills died as a
consequence of failed negotiations between the Senate President and
the I louse Speaker and because of general time constraints faced by
the legislature.
Soaring healthcare costs and the high number of individuals without
insurance should have made healthcare legislation a high priority
Despite the number of healthcare bills this session, few were directed
at delivery system reform to decrease costs or improve coverage

Some of the primary healthcare bills that were passed include:

* The 2004 Affordable Health Care for Floridians Act a major reform bill that attempts to expand
access to care, primarily through consumer-driven techniques.

* Medicaid Funding determines budget amounts for Medicaid and other state healthcare subsidy
I r..;r ii1. r i i,' -. i ii. I ii ti in slil nal11i Irn il~m r1ii s N M" Id 1i 1 h. I 1, i l l l-, V hiV 1 .11 i
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* KidCare a bill that provides funding to reduce the waiting list of KidCare and that tightens
eligibility to the program.

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,:> .rr. .1 .I .| I 'r.-, r ., 1c lilln ( .ir. 1irl.i.I r I)i ..i oli Ili[ iniiT -r.I1 1 A I I e'3 II ol..

* Medicaid Fraud Bill increases the state's authority to punish those who participate in prescription
drug abuse in Medicaid.

* I und I. Athr I'tis ple 2 i'i 'r grirs 'i iri' ; I1t h I t Ir i'anIeT c-i'I lI.' Jlh -.il-, -.irseeing steps
t . .r. 1 1 do ti...... II, f.* illr 1 ., ill.- dl. '.p I.r-lr I.I1 Ir -F, i.c l- 11 i Lbt, COIl-ai' 11' "-

2004 Affordable Health been criticized as a critical not require what some consider
Care for Floridians Act problem with our healthcare necessary services, such as
(C.S. 1629) environment. lhese measures mammography screening and
are an attempt to improve the other preventive services.
'Iis healthcare bill was designed availability of information and
to reduce the cost of care and to promote competitive pricing Higt-Risk Pool Study
to expand access to health amongst healthcare providers.
insurance. The bill does not A controversial provision
allocate any new tax dollars for Additionally, a comprehensive that was not included called
the health care of the poor or program will be established for the reestablishment of a
uninsured. lle bill's principal to increase public awareness high-risk insurance plan for
provisions: of risk-factors associated with small businesses. Instead, due
chronic conditions, to uncertainty surrounding
Require providers to pub- the effectiveness and impacts
lish cost and outcome data Heltlh Savings Accoiunts of such a high-risk pool and
via the Internet because of the recent failure
Require insurers to provide Ihe bill requires insurers of the previous high-risk pool,
SHealth Savings Accounts to to provide cheaper, high- the legislature decided to
small employers deductible plans to small spend $250,000 for a study to
Expand the I health Ilex businesses-another consumer- determine whether the high-risk
program to the entire state driven approach to cost savings, pool would benefit Florida's
lund a study for reestab- I health Savings Accounts (I ISAs) health insurance market. Iy
fishing the high-risk pool allow participating individuals December 1, 2004, a 9-member
in lorida' and families to set aside pre-tax Board of Directors for the FI lIP
establish an agency for dollars for their health care that must submit an actuarial report
reducing medical errors can be rolled over each year outlining the plan's possible
tinder the plans, individuals impact on the small group
In reased Ilnforrrtirron can save as much as $2,600 per market including premiums
for the Public year, and families can save up to paid by insureds.
$5,1 50. hese funds can be used
I hospitals and other healthcare to purchase health care. When established, the high-
entities are required to provide risk pool, will be known as the
the public with performance Expansion o I health Flex Plans Florida I health Insurance Plan
data, outcome data, and (Fli:P). Itwill be designed to
financial data. The Agency for In recent years, the legislature provide insurance to those who
Health Care Administration has allowed Duval and Miami- are uninsurable because of ex-
(Al ICA) will collect information Iade counties to experiment treme health risks, specifically
from various healthcare with "bare-bones" health lloridians who are denied cover-
entities and use it to publish insurance plans for low-income age by two or more insurers, The
performance and price data workers. These plans attempt premiums would be capped at
for 100 common medical to expand access to insurance 300 percent of a standard plan.
procedures. I hospitals and other by removing mandates on
healthcare entities must make benefits packages so insurance Ihe use of high-risk pools as
available on their websites a companies can provide cheaper a means to contain healthcare
description of, and link to, the plans. Inder the bill, such plans costs and increased coverage
data on the Al ICA website. will be expanded statewide. A is also being debated at
controversial aspect of I health the national level, as a part
the lack of access to quality Flex plans is that they provide of democratic presidential
and cost information has long inadequate insurance for those candidate lohn Kerrys health
'h' ii. .....ti h i 1 i l o n who participate, since they do insurance reform proposals.

.... 9 Florida Center for Mediroid and the Uninrured

Higher emergency room

A controversial provision in the
bill involves allowing insurers
to charge higher co-payments
for emergency room visits that
turn out to be deemed non-

Small Employer
Access Programn

Ibis provision calls for
the formation of regional
purchasing alliances for small
businesses. Such alliances are
intended to address the growing
problem of small businesses'
inability to pay for a healthcare
benefit for their employees.

The Small Business I health Plan
will provide to small employers
the option to buy healthcare
benefits for their employees at
an affordable cost through the
establishment of purchasing
pools for employers with up
to 25 employees. I hospitals,
nursing homes, counties, and
school districts located in nrral
areas will also be allowed to join
the purchasing pool.

the Office of Insurance
Regulation (01 R) through
competitive bidding will select
insurers to provide coverage for
the purchasing alliances within
an established geographical area
within the state.

Medicaid Funding
(C.S. 1843)

'Iis is the conforming bill
by which the Appropriations
committee lays out the funding

for Medicaid in the upcoming Medicaid Long-Terni Care
year. It has a significant impact
on the program by: The bill establishes the
framework for switching most
* Making changes to Medicaid of Florida's Medicaid long-
spending for the upcoming term care population to I MOs.
fiscal year lawmakers have instituted
* I establishing the groundwork the requirement that Al ICA
for placing Medicaid long- develop a plan for piloting
term care and mentally ill these changes in a variety of
participants in IIMOs Florida counties. This would
free the government from direct
Medicaid Mental decision-making for the care
I lenllh Care of the many elderly patients.
"he elderly consume a large
hIis session, lawmakers used portion of Medicaid's budget,
the appropriations ilt clarify particularly through nursing
the appropriations bill that homes Nrsing home, hospital,
homes. Nursing home, hospital,
the language from a bill that and home health services for the
was passed last year (S. 2404) elderly are all potentially going
that required Al ICA to contract to be affected by the changes.
with a "single entity for its
mental health population. As I'rm the outset, this legislation
a consequence of this year's was highly controversial. Seniors
clarification, Medicaid will likely told the legislature that they
contract with managed care feared that the changes would
entities, such as I IMOs, for the encourage a decrease in quality
coverage of the mentally ill in of services.
the program.
Ithis long-term care provision
Ihe state currently spends was particularly troublesome
around $320 million a year on to certain lawmakers because
individuals who are mentally of the way in which it was
ill. The potential changes inserted into the budget. At first,
would mean a shift of over the language that was inserted
S t00 million in payments from specified which counties would
community-based health centers take part in the reform and that
to I IMOs. Consequently, the the reform would be effective
changes were strongly opposed this year I however, several of
by many community health the representatives from the
centers. Ihe changes could affect specified counties were strongly
as many as 600,000 mental opposed to the idea.
health patients. Although
community health centers Subsequently, an amendment
will be allowed to participate was passed that negated this
in the bidding process for proposal. Instead of the
the contracts, the likely and changes going into effect in the
intended result of the law will formerly specified counties, the
be the shifting of the mentally final language of the bill created
ill into managed care systems, a $250,000 feasibility study

Florido Center for Medicaid and the Uninsured

for the proposal, and removes
the names of the previously
specified counties for the
potential changes.

Spending chalnes

to be permitted to survive insufficient funds. Immediate
in its current form, next year action was taken in early March
the legislature will have to go by funding $25 million to the
against the wording in this year's program in order to enroll
bill and provide the program 70,000 children who were on
with sufficient funding, the waiting list.

Ihis year, Medicaid will Other spending I however, controversy continues
consume approximately one- to surround the program.
quarter of the $58 billion state Other major spending includes ii 1, ,1., i 1.. .1
budget. By 2015, the Medicaid $40 million towards reducing a ........... .. i .1.
budget is expected to grow portion of the developmentally legislature's decision not to
to $53 billion. I however, one disabled who are awaiting include any additional children
of the loudest complaints services and providing $130 in the program by the end of
regarding this session is that million in additional funding to session, has drawn criticism. lhe
no new money is being directly the KidCare program to include stricter eligibility requirements
allocated to expand access or an additional 35,000 members. include a designated open-
reduce costs, enrollment period, required
Vetoed Spending proof of income, and the
Medicaid costs have been requirement that healthcare
growing at an escalating rate in governorr Bush eliminated $349 costs for the child must exceed
recent years lawmakershave million from this year's budget. 5% of income. The result is
implemented several cuts in Significant healthcare-related that as many as 20,000 of the
the program. These cuts will cuts include: children who were already
include a 5 percent reduction in in the program will be losing
spending for nursing homes and $12 million for eligibility.
a reduction in reimbursement the creation of an
rates for hospitals by nearly 5 Alzheimers Research A bill relating to KidCare that
percent. Center a project of died this session included a 30-
I louse Speaker lohnnie day grace period for those who
Medically Needll' Iyrd are late in their payments and
S$21 million for the state's the opportunity for uninsured
Ihe Medically Needy Program- 21 level-l traumaa centers parents of the eligible children
a source of funding for 27,000 $3 million for a to be able to join the program.
of Florida's extremely sick and biomedical research
costly patients-will receive program at IFlorda State Long-Term Core Delivery
funding once again this year University (C.S. 1226)
I however, tie use of non- $2 million for a cancer
recurring funds continues to research program lhe long-term care system in
threaten the existence of the through the Mayo Clinic Florida has been criticized
program, as being fragmented and
KidCore (C.S. 2000) confusing. A major source of the
Lawmakers have included confusion is the transition by
language in this years budget KidCare is a health program for the elderly from being covered
that presumes to all but over 400,000 Florida children by Medicare to being covered by
eliminate the program in the of the working poor. he Medicaid for long-term care.
future. Plans are in place to legislature began the session by
reduce benefits to only cover responding to the public outcry "Ibis bill makes important
prescription drugs after this against the 90,000 children who changes to the long-term care
fiscal year For the program were placed on a waitlist, due to delivery system by interpreting

poge 4 florida (enls r aor Medaiid and the Uninsured

and outlining the role of the
state agencies that are involved
in long-term care. It is an
attempt to better coordinate the
care of Florida's elderly, as well
as an attempt to reduce costs
paid by Medicaid for the elderly.

Al ICA will be given the author-
ity to use the Comprehensive
Assessment and Review of long-
" 1 *Ii ,. .1 1 111 II. .1 I

preadmission screening pro-
gram for nursing facilities-as a
means of reviewing the necessity
of nursing home stays greater
than 20 days.

the bill also requires Al ICA and
the Department of Elder Affairs
to develop an integrated long-
term care service delivery system
over the next three years, as-
signing specific responsibilities
to each agency and providing a
time frame for the implementa-
tion of the changes.

Medicaid Fraud Bill
(C.S. 1064)

Asa way of combating prescrip-
tion drug fraud in Medicaid, a
law was passed that increases
the State's authority to access
information from providers,
and increases the punishment
for those who participate in any
fraud or abuse of the Medicaid

Al ICA will now have more au-
thority to impose requirements
that will facilitate the identifica-
t; .. . ,. ;, . j .-,, pi. .
t.L,%.I i 1- ... 51, I III .1 .
have the authority to remove
doctors from Medicaid for inap-
propriate prescribing.

Florida Healthy People
2010 Program (C.S. 1178)

Ihis bill provides for the
Depanment of tlealth (DOll)
to develop and implement the
goals of the Healthy People
2010 Program-a nation-
wide health promotion and
disease prevention program.
Although the DO I is currently
implementing some of the
Program's objectives, the bill
provides for more resources
for building reporting systems
that will be able to capture all
relevant data to the program.

A primary objective of the
program is to eliminate health
disparities among different
segments in the population.
the bill prompts the DOI I to
work with minority physician
networks to increase the
proportion ofhealthcare
professionals from minority
backgrounds. The bill also
requires A ICA to contract with
minority physician networks
that provide services to
underserved minority patients.
Additionally, the bill prompts
the DOI to promote research
on ways to reduce health

Healthcare Providers
(H. 1121)

hIis bill amends the Access
to I ealthcare Act that was
passed in 1992 as a means
of encouraging providers to
provide more charity care. The
act laid out the criteria under
which providers can have
immunity from malpractice
suits (under the doctrine of
sovereign immunity) when they

Florida Center for Medicaid and the Uninsured

have contracted with the state to
provide charitable care.

"lhe bill passed this year extends
immunity to include "free clin-
ics." Free clinics are defined as
clinics that provide only medi-
cal, diagnostic, or nonsurgical
services free of charge to low-
income recipients. Many of the
free clinics participate in the
Volunteer I lealthcare Provider
Program through the Depart-
ment of Ilealth.

Healthcare Provider
Deregulation (C.S. 182)

'Ilis bill makes a significant
change to the state's Certificate-
of-Need (CON) laws that
require state approval for
healthcare provider capacity
expansion and construction.
I hospitals will now be able
to add beds and expand their
facilities without the permission
of the state. And, open-heart
surgery can now be provided by
hospitals without having to go
through the CON process.

Proponents of the bill point to
the time efficiencies and cost-
savings that hospitals will expe-
rience by being free of the costly
and burdensome regulation.
Those opposed point out that
the deregulation could result
in unnecessary expansions and
higher final costs to patients.

Florida is experiencing one of
the highest levels of growth in
capital spending by hospitals in
the country. With a population
that is aging and growing, many
hospitals are inclined to think
that demand will keep pace with
their additions.


State Agency for Disabled
[C.S. 1823)

the bill creating the Agency
for Persons with Disabilities,
was passed this session Alhe
developmentally disabled have
previously been served by the
state's Department of Children
and families (I)CF )

Ihe creation ofthe new agency
is hoped to respond to the prob-
lem ofthe continuous budget
shortfalls and growing waiting
list numbers that have been ex-
perienced by DCF Ihere are cur-
rently around 30,000 develop-
mentally disabled members in
the program, and it is expected
that a consequence of the new
agency's creation will be a near
elimination of the waiting list
of more than 10,000 disabled
individuals waiting to enter the

Other healthcare-related

Medicaid March (H. 25)
a bill that urges the
I.S. Congress to change
the formula used in
calculating the federal
match rate. Ibis bill asks
for the use of a formula
based on total taxable
resources, instead of the
current basis of per capital

Prescriptions by PAs and
ARNPs (H. 103) al-
lows advanced registered
nurse practitioners and
physician's assistants to
write valid prescriptions
for their patients, ensur-
ing reimbursement from
insurance companies.

Anesthesiology Assistants
(C.S. 626) a controver-
sial bill that establishes
the category of anesthe-
siologist assistants, who
can assist in anesthetizing
patients for surgery it is
supposed to save money
for providers, since it will
free them from having
to pay to hire Registered
Nurse Assistants.

SNursing Home Beds (C.S.
1062) allows nursing
homes the flexibility to
use inactive beds for As-
sisted living and other
purposes without having
to go through the rigors
of the CON process.


Drug Database (H. 397)

Sponsored by Representatives
Cayle I laurel, R-Port St. Iucie,
and Carl Domino, R-Palm Beach
Gardens, this bill called for the
creation of a government-run
database for prescription drugs.
the database was primarily
intended to combat drug-
overdoses in Florida. A recent
study demonstrated that more
than 3,000 deaths from drug
overdoses occurred in Florida in
2003. The database would have
given doctors and pharmacists
the ability to view the
prescription history of
healthcare consumers, giving
them more opportunities to
catch so-called "prescription

tIhe bill received little support
however, due to concern
that it would infringe upon

individuals' constitutional rights
to privacy.

Price Cap for Emergency
Services (S. 2350)
Sponsored by Senator Mike
Fasano, R-New Port Richey,
this bill would have imposed
a price cap on emergency
services, as a way of reducing
the high amounts paid by
ER patients when there is no
existing contract between that
individual's I IMO and the
hospital. lobbyists representing
hospitals across the state exerted
a great deal of pressure against
the bill. It was later withdrawn.

Small Employer Health
Insurance Plan (S. 2328)
Sponsored by Senator Ron
Klien, D-Delray Beach, this
was a failed attempt to reduce
the insurance costs for small
businesses by allowing their
employees to join the state
health insurance plan.

Small Employer Tax
Credits (S. 598)
'he bill, sponsored by Senators
Rod Smith, D-Cainesville,
and Frederica Wilson, D-
Miami, called for a tax credit of
$1,000 for each employee with
insurance in a business of fewer
than 50 employees and $1,500
if the business is located in an
economically depressed area.

Patient Safety (H. 1885)
lawmakers failed to follow
through on an attempt to cre-
ate a safety authority that would
study the potential return on
investment of computer physi-
cian order entry systems in all of
the state's hospitals. the aim of

Florida Center for Medicaid and the Uninsured

the safety authority would be to market reform to produce more method, even if widely adopted,
improve patient safety and re- coverage, will have little impact upon
duce costs associated with mal-
practice. The bill was sponsored The Affordable I lealthcare Act pricing or quality. Importantly,
by Representative Frank Farkas, and the changes to Medicaid I SAs shift the burden of cost
R-St. Petersburg are unlikely to impact the from employers to employees.
number of uninsured. hIe hbis shift leaves more
KidCore Expansion (S. 210) legislature's decision to expand consumers unable to afford
Sponsored by Senator Debbie the geographic scope ofI health
Wasserman Schultz, D. Ile, the introduction of health comprehensive health services,
Pembroke Pines, Senator Gary savings accounts, and the thereby increasing the number
Siplin, D-Orlando, and Senator possible return of a high-risk of underinsured.
larcenia Bulliard, D-Miami, insurance pool will potentially
this bill would have allowed have some impact on the
a 30-day grace period for la affordability of insurance for Another approach emphasizes
payments by participating certain employees of small the need for directly addressing
members and would have businesses. I however, many the costs of insurance for
expanded eligibility to argue that it will only impact those who cannot afford it.
uninsured parents of children in access to care to a minor degree. hey are more likely to push
the program. for expansion of Medicaid as

Self-py Poatients (H. 715) a priority in increasing access
Self-pay Paoients (H. 715) ane d redn te n
Sponsored by Representative and reducing the numbers
Marcelo lorente. R-Miami, this of uninsured. Critics of this
bill would have required all b m h approach emphasize the
Florida hospitals to provide a increasing costs of Medicaid.
payment discount program for
indigent and uninsured patients.
iw tg t to e a rhun esur ponase t Reform at the Federal level will
to recent pressure by consumer obe a large pan of the debates
groups to change the inflated surrounding the upcoming
rates that self-pay patients are national elections. lhe potential
commonly charged. Under the reforms at the national level will
bill, hospitals would have been The session demonstrated two reforms at th
required to inform patients different approaches to reform continue to be watched closely
whose incomes are less than One approach emphasizes by our state legislature, but
300%o of the federal poverty the use of a consumer-based tile danger is that the national
level that they qualify for the approach such as I health Savings reforms being discussed may
discount, Accounts.
discount Accounovershadow some of the state

CONCLUSION I ISAs rely upon consumer reforms that will be on the table
decisions to create more cost in the coming years. I history
Approximately 2.8 million effective health care. Ilowever, has taught us that national
Floridians are without they tend to offer consumers healthcare reform is difficult to
insurance. Yet, despite the limited resources for use in
growing uninsured population a highly priced market. he accomplish, so the more direct
in Florida, there were few bills difference between consumer line of responsibility rests with
directed at delivery system resources and actual cost our state leadership.
reform to decrease costs, or makes most experts believe this

Florida Center for Meditoid and Ihe Uninsured anne 7

Florda Center Io Medicaid and he Uninsured
',llelge of Publi Heillh and -leallh Profe sion.
lnrimrslt) of Flonda
Email: fcmu@phhp.ufl.edu
Web: fcmu.phhp.ufl.edu
Phone: 352-273-5059
Fax: 352-273-5061

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