Florida’s “Health Care Session”: What Stakeholders Need to Know about the Live Healthy Act and Other Proposed Health Care Legislation

INSIGHTS

• Florida’s annual 60-day Legislative session begins on January 9, 2024, and is scheduled to include major health care legislation.

• Health care providers and educators may find new opportunities, new competitors, and perhaps new regulatory burdens as a result of legislation passed this year.

• Major changes include the approval of a new licensing scheme for birthing centers and expanded scope of practice for mental health providers, among other proposals.

• Provided below is a brief summary of the now 230-page bill that is sure to go through several amendments before becoming law.

Spearheaded by Senate President Kathleen Passidomo and Senators Colleen Burton and Gayle Harrell, the Live Healthy Act, which is comprised of Senate Proposed Bills 7016 and 7018, seeks to revamp current laws and create new laws relating to the state’s health care workforce, health care services, health care practitioner and facility licensure and regulation requirements, the Medicaid program, and health care education programs. The Act also seeks to appropriate hundreds of millions of dollars to various state agencies to accomplish these goals.

The Live Healthy Act is not the only proposed legislation affecting the health care industry. In this article, we provide an overview of the Live Healthy Act and other key legislation that stakeholders need to know.

The Live Healthy Act

The Live Healthy Act seeks to address the health care workforce shortage by:

• Amending the Slots for Doctors Program under the Statewide Medicaid Residency Program SMRP to allow AHCA to fund up to 200 residency slots that were in existence prior to July 1, 2023. The bill proposes to require hospitals that receive state funds under the SMRP to report certain data on an annual basis to AHCA. The Act would also appropriate approximately $70 million in recurring funds to AHCA for the Slots for Doctors program.

• Establishing the Training, Education, and Clinicals in Health (TEACH) Funding Program, which would require AHCA to develop an application process for qualified facilities to apply for funds to offset administrative costs and loss of revenue associated with establishing, maintaining, or expanding a clinical training program. Approved facilities would be required to, among other things, agree to provide appropriate supervision for certain types of students, including nursing students, PA students, and behavioral health students, provide preference for residents and students enrolled in Florida schools or whose legal residence is Florida, and submit quarterly reports. The Act would also appropriate $40 million in recurring funds to AHCA for this program.

• Expanding the list of practitioners eligible for the Florida Reimbursement for Assistance for Medical Education (FRAME) program to include mental health professionals, such as licensed clinical social workers, licensed marriage and family counselors and family therapists, licensed mental health counselors, and licensed psychologists. The bill also lengthens the amount of time over which awards may be given to four years and increases the maximum award amounts for physicians, ARNPs, PAs, mental health professionals, RNs, and LPNs. The Act would also appropriate $50 million in recurring funds to DOH for this program.

• Expanding the existing Dental Student Loan Repayment (DSLR) program to include dental hygienists and private dental practices located in dental health professional shortage areas. The Act would also appropriate $13.2 million in recurring funds to DOH for this program.

• Revising the existing statutory definition of “clinical psychologist” to remove the three years of experience required and authorizes a licensed clinical psychologist of any experience to perform certain actions, including an involuntary examination under the Baker Act and determining if a patient’s treatment plan is clinically appropriate. However, the Act would retain a three-year clinical experience requirement for clinical psychologists to perform other actions, including authorizing the transfer of a voluntary patient to an involuntary status, authorizing the discharge of a patient, and providing a statement to the court justifying a request to continue involuntary outpatient services beyond the time ordered.

• Revising the existing statutory definition of “psychiatric nurse” to reduce the experience requirement from two years to one year and authorizing a psychiatric nurse with one year of experience to perform certain actions, including determining if a patient’s treatment plan is clinically appropriate.

• Enacting the Interstate Medical Licensure Compact, Audiology and Speech-Language Pathology Interstate Compact, and Physical Therapy Contract to allow licensed professionals in these areas to become licensed in multiple states and increase access to these services.

• Creating an additional path to Florida licensure for foreign-trained allopathic physicians who have graduated from a foreign medical school that provides an educational program reasonably comparable to that of similarly accredited U.S. institutions. The physicians are exempt from the one-year residency requirement if they (1) have an active license to practice medicine in a foreign country, (2) have actively practiced medicine for the four preceding years, (3) have completed a residency or substantially similar postgraduate training in a country recognized by the licensing jurisdiction, and (4) have an offer for full-time employment in Florida.

• Allowing the Board of Medicine and Board of Osteopathic Medicine to issue temporary certificates to practice in areas of critical need to allopathic and osteopathic physician assistants and Board of Nursing to issue temporary certificates to APRNs who hold a valid license in another U.S. jurisdiction and meets educational requirements.

• Authorizing the Board of Medicine and Board of Osteopathic Medicine to create limited licenses for Graduate Assistant Physicians. A two-year limited license, which allows for practice under supervision of a board-approved Florida physician, will be issued to an applicant who (1) graduated from an accredited medical school, (2) has successfully passed all parts of the allopathic or osteopathic medical examination, (3) has not received a residency match, (4) is at least 21 years old, (5) is of good moral character, (6) agrees to enter a written protocol which is submitted to the Board, (7) has not committed a disqualifying criminal offense, and (8) submits finger prints to DOH.

• Appropriating approximately $200 million in recurring funds in the Home and Community Based Services Waiver category to the Agency for Persons with Disabilities to provide a uniform iBudget Waiver provider rate increase.

• Appropriating approximately $100 million in recurring funds to AHCA to provide to statutory teaching hospitals meeting certain criteria.

• Appropriating approximately $152 million in recurring funds to AHCA to establish a Pediatric Normal Newborn, Pediatric Obstetrics, and Adult Obstetrics Diagnosis Related Grouping (DRG) reimbursement methodology and increase the existing marginal cost percentages for transplant pediatrics, pediatrics, and neonates.

• Additional appropriations to AHCA under the Act include:

• Approximately $17 million in recurring funds to provide a Medicaid reimbursement rate increase for private duty nursing services.

• Approximately $33 million in recurring funds to provide a Medicaid reimbursement rate increase for occupational therapy, physical therapy, and speech therapy providers.

• Approximately $21 million in recurring funds to provide a Medicaid reimbursement rate increase for CPT codes 97153 and 97155 related to behavioral analysis services.

The Live Healthy Act seeks to increase access to health care by:

• Requiring DOH to implement a Health Care Screening and Services Grant Program to fund the provision of no-cost health care screenings and services for the general public by nonprofit entities. The Act would also appropriate $10 million in recurring funds to DOH for this program.

• Advanced birth centers – The Act would create a new designation for licensed birth centers as advanced birth centers (“ABCs”) if they meet certain criteria. Designated ABCs are required to have an onsite clinical laboratory, may perform additional surgical procedures such as planned low-risk cesarean deliveries, administer analgesia and anesthesia for such procedures as long as administered by personnel who have statutory authority to do so, and may use chemical agents to inhibit, stimulate, or augment labor if prescribed by personnel who have the authority to do so. The Act would also require AHCA to establish standards for designation as an ABC that must be at least equivalent to the minimum standards for ambulatory surgical centers. They also must enter into a written transfer agreement with a hospital or an obstetrician who has hospital privileges. The Act would also appropriate $300,000 in nonrecurring funds to AHCA to contract with a vendor to develop a reimbursement methodology for covered services at advanced birth centers.

• Requiring autonomous APRN certified nurse midwives, as a condition precedent to providing out-of-hospital intrapartum care, to have a written transfer policy for patients needing a higher acuity of care or emergency services, including an emergency plan-of-care form signed by the patient before admission which contains certain information.

• Requiring all hospitals with EDs, including hospital-based off-campus EDs, to submit a diversion plan to AHCA for assisting patients who present at the ED with non-emergent health care needs with gaining access to appropriate care settings. The diversion plan must include a partnership agreement with an FQHC or other primary care setting or the establishment of a hospital-owned urgent care center near the hospital ED. The Act also proposes to require that each hospital maintain a certified electronic health record to make available certain data to the Florida Health Information Exchange program to support public health data registries and patient care coordination.

• Increasing the maximum income a patient can have in order to be considered low-income from 200 percent to 300 percent of the federal poverty line.

• Creating a structure for general Mobile Response Teams with a focus on emergency room diversion and the reduction of involuntary commitment that requires triage and rapid crisis intervention within 60 minutes, provisions of and referral to evidence-based services for the individual and family, and screening, assessment, early identification, and care coordination. The Act would also appropriate $11 million in recurring funds to the Department of Children and Families to enhance crisis diversion through mobile response teams by adding an additional 16 teams.

• Requiring that AHCA prepare a report on the “Analysis of Potentially Preventable Health Care Events of Florida Medicaid Enrollees” annually, to include analyses of the potentially preventable hospital ED visits, admissions, and readmissions.

• Requiring Medicaid Managed Medical Assistance (MMA) plans to assist new enrollees with initial primary care appointments and to coordinate with a hospital on primary care issues when the plan’s member presents at the hospital’s ED for nonemergent care.

• Creating a non-statutory section of the Laws of Florida to require AHCA to seek the necessary federal approval to implement a Florida Medicaid Acute Hospital Care at Home program.

• Appropriating $2.4 million in recurring funds to AHCA to provide behavioral health family navigators in state-licensed specialty hospitals providing acute care services to children to help facilities early access to mental health treatment.

Lastly, the Live Healthy Act seeks to incentivize innovation in health care by:

• Creating the Health Care Innovation Council, a 15-member council within DOH to facilitate public meetings across the state to lead discussions with innovators, developers, and implementers of technologies, workforce pathways, services delivery models, or other solutions. Based on those discussions, the Council is to create best practice recommendations and focus areas for the advancement of health care delivery.

• Creating a revolving loan program within DOH to provide low-interest loans to applicants to implement one or more innovative technologies, workforce pathways, or service delivery models.

Other Health Care-Related Legislation

In addition to the Live Healthy Act, legislators have proposed a number of health care-related bills:

• Invalid Restrictive Covenants

• House Bill 11 would amend existing law to provide that “[a] restrictive covenant which prohibits a physician from practicing medicine within a geographic area for any period of time after the termination of a contract, partnership, employment, or professional relationship is not supported by a legitimate business interest and is void and unenforceable.”

• Senate Bill 458 contains similar language.

• Payment Disputes Between Health Care Providers and Plans

• House Bill 659 would amend existing law to provide that a health plan may not decline to participate in the Statewide provider and health plan claims dispute resolution program.

• Senate Bill 584 contains similar language.

• Medicaid Managed Care Plan Performance Metrics

• Senate Bill 794 and House Bill 783 would create a new statute titled, “Managed Care Performance Metrics,” which would require managed care plans to submit metrics on a monthly basis regarding credentialing of new providers, prior authorizations, and prompt payments. The new statute would further require AHCA to develop and display on its public website a “dashboard” containing the information reported by the plans, as well as certain information regarding managed care plan complaints.

• Autonomous Practice for Certified Psychiatric Nurses

• Senate Bill 936 and House Bill 771 would authorize certain advanced practice registered nurses who are psychiatric nurses to engage in autonomous mental health practice.

• Naturopathic Medicine

• Senate Bill 898 and House Bill 843 would create the Board of Naturopathic Medicine within the Department of Health, authorize creation of a regulatory scheme to license and regulate naturopathic physicians, and provide that patients are responsible for advising treating health care practitioners about any naturopathic treatment they are receiving.

• Continue Expansion of Telehealth

• HB 855 and SB 302 expand telehealth for dental services.

• HB 849 and SB 261 allows telehealth for veterinarian.

Parker Hudson’s Tallahassee office is closely following this legislation. Check back here for a summary of the legislation when it is enacted in final form. For any questions, contact: Seann Frazier, Kristen Bond Dobson, and Ian Waldick.