The 2019 Florida Legislative Session focused on healthcare and made significant changes to the delivery system of healthcare. The Legislature opened regulatory structures in an effort to expand competition, with the ultimate goal of lowering costs to the consumer.
The issue that got the most attention – the Certificate of Need program for the general and specialty hospitals – has been a well-worn battle for the last decade. Certificate of Need, or CON, is the regulatory process that requires certain health facilities to obtain state approval prior to offering new or expanded services. CON applies to hospitals, nursing homes, hospice, and intermediate care facilities for individuals with intellectual disabilities. State approval is required prior to construction of a new facility or adding additional beds. However, this year the Legislature eliminated the Certificate of Need process for hospitals. The new law removes this approval process for the expansion and new construction of hospitals, but CON still applies to the other healthcare facilities.
Another hot button issue is the cost of drugs. Soon, certain state-funded healthcare programs may import safe and effective prescription drugs from eligible Canadian suppliers, if at a lower cost to the state. This program would not open Canadian drugs to the commercial insurance market, but to state programs such as Medicaid or correctional institutional healthcare. This program will require federal approval, however Florida will be the first state to attempt to implement the program.
While telehealth has been available in the state for a few years, the prevalence of telehealth services is expected to increase quickly, due to the new telehealth legislation adopted by the Legislature in 2019. The new legislation not only authorizes Florida licensed healthcare professionals to use telehealth within their respective scopes of practice, it also allows state registered, licensed, out-of-state providers to offer telehealth to Florida residents. This could be especially beneficial for rural areas where it may be more difficult to find specialists.
Payment for telehealth has been a sticking point in opening up this market. In the past, there has been a proposed requirement to structure reimbursement in the same manner as in-person appointments. Instead, the bill:
- Requires a contract between a HMO and telehealth provider to be voluntary. The contracts would have to establish mutually acceptable payment rates or payment methodologies for services provided through telehealth.
- Only telehealth providers can “initiate” contracts that reimburse telehealth differently than for face-to-face healthcare delivery.
Regulatory bills, often called trains because they contain so many smaller issues within them, can be difficult to pass. However, this year a healthcare deregulation bill made it across the finish line. The healthcare deregulation bill seeks to restrain healthcare costs by increasing competition among providers. To that goal, the bill provides for the following policy changes:
- Expands stays at ambulatory surgical centers to 24 hours; which will expand the scope of surgery options at a center rather than a hospital.
- Creates the dental student loan repayment program and the donated dental services program.
- Nullifies certain restrictive terms in physician-employment contracts.
- Expands direct primary care agreements from primary care physicians to other healthcare providers.
The Legislature has also revised other areas of Florida Healthcare law with the goal of empowering patients. Such revisions include:
- Prohibition of step therapy protocols in certain conditions.
- Requiring hospital quality information to be available to patients upon admittance. Information must include rate of hospital-acquired infections, overall rating and readmission rates.
- Requiring hospitals to provide patients written notice of their observation status (rather than inpatient) immediately when a patient is placed in observation status.
- Requiring hospitals to notify and consult (if patient requests) a patient’s primary care provider (PCP) within 24 hours of the patient’s admission and discharge from the hospital.
- Establishing pediatric cardiac standards of care.
Regardless of whether these efforts achieve the Legislature’s desired effect of lowering costs and empowering patients, the landscape of healthcare in Florida has dramatically changed. Florida healthcare providers should review their operating policies and procedures to ensure they remain compliant with the new regulations.