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House health panel passes six ‘disruption’ bills

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A healthcare panel on Wednesday took up and passed six bills that, combined, House leaders claim will lower the costs of health care and, in turn, increase access to doctors and services.

The Health and Human Services Committee spent two hours hearing the bills, which range from establishing a new healthcare provider called recovery care centers, to eliminating certificates of need for hospitals, to allowing nurses and physician assistants to prescribe controlled substances. They all passed by comfortable margins.

One of the more controversial measures, the CON repeal for hospitals, HB 31A, was amended by the committee on Wednesday to address quality of care concerns stemming from a CNN report that St Mary’s Hospital in West Palm Beach has a higher than customary mortality rate for pediatric open heart surgery.

The facility has subsequently stopped performing elective open heart procedures.

Democrat and committee member state Rep. Lori Berman raised a point of order on the amendment, saying it broadened the bill, was outside the scope of the legislative call because it dealt with hospital licensure, and that it was an unconstitutional delegation of legislative authority to an agency. While her point of order was quashed, Berman said that she would appeal the ruling issued by vice chairman MaryLynn Magar, who chaired the committee because committee chairman state Rep. Jason Brodeur is the bill sponsor.

HB 31 A eliminates CON for hospitals but keeps it intact for long-term-care hospitals and hospices, a high growth area of health care in Florida according to Agency for Health Care Administration data. The agency received 106 applications for new nursing homes and hospices in 2014. By contrast, the agency received 13 applications in 2014 for new hospital facilities.

Fourteen states have no CON regulation at all, including Texas and California. Eight states have no CON regulation for hospitals.

A House healthcare subcommittee heard the bill on Tuesday.

Brodeur said using CON to keep healthcare costs down is an idea whose time has come and gone, similar to “bloodletting.”

Another controversial bill, HB 21A, is a rewrite of the state group health insurance plan, which is expected to cost $2.2 billion in FY 2015-2016 in health benefits. Also offered by Brodeur, the bill would redesign the state group insurance plan and begin offering employees access to a variety of plans, including discount medical plans and direct primary care plans beginning 2016.

The proposed changes to the plan are phased in. The first phase, effective 2016, directs the Department of Management Services to establish employee contribution rates in 2016 that reflect the actuarial benefit difference between HMOs and PPOs. Also effective 2016 the bill requires the state to offer employees access to a variety of health options, from prepaid health plans to direct primary care to discount medical plans.

State Rep. Mia Jones asked that the House “slow this train down” so members can better understand the impact of the proposed changes. “Just be mindful on any given day each and every one of these people are human beings and they have families,” Jones said, adding that state employees may not have the benefit of a “trust fund” to help offset any of the increased costs they may be forced to absorb under the rewrite.

Brodeur said that the unions who represent state employees who oppose the bill are being disingenuous. He also said he has presented the bill for three years and that it has been heard in a variety of committees and that the measure doesn’t need to be “slowed down.”

The bills that cleared the committee on Wednesday include
HB 23A — Recovery Care Services
HB 25A — Direct Primary Care
HB 27A — Drug Prescription by Advanced Registered Nurse Practitioners & Physician Assistants
HB 29A — Responsibilities of Health Care Facilities

House budget chief state Rep. Richard Corcoran has said the problem in health care are the high costs of services and that Floridians don’t know what care costs. The goal is to disrupt the “status quo,” which should lower costs.

When asked about the bills Senate President Andy Gardiner said on Wednesday that the Senate has focused its efforts on providing healthcare access to the uninsured. “I’m not sure how it gets to the uninsured piece,” Gardner said of the six House bills “but we’ll give them their due.”

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