News & Press

Florida Leaders Continue Push for Health Care Deregulation

Tue, 28 Feb 2017 13:39:53 GMT

The Florida Orthopaedic Society and AAOS DC Office staff have participated in a number of important meetings over recent weeks offering our support and encouragement for efforts underway in Tallahassee to reduce some of the regulatory burdens in the health care industry. Separate legislation has been filed in both chambers that would expand utilization of Ambulatory Surgery Centers (SB 222) and would eliminate the Certificate of Need process (SB 676). Expanded use of ASCs remains a priority for the FOS having supported efforts to pass the bill through the Florida House of Representatives each of the past few years. We hope the continued focus of elected officials on reducing administrative burdens to increasing quality and lowering cost will provide greater opportunities to address some of our legislative priorities.

The FOS will be providing multiple avenues for you to stay engaged throughout the upcoming Legislative Session including weekly updates and occasional webinars.

Your voice and engagement truly makes a difference.

Representative Julio Gonzalez, MD Files MOC Legislation

Tue, 28 Feb 2017 13:39:14 GMT

Representative Julio Gonzalez, MD, an orthopaedic surgeon and member of the Florida House of Representatives, has filed legislation in Tallahassee that would prohibit insurance carriers and hospitals from requiring Maintenance of Certification to remain in insurance networks or maintain medical staff privileges. The legislation differentiates between original board certification and maintenance of certification. By doing so, insurance carriers and hospitals could still require initial board certification to participate. The legislation, HB 723, also would prohibit any state agency from requiring MOC for medical licensure purposes in Florida. The State currently does not require board certification or MOC for licensure, but this legislation would pre-empt any future efforts in that regard.

The FOS strongly supports this legislation and looks forward to working with Representative Gonzalez to pass the bill this legislative session.

Legislation Taking Effect July 1, 2016 - What Physicians Need to Know

Tue, 28 Jun 2016 14:35:30 GMT

Legislation Taking Effect July 1, 2016 - What Physicians Need to Know

There are a number of bills passed during the 2016 Florida Legislative Session that are due to take effect on July 1st, 2016. There are 4 bills in particular that will have some impact on our members that warrant some discussion so you are prepared. Those issues are listed below and summarized further in this email.

Transparency
Workers Compensation Fee Schedule
Out of Network Billing.
PA and ARNP Prescribing Controlled Substances

1. Transparency - (HB 1175 can be downloaded here)

The notice that the Board of Medicine distributed concerning physician obligations due to the Transparency Legislation that passed this legislative session, HB 1175, can bedownloaded here. The bill does take effect on July 1, 2016. A copy of the entire bill can be downloaded above. And a summary of the various impact of the legislation on different stakeholders in the system can bedownloaded here.

As you will see, the impact of the new law for physicians primarily focuses on the provision of written estimates and financial policies when providing non-emergency care in a facility. However, Florida already has a Patient Bill of Rights that also requires physicians to provide a written estimate of charges upon request as well as other rights that patients enjoy. That language already in the statutes concerning a written estimate is as follows:

381.026(4) (c)(5) A health care provider or a health care facility shall, upon request, furnish a person, before the provision of medical services, a reasonable estimate of charges for such services. The health care provider or the health care facility shall provide an uninsured person, before the provision of a planned nonemergency medical service, a reasonable estimate of charges for such service and information regarding the provider's or facility's discount or charity policies for which the uninsured person may be eligible. Such estimates by a primary care provider must be consistent with the schedule posted under subparagraph 3. Estimates shall, to the extent possible, be written in language comprehensible to an ordinary layperson. Such reasonable estimate does not preclude the health care provider or health care facility from exceeding the estimate or making additional charges based on changes in the patient's condition or treatment needs.

That entire existing statute the comprises the Florida Patient Bill of Rights can be
downloaded here.

Our recommendation would be that you have one process in place to manage the provision of written estimates and financial assistance policies that meet these requirements of the current law as well as the new law, regardless of site of service.

2. Workers Compensation Physician Fee Schedule -
(the new fee schedule can be downloaded here)

After eight years of waiting, a new Workers Compensation Fee Schedule for physicians will take effect on July 1, 2016. The new fee schedule can be downloaded from the link above. The new fee schedule did not alter the statutory formula for reimbursement in Workers Compensation. The formula remains 110% of Medicare for Non-Surgery and 140% of Medicare for Surgical Procedures. The new law does allow the Division of Workers Compensation to calculate that formula based on updated Medicare values. Since it is a Medicare based framework, each CPT code will be impacted differently based on how the values have changed over the eight years since the fee schedule was last updated. According to NCCI, The overall impact in medical service expenditures due to the updated fee schedule is a 10.6% increase.

Physicians will want to look at their specific utilization of services in Workers Compensation to determine the overall impact to your practice.

This is also a good time to remind you of the purpose of the column in the Workers Compensation fee schedule that is labeled "2003 MRA" which is the Maximum Reimbursement Amount in 2003. The reason that 2003 MRA Column is included in the fee schedule is because back in 2003 when the Legislature passed the last major Workers Compensation Reform, language was placed in the statutes that would prevent reimbursement for any code from going below what the reimbursement amount was back in 2003. Part of the intent of the legislation in 2003 was to increase access to care for injured workers as reimbursement had fallen to a level where many physicians discontinued participating in the system. Therefore, the statutes provide that reimbursement will be the formula based on Medicare (110% for non surgery and 140% for surgery) or the 2003 MRA, whichever is higher. Physicians will want to monitor some codes that have been decreased over the years to determine if this 2003 payment reduction threshold will be triggered so you can make sure you are receiving the higher amount.

3. Out of Network Billing - (HB 221 can be downloaded here)

HB 221, Out of Network Billing, also takes effect on July 1, 2016. This legislation includes the ban on balance billing for PPO patients in the emergency setting and for all patients in an In-Network Facility when the physician is out of network and the patient has no choice but to use an out of network physician. A summary of the legislation can bedownloaded here. HB 221 maintains a "charge based standard" for out of network care. The legislation defines Usual & Customary Charges as follows: "The usual and customary provider charges for similar services in the community where the services were provided."

The legislation builds upon the existing dispute resolution process that Out-of-Network physicians can use if they feel the insurance carrier has not paid them the Usual & Customary Charges in the community. There are a number of sources of charges that are available to physicians and the public. One such example is:http://fairhealthconsumer.org/. Physicians should avail themselves of these charge based comparison tools if they intent to challenge a Usual & Customary Charge payment through the dispute resolution process. Our organization will continue to work with our members to prevent insurance carriers from violating the intent of this charge based standard.

For in-patient non emergency care where patients have a choice of physicians to render care, our organization recommends that physicians inform patients of their network status where possible and try to get in writing that they are aware you are out of network prior to rendering a service and that the patient understands they may be balance billed depending on what their insurance company allows.

4. PA and ARNP Prescribing - (HB 423 can be downloaded here)

While HB 423 takes effect on July 1st, the Board of Medicine has stated (attached)that according to the law PAs and ARNPs cannot start writing prescriptions until January 1, 2017. Since there has been confusion on when these professionals can start writing, the Board has made it very clear with that statement on their website that January 1, 2017 is the date.

The statement from the Board of Medicine can be found here:

http://flboardofmedicine.gov/latest-news/change-in-legislation-relating-to-medical-assistant-certification-information/

The Board of Medicine document linked above and attached is the key document to review as you prepare your Physician Assistants for this new capability to prescribe. It discusses limitations of their authority as well as educational requirements, etc. If you have ARNPs you need to monitor announcements from the Board of Nursing as well as the statement from the Board of Medicine.

Please pay attention to the limitations imposed on these professionals in terms of prescribing controlled substances since they are doing so under the supervisory relationship established with their physician.

2016 Bills Impacting Healthcare Professionals

Mon, 20 Jun 2016 18:02:49 GMT

Summaries of the enrolled bills from the 2016 legislative session that affect Florida's health care professions: Click here to view

HOUSE BILL

SENATE BILL

Legislative Update for Physician Assistants

Tue, 31 May 2016 16:48:16 GMT

Important Legislative Update

Physician Assistants

Effective Date: July 1, 2016

Governor Scott signed HB 375 into law on Monday, March 28, 2016. The bill relates to Physician Assistants (PA) and includes these changes to the law:

At renewal, a PA must acknowledge that he/she has completed a minimum of ten (10) hours continuing medical education in the specialty practice in which the PA has prescriptive privileges. A signed affidavit is no longer required.
PA may perform services delegated by the supervising physician in the PA's practice according to his/her education and training unless expressly prohibited under Chapter 458, Florida Statutes or the rules adopted by the Board of Medicine or Chapter 459, Florida Statutes or the rules adopted by the Board of Osteopathic Medicine.
Prescriptions may be written in paper or electronic form but must comply with sections 456.0392(1) and 456.42(1), Florida Statutes.
Changes to requirements for licensure:
- No longer need two letters of recommendation;
- No longer required to submit a sworn, notarized statement regarding criminal history; and
- Deletes obsolete provisions related to administering a licensure examination for certain foreign-trained PA applicants.

These changes effect PA's that practice with allopathic physicians and osteopathic physicians.

To read the entire bill, clickhere.

Source: Florida Board of Medicine

Legislative Update: Relates to Transparency in Health Care

Tue, 31 May 2016 16:47:32 GMT

Relates to Transparency in Health Care

Effective Date: July 1, 2016

Governor Scott signed HB 1175 into law on Thursday, April 14, 2016. It relates to billing. This bill amends section 456.0575, Florida Statutes and requires health care practitioners to:

Provide a patient, before providing non-emergency medical services in a facility licensed under chapter 395, and upon his or her request, a written or electronic good faith estimate of anticipated charges;
Provide the estimate to the patient within seven business days after receiving the request;
Inform the patient that he or she may contact his or her health insurer or health maintenance organization for additional information concerning cost-sharing responsibilities;
Provide information to uninsured patients and insured patients for whom the practitioner is not a network provider or preferred provider that discloses the practitioners financial assistance policy, including the application process, payment plans, discounts, or other available assistants, and the practitioners charity care policy and collection procedures.
- Providing the estimate does not preclude the actual charges from exceeding the estimate.

The practitioner is not required to adjust the estimate for any potential insurance coverage.

Failure to provide a patient with the estimate, without demonstrating good cause, shall result in disciplinary action against the practitioner and a daily fine of $500 until the estimate is provided to the patient.

To read these bills, click here.

Source: Florida Board of Medicine

Legislative Update: Relates to the Prescription Drug Monitoring Program

Tue, 31 May 2016 16:46:39 GMT

Relates to the Prescription Drug Monitoring Program

Effective Date: July 1, 2016

Governor Scott signed SB 964 into law on Friday, April 1, 2016. It relates to the Prescription Drug Monitoring Program (PDMP). Section 893.055, Florida Statutes has been changed to allow a practitioner to assign a designee to have access to the PDMP on his or her behalf.

To read these bills, click here.

Source: Florida Board of Medicine

Legislative Update Regarding Billing Members of a PPO or EPO

Tue, 31 May 2016 16:45:24 GMT

Important Legislative Update

Important Legislative Update Regarding Billing Members of a PPO or EPO:

Not knowing the requirements or grounds for discipline within your profession does not alleviate you from accountability of practicing your profession responsibly. Therefore, please read the information below carefully as it pertains to your professional responsibilities.

Health Care Services

Effective Date: July 1, 2016

Governor Scott signed HB 221 into law on Thursday, April 14, 2016. It relates to billing and includes these changes to the law:

Prohibits health care providers from balance billing members of a PPO or EPO for emergency services, or for non-emergency services when the non-emergency services are provided in a network hospital and the patient had no ability or opportunity to choose a network provider.
Consumers who have PPO or EPO coverage would only be responsible for billing differences in circumstances where they knowingly opted to receive out-of-network care.
Hospitals are exempt from the balance billing prohibition.

Participating and non-participating providers are defined in section 627.419 and section 627.6471, Florida Statutes.

Protections for members of HMO's would remain unchanged.

The bill also adds new grounds for disciplinary action by the Board and the Department:

Section. 456.072(1)(oo) - Willfully failing to comply with s. 627.64194 or s. 641.513, Florida Statutes. Chapter 456, Florida Statutes are general laws related to all health care practitioners.

Section. 458.331(1)(tt) - Willfully failing to comply with s. 627.64194 or s. 641.513, Florida Statutes. Chapter 458 is the medical practice act.

The Board of Medicine will be creating penalty ranges for the grounds for disciplinary action listed above at their June 2, 2016 Rules/Legislative Committee Meeting. The meeting is being held at the Tampa Westshore Marriott, 1001 N. Westshore Boulevard, Tampa, Florida. See the Board of Medicine's website at www.FLBoardofMedicine.gov for more information regarding the meeting.

To read the entire bill, click here.

Source: Florida Board of Medicine