Session convenes January 14
As the 2020 Florida Legislature gets ready to convene, the Physicians Society of Central Florida (PSCF) is supporting a patient-focused healthcare agenda.
“There are a lot of issues related to access to treatment and care for patients that we serve, and we’ve launched some good patient protection initiatives,” said Fraser Cobbe, executive director of PSCF.
Cobbe says that since it is an election year, historically it’s not unusual for some big-ticket items to fail, so physician support is important.
Priorities for this session
(See full agenda in box below article)
Elements of the highest priority pieces of legislation for this session have been before the legislature previously and did not pass.
“Among the priorities for us are Senate Bill 820 and House Bill 373, which makes sure that patients have access to certain cancer treating drugs, especially related to stage 4 metastatic cancer medications that patients are reporting difficulty acquiring in a timely manner. As well, we are looking at retroactive denials. This legislation would prohibit health insurers, once they've given physicians the treatment authorization to perform a procedure, to later come back and deny that claim based on the patient not being eligible for those services. That's something that we've tried to get passed the last three or four years and we're going to try and do it again,” said Cobbe.
There's also a new component of that bill that looks at surgical procedures, in particular, that is modeled after successful language that has moved legislation in Washington.
“We are seeing in our surgical specialties, situations where surgeons determine a necessary procedure based on diagnostic imaging or whatever, they’ll get that procedure authorized from the carrier and then when the physicians begin the procedure, they determine that the procedure they planned on performing should change slightly in the patient's best interest. And then, of course, that gets reported with a different CPT code. We've been seeing the insurers deny these claims for years because the procedure that was ultimately performed is not the one that was originally authorized,” he said.
It starts an administrative nightmare trying to go back and get the ultimate procedure reimbursed.
“So, we do what we're supposed to do and just perform the proper procedure, and then just try and chase the paperwork later on. We think there's a common-sense solution that if a surgical procedure is in a family of other common surgeries and you've got treatment authorization for one, and you're treating that underlying condition, the carrier should not be able to deny payment, if what is ultimately performed changes slightly,” Cobbe said.
The second legislation on the list is Senate Bill 696 and House Bill 561. This one is also pro-patient to make sure that when patients sign up for an insurance, they can stay on the medications they need to be on and not switched off. That gives some protection for patients, and it’s something that's going to impact the insurance industry.
“Potentially they'll probably say that protection is going to increase premiums on patients. Whenever we get into that scenario where the carriers are saying premiums are going to go up if we implement this patient protection, that's typically where we have difficulty getting those bills passed. We think it costs more money downstream by switching a patient off a drug that's working and put them on something that is not working and causes their condition to deteriorate,” according to Cobbe.
In this legislation, there’s also a component addressing situations where patients really struggle to afford their medications. There are cost sharing opportunities from foundations and other entities where patients receive either coupon codes or discounts from manufacturers to help pay for out-of-pocket costs to make sure they can purchase those medications.
“Many of the carriers are not applying those third-party assistance programs to the patient's out of pocket match they must reach before insurance kicks in. We don't think that’s right. If a patient is able to find a foundation or other source of assistance to ensure they can meet their copay, the carrier should be obligated to accept that money as contribution to their copay rather than making the patient actually come up with the funding on their own,” he stressed.
Cobbe says the patient shouldn't be penalized and be potentially limited in their access to a medication just because the money's coming from a third-party source rather than direct from the patient.
As for society opposition, there is legislation – HB 607 and HB 389 – for expansion in scope of practice. The Speaker of the House has supported this concept and first hearings have already occurred. (See box for further information.)
Physician members are encouraged to join in lobbying legislators during two Physician Day visits to Tallahassee, February 10 and 11.
Meanwhile the PSCF will be offering, once again, its weekly webinars for physician members to be updated on current healthcare related legislation by registering at https://pscfl.org The group will also be sending newsletters and pushing alerts via emails.
Physicians Society of Central Florida 2020 Legislative Agenda
Health Insurance Prior Authorization (SB 820 Harrell & HB 373 Massullo)
Prohibiting health maintenance organizations from excluding coverage for certain cancer treatment drugs; prohibiting health insurers and health maintenance organizations from requiring, before providing prescription drug coverage for the treatment of stage 4 metastatic cancer and associated conditions, that treatment has failed with a different drug; requiring health insurers to provide and disclose procedures for insureds to request exceptions to step-therapy protocols; prohibiting health insurers, under certain circumstances, from retroactively denying a claim at any time because of insured ineligibility, etc.
Importance to PSCF?
Insurance Carrier use of prior authorization processes and step therapy protocols has restricted access to certain medications and has created a major burden for physicians and patients securing medical necessary services. In addition to denied or delayed treatment, a report from the Annals of Internal Medicine revealed that for every hour a physician spent seeing patients, another two hours were spent on paperwork and dealing with treatment protocols. This legislation will restore common sense to coverage decisions and step therapy protocols. It will also end the process of retroactive denials where physicians are financially harmed by acting on behalf of and with prior approval from insurance carriers. It will also enact a surgical exemption to make sure patients are not subjected to a second or unnecessary surgical procedure if a surgeon has to change the authorized procedure during the course of surgery.
Prescription Drug Coverage – (SB 696 Mayfield & HB 561 Altman)
Requires individual & group health insurers & HMOs to provide notice of prescription drug formulary changes; specifies requirements for notice of medical necessity submitted by treating physicians; specifies coverage requirement & restrictions on coverage modification by insurers & HMOs receiving such notice; requires insurers & HMOs to maintain record of formulary changes; requires small employer carriers to comply with requirements for prescription drug formulary changes; requires insurers & HMOs to apply reductions in out-of-pocket expenses for prescription drugs toward cost-sharing obligations.
Importance to PSCF?
Cost and availability of drugs is becoming more of a critical consideration for patients, especially those in vulnerable patient populations. This legislation requires carriers to provide adequate notice of formulary changes and provides treating physicians an opportunity to bypass the formulary change if it presents a danger to the patient. The bill also requires carriers to accept third party contributions as means for patients to meet their co-insurance and co-pays.
Peer-to-Peer Support for First Responders – (SB 160 Perry & HB 573 Casello and McClain)
Prohibits certain persons who provide peer-to-peer support to first responders from testifying or divulging specified information; prohibits liability & cause of action.
Importance to PSCF?
Given the nature of their duties, there is ample evidence that the burden of mental health disease and burnout in First Responders is extremely high. Often First Responders seek counsel and support from their peers who understand the unique pressures and realities of the profession. Early peer support is an important mechanism for First Responders to deal with burnout and mental health conditions. The PSCF supports this legislation that will make sure First Responders can seek counseling and support from their peers with the knowledge that those conversations are protected from discovery.
Keep our Graduates Working – (SB 356 Hutson & Diaz & HB 115 Duran)
Prohibits state authority from denying or suspending or revoking person's professional license, certificate, registration, or permit solely on basis of delinquency or default in payment of student loan.
Importance to PSCF?
The burden of medical school loans for medical students has become a crisis. The average medical school debt in 2016 was $190,000 and 25% of medical school graduates are carrying debts over $200,000. While solutions to this crisis are explored, we need to make sure you’re young physicians do not face the threat of losing their ability to practice the profession if they are unable to meet a debt obligation. The State has a vested interest in not throwing away the investment in state resources we have made on a medical student that may have a temporary inability to satisfy their loan payment.
Prescription Drug Donation Repository Program – (SB 58 Harrell & HB 177 Duran)
Creates Prescription Drug Donation Repository Program within DOH; provides criteria & conditions for donation of prescription drugs & supplies from certain authorized entities for dispensing to eligible patients; authorizes Governor to waive program patient eligibility requirements during declared state of emergency.
Importance to PSCF?
The ongoing impact of rising drug costs and an inability for many patients to afford their medications has been well documented. According to the Kaiser Family Foundation, “The groups most likely to report difficulties affording their medications include people with monthly drug costs of $100 or more (58 percent), in fair or poor health (49 percent), with annual incomes less than $40,000 (35 percent), or taking at least four drugs monthly (35 percent). Three in ten 50-64-year-olds report problems affording drugs.” We strongly support the creation of safe mechanism for patients to return unused medications that can be repurposed and made available to patients that are unable to afford the medications they need.
Prohibited Acts by Health Care Practitioners – (SB 500 Harrell & HB 309 Massullo)
Authorizes disciplinary action to be enforced by DoH for use of specified names or titles without valid license or certification to practice as such; provides penalties.
Importance to PSCF?
Transparency and accuracy in qualifications is critically important for patients that are in need of medical care. Patients deserve to have a clear understanding of the level of training and expertise of the medical professionals in which they entrust their safety and well-being.
Scope of Practice Expansions - (HB 607 Pigman & HB 389 Sirois)
The PSCF is committed to a high-quality standard of care for all Floridians regardless of their economic status or health insurance coverage. We must protect the safety of Florida patients and ensure they receive care from the most qualified people trained to deliver that care. We firmly believe that high-quality care can only be achieved by a well-trained team of professionals under the supervision of a physician. Non-physician practitioners are valuable members of the health care team but they are limited by their education and training. Physicians are the only members of the health care team who have the broad clinical experience and training to exercise independent judgment and provide overall direction of a patient’s care.
House Bill 607 would enact autonomous practice for Advanced Practice Registered Nurses.
House Bill 389 would enable pharmacists to test and treat Influenza and Streptococcus.