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Healthcare deregulation on fast track in Florida House

Florida House Speaker José Oliva has some big priorities he wants to pass.
House speaker Jose Oliva, R-Miami Lakes speaks at a pre-legislative news conference, Wednesday, Jan. 30, 2019 in Tallahassee, Fla. (AP Photo/Steve Cannon)
House speaker Jose Oliva, R-Miami Lakes speaks at a pre-legislative news conference, Wednesday, Jan. 30, 2019 in Tallahassee, Fla. (AP Photo/Steve Cannon)

When House Speaker José Oliva gaveled in the new legislative session this week, he promised he would fight rising healthcare costs by pushing to deregulate the market — and several of his promised bills are starting to get their first approvals in committee stops.

The Miami Lakes Republican highlighted several changes he wants to make to healthcare regulations, including expanding scopes of practice for nurse practitioners, increasing options for providers to deliver care electronically and broadening how much care can be provided by outpatient facilities. But chief among his wish-list items is a full repeal of the “certificate of need” process that determines whether or not hospitals and other healthcare facilities can build or add beds, which passed its first stop Thursday.

It’s typical for leadership priorities to be among the first to be heard in committees so they can reach the floor earliest during the 60-day legislative session and have the best chance of passing each chamber.

Rep. Heather Fitzenhagen, Fort Myers, who is sponsoring the bill, told lawmakers in the House’s Health Market Reform subcommittee that the program restricts needed competition and racks up costs for applications and litigation that often results.

Certificate of Need "needs to go the way of the dinosaur,” she said, referring to the process, which has been in place for more than 40 years. She called on lawmakers to “unshackle” facilities from needing to go through additional regulatory hurdles, which she and other Republican leaders say unfairly and needlessly throttle the market.

Applications for certificates of need can range from $10,000 to $50,000, according to a legislative staff analysis. AHCA officials have told legislative committees that when the application process is contested, cases can last in administrative courts for more than a year.

Fitzenhagen carried a similar bill last year that failed to pass both chambers, but Thursday’s bill cleared the committee unanimously with minimal debate.

Should the state abolish the certificate of need process, existing facilities could face more competition. Some of those facilities have argued the move will lower their caseloads and could lower the quality of low-volume but complex treatment by siphoning away cases needed to keep their providers trained.

The Florida Hospital Association is among those organizations opposing the bill. A lobbyist for the Florida Health Care Association, which represents nursing homes, also said Thursday the policy is needed to keep beds full and focus on keeping seniors in home- and community-based options for care.

Though some committee members raised concerns about the inclusion of nursing homes in the bill, it still passed unanimously. It has two more stops before it can be heard by the full House.

The committee Thursday also voted to approve seven other bills, including HB 999, which would require a facility to provide an estimate of medical bills and prohibit them from substantially exceeding it, with some exceptions, HB 843, which would require hospitals to inform a patient’s primary care physician within 24 hours of their admission or discharge and HB 997, which would expand short-term health plans.

Some of Oliva’s priorities, particularly his focus on removing the CON process, are expected to face opposition in the Senate. President Bill Galvano, R-Bradenton, has expressed some reservations about his counterpart’s sweeping deregulatory approach.

But Oliva’s priorities are getting an early boost on that front from Americans for Prosperity, which launched a six-figure ad campaign Thursday supporting CON repeal. The campaign is sending mail to constituents for senators expected to soon hear the companion bill as well as launching a statewide digital ad.

The Senate companion to Fitzenhagen’s bill, SB 1712, filed by Health Policy chair Gayle Harrell, R-Stuart, has not yet been assigned to committees.

Other committees this week have also waved through a number of bills supported by Oliva: including HB 23, which expands providers’ ability to deliver some healthcare services through the Internet or other technology through telehealth, also called “telemedicine.”

Some Democrats raised concerns about tax incentives in the bill, which could total $30 million. The bill allows insurers and health maintenance organizations to claim a tax credit if they reimburse providers for telehealth services.

But Rep. Carlos Guillermo Smith, D-Orlando, who eventually voted against the legislation, asked why the state could not mandate insurers and HMOs comply with providing telehealth services instead, pointing to some of the costs that are expected to add to an already strained budget this year.

The cost of the tax incentives, he said, “is a fairly large budget hole.”

Its sponsor, Rep. Clay Yarborough, R-Jacksonville, responded he would prefer to encourage insurers to participate rather than force their hand. The bill passed the committee nonetheless, with only two lawmakers opposing it.