Healthcare deregulation measures passed by Florida Legislature

The votes, which advance parts of the healthcare agenda that has dominated House Speaker José Oliva’s priorities this session, also inch Gov. Ron DeSantis closer to a major win on the drug importation proposal he has pushed in the Florida Legislature.
Published April 29, 2019|Updated April 29, 2019

TALLAHASSEE -- State lawmakers approved sweeping healthcare changes Monday that will overturn long-standing regulations on building or expanding hospitals and allow the state to pursue importing foreign drugs, as well as make several other changes long sought by conservatives in the Legislature.

The votes signal success for several agenda items House Speaker José Oliva, R-Miami Lakes, has outlined in healthcare this session, and the bills are expected to become law as they head now to Gov. Ron DeSantis’ desk.

“This is going to go down as a historic day in the state of Florida,” said House healthcare chief Rep. Ray Rodrigues, R-Estero, Monday night, nodding to the roughly dozen House proposals that were rolled into four bills passed by both chambers.

He cast the growing healthcare budget as an existential threat to Florida’s economic stability — “If we don’t get control of the rising cost of healthcare it will take over the budget” — and added that the deregulatory changes would cement its reputation as a bellwether state for policy making.

“What happens in Florida gets noticed by the rest of the country,” he said.

Senators debated the bills briefly Monday morning before passing them largely on party lines, with supporters casting the proposals as efforts to modernize healthcare operations and remove burdensome regulations on facilities. The House took up the bills later Monday evening and passed them with the Senate’s changes intact.

Chief among those bills was HB 21, which would remove long-targeted regulations that require healthcare facilities to obtain approval from the state before adding buildings or services. This year, Oliva had made repealing the “certificate of need” system his top legislative item, and the House passed a broad measure completely removing the requirement for hospitals, nursing homes and hospices.

The Senate had initially pushed a much more restrictive repeal version limited only to general hospitals, and set a bevy of requirements on hospitals that could circumvent the approval process: having emergency rooms or minimum bed requirements, and providing charity care as well as care to Medicaid and Medicare patients. But in its last committee stop, those requirements were stripped from the bill as top leaders negotiated for their priorities.

The version passed by the Senate, then again by the House, would apply to general hospitals and tertiary services (like transplants and neonatal intensive-care units) starting in July. Specialty hospitals, such as pediatric hospitals, would also no longer be subject to the regulations starting in 2021.

Supporters say repealing the requirements will open up hospitals to more free market competition that will lower costs and improve care, though opponents have contended lower caseloads at hospitals will weaken providers’ training for complex cases and draw away paying patients that some hospitals need to offset their charity care and less lucrative Medicaid and Medicare reimbursements.

Lawmakers also voted to approve HB 19, a DeSantis-backed proposal to allow Florida to pursue importing prescription drugs from abroad. The proposal would direct the state to ask federal officials for permission as required under a 2003 federal law, and open up three pathways for bringing medication in from different countries.

One would authorize the state Agency for Health Care Administration to bring drugs in from Canada for state purposes, serving entities like the Department of Corrections or Medicaid patients. Another would create a broader international program under the Department of Business and Professional Regulation for commercial use, and a third would create a pilot program overseen by DBPR and the Department of Health that would not need federal approval.

DeSantis had lobbied for weeks for lawmakers to approve the bill, despite hundreds of thousands of dollars pharmaceutical interests had poured into ads criticizing the proposal as unsafe and dangerous. On the floor Monday, Senate sponsor Sen. Aaron Bean decried the claims and said the programs if implemented could save patients substantial amounts of money on prescription drug costs.

Though Vermont passed a similar plan last year, the federal government has not yet approved any state-level program to bring in drugs from abroad. Even if federal authorities authorize Florida to pursue foreign importation — something they have never done in 16 years — the Senate version of the bill still requires the first two programs to return to the Legislature for funding approval.

HB 23, another oft-proposed bill to set standards for “telehealth” services where healthcare providers could deliver care online or through other technology remotely, also passed both chambers easily. The bill creates regulations that would govern how telehealth can be conducted, and the version approved by lawmakers permits providers out of state to offer those services to Floridians if they register to the state, with some exceptions. The House had also advanced about $30 million in tax incentives to encourage insurers to adopt telehealth measures, but the Senate did not include those measures in its version.

Lawmakers voted unanimously in both chambers for HB 843, which tackled more than half a dozen healthcare proposals that had started in the House. Among them were adding requirements that patients be notified if they are put on observation status rather than admitted to a hospital outright, allowing patients to stay at outpatient surgical centers overnight rather than until midnight and expanding the definition of direct care agreements.

The bill was also amended to include language that would strengthen oversight of pediatric cardiac surgery programs, after reporting that included a Tampa Bay Times investigation that revealed deaths and other issues at the Johns Hopkins All Children’s Hospital Heart Institute in St. Petersburg.

Oliva, after the bills passed, touted the Legislature’s deregulatory moves as transformational. But he added that other bills are still awaiting hearings in either chamber and that he intends to continue to focus on healthcare legislation into next year’s session.

“There’s still a great deal of work to do on healthcare,” he told reporters. “It’s not a problem that was created overnight, and it won’t be resolved overnight.”

The passage of several of Oliva’s priorities also signal the convergence of leadership priorities that often accompanies the final days of lawmaking — and agreement on the sprawling state budget — before legislators head back to their districts. The session is scheduled to end Friday, May 3.