TALLAHASSEE — A contentious debate over Medicaid expansion has overshadowed much of the 2015 legislative session, but it isn't the only health care issue under consideration.
A proposal that would allow doctors to make better use of digital communications technology is gaining steam late in the session, as are bills seeking to expand the prescribing powers of nurses and encourage medical tourism.
Lawmakers are also advancing a plan that would broaden the list of vaccines that pharmacists and pharmacy interns can administer (HB 279/SB 792).
"We're working on all kinds of things," said Senate Health Policy Chairman Aaron Bean, R-Fernandina Beach. "There are a lot of ways we can improve access and quality of care."
One of Bean's top priorities is to establish a legal framework for telehealth, the practice of using digital medical devices and Web-based communications technology to treat patients remotely.
The House and Senate considered the concept last year, but quibbled over who should be allowed to practice remotely. The Senate wanted the practice to be limited to licensed physicians; the House said it ought to be available to a wide range of health care professionals.
There was also a disagreement over language that would have required insurance companies to reimburse telehealth services at the same rate as in-person services.
"Last year we learned a lesson," Bean said. "We tried to do everything for everybody."
This year's telehealth proposals (HB 545/SB 478) are far more simple. Both the House and Senate are aiming to create telehealth standards to cover all health care practitioners.
Neither bill takes up the insurance issue.
Bean said the measure would improve access to health care — especially for patients who live far from big cities.
Supporters include Dr. M. Narendra Kini, the CEO of Miami Children's Health System, who recently told a Senate panel that his hospital system uses telehealth to help care for children in Ukraine.
"We're confident that technology has matured and we can provide effective high-quality care that is also cheaper," he said.
Morgan McCord, of the research group Florida TaxWatch, said the bill would provide an economic boost to the entire state.
"Our most recent research report shows that if we can reduce costly medical interventions by at least 1 percent through telemedicine, the state can save more than $1 billion," she said.
Another closely watched bill (HB 281) would authorize physician's assistants and advanced registered nurse practitioners to prescribe controlled substances, so long as they are under the supervision of a physician.
The sponsor, Rep. Cary Pigman, R-Avon Park, said the measure would save time and money — and allow Florida to catch up with the rest of the nation.
Florida is the only state that does not allow advanced registered nurse practitioners to prescribe controlled substances, and one of two states that does not let physician's assistants do so.
Although the bill has been advancing steadily, it has met opposition from the Florida Medical Association, which thinks highly trained physicians alone should have the power to prescribe.
Some lawmakers have also raised concerns about letting additional health care practitioners prescribe potent drugs like morphine and oxycodone.
"Treating chronic non-malignant pain is a skill," said Republican Rep. Ronald Renuart, a Ponte Vedra Beach physician. "What we'd be doing is putting 20,000 more practitioners out there in the state of Florida that would have licenses to prescribe, and it is going to put a lot more drugs out there."
A similar bill in the Senate (SB 532) would apply only to advanced registered nurse practitioners working in hospitals. It is scheduled to come before the Senate Appropriations Committee on Tuesday.
Another high-profile Senate proposal seeks to create a commission to review any insurance practices that limit services (SB 784). Some plans, for example, require beneficiaries to try a certain drug before they will cover a different drug for that condition.
The bill's chances are dimming. Business groups have fought it, saying the costs would go up for employers, and the House companion (HB 863) has stalled.
But Nikki Yager, a 27-year-old New Port Richey resident who had to try a series of medications to treat her plaque psoriasis before she could get authorization for a drug called Enbrel, hopes lawmakers will consider it.
"It is silly that the doctors have to jump through so many hoops," she said. "If a prescription has been proven to work for psoriasis, a doctor should be able to prescribe it without having shown all of these other things don't work."
Bean said he was hopeful some of the bills would cross the finish line, even despite growing uncertainty over the health care budget.
But he recalled how the House and Senate combined many of their health care priorities into single bills last year — only to see the proposals die on the final day of session.
"Although I'm optimistic, I'm still very cautious," Bean said. "It's never done until the governor's signature is on it."
Contact Kathleen McGrory at firstname.lastname@example.org. Follow @kmcgrory.