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Proposals: Scrap Hospital Regulatory Process, Give Some Nurses More Power to Prescribe Drugs

| May 27, 2015

nurse practitioners prescription drugs authority

The special session starting next week in Tallahassee will revive an ongoing attempt to broaden prescription-writing authority to nurse practitioners and physicians’ assistants, a move the the powerful Florida Medical Association and other physician groups have long fought. (Waldo Jaquith)

The House and Senate have long been divided about a proposal to expand health coverage for hundreds of thousands of low-income Floridians.

But when lawmakers return to the Capitol next week for a special session, they also will wade into a series of other controversial health-care issues, including a proposal to revamp insurance coverage for state workers and a push to overhaul some longstanding health-industry regulations.


House Republicans filed six bills Wednesday that delve into hot-button issues such as getting rid of a regulatory process for new or expanded hospitals and allowing advanced-registered nurse practitioners and physician assistants to prescribe controlled substances.

The proposals are not new, with House GOP leaders also pursuing many of the ideas during this spring’s regular legislative session. But they will come up during the pressure cooker of a special session, which was called to pass a state budget and also is expected to feature a fight over a Senate proposal to use federal Medicaid money to expand health coverage.

The bills will draw heavy lobbying, as they did during the regular session.

As an example, Rep. Cary Pigman, R-Avon Park, filed a bill (HB 27A) on Wednesday that would expand the drug-prescribing powers of advanced-registered nurse practitioners and physician assistants. Pigman, a physician, and other supporters argue the bill could help expand access to care, particularly in rural areas. But the powerful Florida Medical Association and other physician groups have long fought such proposals, saying in part that nurse practitioners and physician assistants don’t have the same level of training as doctors.

Meanwhile, the hospital industry likely will focus on a bill (HB 31A), filed by House Health & Human Services Chairman Jason Brodeur, R-Sanford, that would eliminate what is known as the “certificate of need” process for hospitals. That regulatory process requires hospitals to get state approval for new or expanded facilities and often serves as a legal battleground in disputes about projects in the industry.

Also, Rep. Heather Fitzenhagen, R-Fort Myers, filed a bill (HB 23A) that would allow ambulatory surgical centers to keep patients overnight and also would open the door for “recovery care centers” that could keep post-surgical patients for up to 72 hours. Hospital-industry officials objected to such proposals during the regular session, contending the changes would lead to profitable services being diverted from hospitals to the other types of facilities.

Aside from such regulatory issues, House leaders also want to use the special session to make changes in the health-insurance system for state employees — an issue House Republicans have long discussed.

Brodeur filed a bill (HB 21A) on Wednesday that would set the stage for employees in 2018 to choose among insurance plans with four different benefit levels. Also, the bill would seek to offer financial incentives that could ultimately lead to employees shifting away from the richest plans.

House Appropriations Chairman Richard Corcoran, R-Land O’Lakes, made clear as early as March that he wanted to inject the state-employee insurance issue into budget talks with the Senate. Dubbing the concept “Brodeur-care,” Corcoran said such changes would give more choices to state workers than under the current insurance system.

It remains to be seen, however, if the Senate will go along with any of the House health-care bills during the special session that starts Monday. Senate President Andy Gardiner, R-Orlando, did not take a firm position when asked this week.

“They’ll be fully debated,” Gardiner said during a news conference Tuesday. “We’re going to send them to committee, and the Senate will have every opportunity to review them.”

Along with negotiating a budget, the major debate during the session will be on the Senate’s proposal to use Medicaid money to offer private health insurance to about 800,000 Floridians. House Republican leaders and Gov. Rick Scott have adamantly opposed the idea.

Gardiner, however, said the Senate is more focused on that issue than the other health-care proposals.

“We in the Senate have always been focused on the uninsured piece,” he said.

–Jim Saunders, News Service of Florida

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