Legislative Report
Week 9
May 2, 2021

Paul D. Seltzer, DO, Legislative Chair
Stephen R. Winn, ED
Michelle W. Larson, Assoc. ED
Jason D. Winn, Esq.
After a week of maneuvering to amend floundering bills onto other vehicles, the Florida Legislature adjourned SINE DIE on Friday, April 30, concluding all business for the 2021 Legislative Session. This session, a total of 3,140 bills and PCBs were filed, 275 of which passed both chambers. Although the pandemic cast a long shadow over the session, legislators overcame many obstacles, passing a number of bills supported by the FOMA and its advocacy partners. 

Despite the gloomy budget projections by some, the legislature passed a record budget for FY 2021-22 totaling $101.5 billion, an increase of 10.1 percent over the current year. As a result of enhanced revenue projections by the Office of Economic and Demographic Research (EDR), combined with federal stimulus totaling $10 billion, the state fully funded most health care programs, holding back significant cuts to Medicaid services and hospital and nursing home rate cuts.  The Senate’s original plan would have eliminated optional Medicaid services for vision, hearing and podiatry.  In conjunction with others, the FOMA successfully lobbied to get this program and funding restored.  
House and Senate Sergeant at Arms Participate in Annual Sine Die Ceremony
Post Session Press Conference
Graduate Medical Education
In addition to maintaining needed programs, the budget also provides robust funding for graduate medical education, totaling $287.6 million.  $197.3 million is set aside to fund the Statewide Medicaid Residency Program and the Graduate Medical Education Startup Bonus Program.  This represents an increase of $9.4 million above current year funding.  
Of these funds, a total of $57.7 million is allocated to support the Graduate Medical Education Startup Bonus Program for the following physician specialties and subspecialties that are in statewide supply/demand deficit: allergy or immunology; anesthesiology; cardiology; endocrinology; family medicine; general surgery; hematology; oncology; infectious diseases; nephrology; neurology; obstetrics/gynecology; ophthalmology; orthopedic surgery; otolaryngology; psychiatry; pulmonary; radiology; rheumatology; thoracic surgery; and urology.
Doctor of the Day
Thank you
FOMA President Marc Kaprow, DO, for serving as Doctor of the Day.
Thank you
Mark Alan Dobbertein, DO,
for serving as Doctor of the Day.
Other Health Care Budget Highlights

  • $4.3 billion ($1.2 billion General Revenue) to fund the Medicaid Price Level and Workload. The funds will serve an anticipated 4.8 million beneficiaries with no reductions to eligibility groups or services. This is the highest caseload in Florida’s history — over 20% of Florida’s population is enrolled in Medicaid; 
  • $239.8 million ($89.2 million General Revenue) to extend postpartum Medicaid-eligibility of pregnant women from 60 days following birth to 12 months following birth. This will help 97,600 mothers maintain their coverage and ensure a healthy start for their babies; 
  • $9 million for Minority Health Equity Planning to reduce minority morbidity and mortality in the priority areas of HIV/AIDS, chronic diseases, and infant mortality to combat health disparities; 
  • Physician Supplemental Payments - $89 million;
  • Healthy Start MomCare Network Increase - $22 million;
  • New Reimbursement Rate Level for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) - $18.3 million;
  • Medicaid Reimbursement for Florida Assertive Community Treatment (FACT) Team Services - $25 million TF (Authorization Subject to Federal Approval);
  • Prescribed Pediatric Extended Care Center (PPEC) Rate Increase - $5.4 million;
  • Certified Public Expenditure for Emergency Medical Services Care - $46.3 million;
  • Florida Cancer Hospitals - $154 million TF;
  • Florida Medicaid Management Information System (FMMIS) - $48.1 million;
  • Child care assistance for essential workers including health care sector employees, emergency responders, and sanitation workers - $950.4 million.
FOMA Executive Director
Steve Winn
Testifying in Committee
COVID-19 Liability Protections
Ensuring health care providers are protected from civil liability relating to the pandemic was of vital importance to the FOMA, successfully lobbied on behalf of SB 72. We thank the bill sponsors, Senator Brandes and Representative Burton for their support of our frontline health-care professionals and Florida businesses.
The bill creates strong affirmative defenses for health care providers who substantially complied with and relied upon health standards. Under the bill, a claimant must establish by the greater weight of the evidence that the healthcare provider was grossly negligent or engaged in intentional misconduct. The bill was signed into law by Governor DeSantis on Monday, March 29, 2021, becoming effective immediately.   
Senate President Simpson Remarks on SB 72
“Our hardworking and dedicated health care providers have been on the front lines of this pandemic from day one, putting their own health in jeopardy to help others. Meanwhile, businesses across Florida are doing the best they can to safely reopen and keep people employed during a period of extreme uncertainty.”

“The last thing we want is for businesses and health care providers, who do the right thing, to face a constant threat of frivolous lawsuits that hamper their ability to serve their patients and customers.”
Senate President Wilton Simpson &
 Steve Winn Discuss Legislation
Senate President Wilton Simpson & Governor DeSantis
The FOMA Supports Pelvic Examination
Written Consent Clarification Legislation
In response to the confusion surrounding pelvic examination written consent, the FOMA and others actively supported and advocated on behalf of legislation to clarify the policy.  

The FOMA is pleased to announce that SB 716 by Senator Book, passed out of both chambers and is on its way to the Governor for his consideration.  The bill narrows and simplifies the definition of “pelvic examination” and amends current law to require written consent for anesthetized or unconscious patients and require verbal consent from any conscious patient. SB 716 provides three new exceptions, thereby allowing an examination without consent, related to emergency medical conditions, a child protective investigation, and certain criminal offenses against a child.  Finally, the bill provides that a single written consent for a pelvic examination may authorize multiple health care practitioners or students to perform a pelvic examination on a pregnant woman having contractions.

In 2020, the Florida Legislature passed a law requiring that a health care practitioner must obtain specific written informed consent from a patient before performing a pelvic examination. Since the state adopted the policy, many in the medical community, including the Department of Health and professional regulatory boards, had more questions than answers regarding the real-world application of the law.  
Steve Winn, Senator Doug Broxson,
and Jason Winn, Esq.
Special thanks to FOMA Past President and FMA President Elect Joshua Lenchus, DO and Jason Winn, Esq., for working diligently with Senator Book to clarify the pelvic exam consent policy.
The FOMA Push Back on
Scope-of-Practice Legislation
While some COVID legislation was necessary, the FOMA successfully fended off most bills filed as Trojan Horses, designed to expand the scope-of-practice under the guise of responding to the needs of the pandemic. Several scope bills were filed, representing a clear departure from the high-level educational and training standards patients rely on for competent and safe care.  The FOMA believes the physician led interdisciplinary model is the only clinically proven system for delivering safe and efficacious care. 

The FOMA, in conjunction with our advocacy partners, were successful in defeating the following bills expanding scope-of-practice:

  • HB 111 Autonomous Practice by an Advanced Practice Registered Nurse by Maggard - would have allowed independent specialty practice.

  • SB 424 Autonomous Practice by Advanced Practice Registered Nurses by Brandes

  • SB 160 Prescriptive Authority Certification for Psychologists by Brandes

  • HB 687 Prescriptive Authority Certification for Psychologists by Alexander

Mitigates Impact of PA Autonomy Legislation
After a disappointing session in 2020, removed from the independent practice legislation for advanced nurses, physician assistants returned in the 2021 Legislative Session seeking autonomous practice.  Many legislators, viewing the profession as equal in education and training to advance practice nurses, were sympathetic to allowing physician assistants to practice independently.  

The FOMA and others, faced with an uphill battle, were successful in mitigating the legislation’s impact, expanding PA scope within established guardrails while removing the autonomous practice and unlimited supervision provisions of HB 431.
Richard Thacker, DO
Testifies on PA Legislation
Aimee Diaz Lyon, FAFP 
Richard Thacker, DO 
Jeff Scott, FMA
The FOMA thanks Dr. Richard Thacker, D.O. for testifying on behalf of the FOMA, FMA, FAFP, and the FSACOFP, leading the way toward a viable resolution.

"To allow one physician to supervise a thousand PAs is neither true supervision nor is it true collaboration, and in fact; it's a threat to patient safety. In this particular case there is not safety in numbers. While the autonomous practice provision has been taken out of this bill, the deletion of the four PA limit would essentially allow the functional equivalent of practicing autonomously.” 

“We understand the PAs desire to compete with APRNs and we have agreed to work with them – all of the entities I represent today."

HB 431 relating to physician assistants passed both chambers and is on its way to the Governor for his consideration. The FOMA successfully amended the legislation to include the American Osteopathic Association as an approved continuing medical education provider for the controlled substance course required of PAs for licensure renewal. The bill increased the number of PAs a physician may supervise from four to ten and further expands PA scope of practice.  

The FOMA, in conjunctions with our partners, were able to remove language relating to autonomous practice and place guardrails around the prescribing of schedule II psychiatric controlled substances to minors.
Senator Burgess
Bill Sponsor, SB 54
Representative Grall House Bill Sponsor
Legislature Passes SB 54 - Repealing PIP & Replacing it with Mandatory BI Coverage.
After five years, the legislature finally agreed to repeal the states No-Fault Law requiring personal insurance protection and replace it with mandatory bodily injury coverage. SB 54 passed on the final day of the session.

Although PIP is repealed, the FOMA and others amended the legislation to include medical payment coverage, providing some measure of assurance health care providers may be reimbursed for services of individuals without health insurance. As amended, the bill requires insurers to offer medical payments coverage at specified limits with deductibles and provides that a policyholder is deemed to have $10,000 in such coverage unless the policyholder opts out in writing.  

In addition, the bill:

  • Requires owners and operators of motor vehicles that must be registered in Florida to maintain financial responsibility of at least $25,000 for bodily injury or death of one person, and subject to such limit, $50,000 for bodily injury or death of two or more persons. ($25,000/$50,000 BI requirement)

  • Establishes a $10,000 setoff on noneconomic damages recovered by an uninsured driver (does not apply in wrongful death actions).

  • Allows a claimant to recover attorney fees and costs if an insurer does not timely provide the liability disclosure required by s. 627.4137, F.S.

  • Provides a framework governing actions for bad faith failure to settle third-party claims, including the establishment of claim handling best practices for insurers. The bill was amended, adding a statement that the statute governing these bad faith actions is not intended to expand or diminish any cause of action currently available against insurance agents who sell motor vehicle liability insurance policies in this state.
FOMA Defends Vital Patient Protections
On Tuesday, April 27, at 11:42 PM, a strike-all amendment was filed to the Department of Health bill, SB 1568. The House amendment included language which would have allowed direct mailing of hearing aids for individuals over the age of twenty-one. Our team discovered the amendment shortly after midnight and began implementing a strategy to have the language removed. By 8:00 AM the next morning, the FOMA and our partners were able to obtain the amendment sponsor’s support to strike the language. The language was removed on second reading on the House floor.

FOMA Executive Director Steve Winn and FOMA General Counsel Jason Winn, Esq., put together a coalition of healthcare groups to fight this bad piece of legislation. The group consisted of the Florida Osteopathic Medical Association, the Florida Society of Hearing Healthcare Professionals, the Florida Medical Association, the Florida Society of Otolaryngology, the Ballard Group, Capital City Consulting, and groups represented by Theresa Bulger including the Clarke School for Hearing and Speech, the Florida Academy of Audiology, the Florida Coalition for Spoken Language Choices, and the Sertoma Speech and Hearing Foundation.  

The group worked together to maintain current law, established years ago to ensure patients, particularly the most vulnerable, are protected.  
Public Health Emergency
Legislation Passes
On the final day of the session, the legislature passed SB 2006, amending the State Emergency Management Act to address the threat posed by a pandemic or other public health emergency. In part, the bill places guardrails on state and local officials when issuing emergency orders. The bill also prohibits a business or governmental entity from requiring proof of immunization regarding COVID-19 vaccinations.  
1LT Stephen R. Winn (Ret), Speaking on Behalf of the POW-MIA Vietnam Veterans Bracelet Memorial
FOMA in the Community
It is out honor and privilege to announce the Florida Senate and Florida House of Representatives passed SB 416, authorizing the placement of the POW-MIA Vietnam Veterans Bracelet Memorial. The FOMA supported this important legislation, honoring those who never returned to our shores and their families. 

Presently, 1,585 Vietnam Veterans are listed as missing in action, 54 are from Florida. This legislation ensures our Vietnam Veterans listed as missing in action are not forgotten. 
Enrolled Bills
Bills Passing Both Chambers
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