May 27, 2015

House responds with batch of bills it says will lower health care costs

After spending the last legislative session knocking down Senate proposals for expanding health care coverage while offering no alternative of their own, Florida House Republicans filed a series of bills Wednesday that attempt to take a rifle-shot approach to lowering the spiraling costs of health care in Florida.

Many of the proposals are not new, and some have been passed by key committees in the state Senate, but all embrace the belief of many House leaders that the state must inject free-market competition into the health care marketplace to lower costs of health care before expanding access to the uninsured. Opponents, however, claim that many of the proposals just unleash turf battles within the health care industry that will not suppress costs.

“The crisis in health care begins at the cost part of that equation,’’ said Rep. Jose Oliva, R-Miami, a top House lieutenant. “Until we address costs there will never be enough [Medicaid] expansion as those costs continue to rise. What I need to do is put together a system that is heavily dependent on competition and consumerism and free markets.”

The bills, filed along with several budget bills that will be introduced in the three-week special session that begins Monday, include:

Continue reading "House responds with batch of bills it says will lower health care costs" »

May 26, 2015

Is it really a $1 billion budget hole? Scott/AHCA and Senate disagree

Tensions continued to mount Tuesday between Gov. Rick Scott and the Senate as the governor blasted a Senate compromise and the governor’s Agency for Health Care administration issued a letter to the federal government suggesting that the state would not lose the $1 billion in federal money to reimburse hospitals for serving the uninsured under the low income pool as legislators previously suggested.

Agency for Health Care Administration deputy director Justin Senior sent a letter to the federal Department of Health and Human Services suggesting that “there is no need to infuse additional state general revenue to maintain current Medicaid hospital funding levels” in the 2015-16 budget year because local governments could draw down matching funds to offset the $1 billion not coming to the state.

He quotes the May 21 letter from the Centers for Medicare and Medicaid Services which suggests that the state will get $1 billion and notes that "this level of funding for the LIP coupled with the options the state may elect at its discretion described in this letter would enable Florida to retain Medicaid investment in the state at or above the current $2.16 billion level of LIP funding.”

Senior concludes: "Based on this communication and our subsequent clarifying conversations, we understand that the renewed LIP will provide us with enough money to maintain current Medicaid program funding levels."  Download Wachino 526

He then attached a funding proposal that assumes local governments will draw down another $906 million and therefore eliminating the need for legislators to fill the funding gap for hospitals with general revenue funds.  Download Proposal

Senate President Andy Gardiner's response: not so fast.

He called the approach “shortsighted and only kicks the can down the road” because it fails to address the reforms the federal government wants the state to adopt in order to provide insurance to the uninsured.

“The plan proposed by AHCA relies on a particular premise—it assumes that CMS will approve a LIP plan or distribution model that devotes all or most of the LIP spending authority to incentivizing IGT [Inter-governmental transfers] donations and does not advance any of the reforms required for compliance with CMS principles,'' Gardiner said in a statement. "This assumption must be verified by CMS before the Legislature acts on this proposal.

“Using LIP exclusively as a financing mechanism in FY 2015-16 appears to minimize the amount of general revenue needed in rates or other provider payments for the coming year, but that approach is shortsighted and only kicks the can down the road, pushing the general revenue need to subsequent budget years.

“Any proposed spending plan should be a multi-year plan that establishes a foundation for comprehensive solutions. Specifically, the LIP cap declines by another $400 million in the next year and distribution of LIP payments must align with uncompensated care costs in the second year. Additionally, stricter guidelines on distribution of LIP payments take effect in the next year.

"“We believe any proposal must also be accompanied by a full LIP model in order to evaluate the specific impacts.”

May 10, 2015

What might legislative middle ground look like? Some ideas

Florida legislators may have ended their stalemate last week when they agreed to convene a three-week special session to resolve the budget crisis in June, but they didn’t agree on the hard part: how to resolve stark differences over health care.

Some compromise ideas are emerging — from using $600 million intended for tax cuts to bail out hospitals that treat poor patients, to seeking a one-of-a-kind federal waiver, to drawing federal money without passing it through Medicaid.

But finding the middle ground won’t be easy because of the deep ideological divide between House and Senate Republicans over whether or not to expand Medicaid to draw down federal money to provide healthcare for more than 800,000 uninsured residents who must otherwise rely on charity care.

“Ideologies are going to have to be on the back burner and good public policy that satisfies both sides is going to have to prevail,’’ said Rep. Holly Raschein, a Key Largo Republican whose district has among the state’s highest number of uninsured. She is among a minority of House Republicans who support taking federal money if it’s tied to an aggressive health care reform plan that reduces costs.

The legislative session ended abruptly April 28 when the House adjourned in protest over the impasse.

Among the ideas emerging to bridge the divide: bypass Medicaid, bypass hospitals, seek a new federal waiver or just plug the hole and buy time.

More here.

December 01, 2014

Richardson the first openly gay representative to hold House leadership post

State Rep. David Richardson, D-Miami Beach, has been selected as the Democratic Floor Leader by House Democratic leader Mark Pafford, D-West Palm Beach, and Democratic Leader pro tempore, Mia Jones, D-Jacksonville. Richardson will be the first openly gay representative in Florida history to serve in a leadership position in the Florida legislature, according to House Democrats. 

Here's the Democrats' press statement:

Richardson, D-Miami Beach, was the first openly gay member ever elected to the Florida Legislature when he was elected on August 14, 2012. Richardson has been a licensed CPA in Florida for 30 years and began his career as a Pentagon auditor identifying fraud, waste and abuse in government contracts. He was re-elected earlier this year to represent House District 113 for his second two-year term and is the only openly gay member of the Florida Legislature. Richardson joins the leadership team that will guide policy and action for House Democrats. As Floor Leader, he will serve as the chief liaison between the Democratic Leader and the Office of the Speaker. Richardson will also serve as ranking member on the House Rules, Calendar & Ethics Committee. In that role, Richardson will work on daily schedules of action for the House. Richardson will also manage, in conjunction with Republican leaders, floor debate on bills and amendments.

Continue reading "Richardson the first openly gay representative to hold House leadership post" »

October 06, 2014

Movers & Shakers

Update on the Status of Women: Melissa Hagan has been appointed by Senate President Don Gaetz, R-Niceville, to the Florida Commission on the Status of Women.

Hagan and her husband, Aaron, own Emerald Coast Interview Consulting, and she recently served as chief development Ooficer for Gulf Coast State College. Hagan, of Lynn Haven, is a former teacher, curriculum designer and caseworker for at-risk youth.

The Commission, established in 1991, makes recommendations to the legislature, governor and cabinet on issues affecting women.

Her term starts immediately and expires Oct. 1, 2017.

Connie Mack IV joins public relations firm:  The former Florida congressman and state representative has joined Levick, a Washington D.C.-based public relations & communications firm, as an executive vice president.

Mack will also lead Levick's expansion into Florida and will open the firm's Miami office.

Continue reading "Movers & Shakers" »

August 04, 2014

Movers & Shakers

Sen. Grimsley named to new human trafficking council

Sen. Denise Grimsley, R-Sebring, has been appointed by Senate President Don Gaetz to the Statewide Council on Human Trafficking, which was established by the legislature this session.

The first meeting of the 15-member council will be held at 2 p.m. Aug. 18th in Room 214 of the Knott Building at the Capitol.

Grimsley, chairwoman of the Senate Health and Human Services Appropriations Subcommittee, is the newest addition to the council. Rep. Jeanette Nunez, R-Miami, was appointed by House Speaker Will Weatherford. The two remaining members will be appointed by Gov. Rick Scott.

Attorney General Pam Bondi, the council's chairman, appointed Miami-Dade State Attorney Katherine Fernandez Rundle; Martin County Sheriff William SnyderTerry Coonan, executive director of the Florida State University Center for the Advancement of Human Rights; and Dotti Groover-Skipper, chairwoman of the Community Campaign Against Human Trafficking to the council.

The other members are Mike Carroll, interim secretary of the state Department of Children and Families, who will serve as vice chairman; State Surgeon General Dr. John ArmstrongElizabethDudek, Secretary of the state Agency for Health Care Administration; Florida Department of Law Enforcement Commissioner Gerald Bailey; Florida Department of Juvenile Justice Interim SecretaryChristina Daly; and Education Commissioner Pam Stewart.

Florida ethics commission elects a new chairman

Linda McKee Robison, the former vice chairman of the Florida Commission on Ethics, was elected its chairman at the panel's July 25th meeting.

Robison, who is a partner in the Corporate Transactions Group of Shutts & Bowen, LLP, has served on the commission since 2011.

Continue reading "Movers & Shakers" »

May 13, 2014

ALF reforms fail again in Legislature

TALLAHASSEE -- Legislative leaders identified reform of Florida’s assisted-living facilities as one of their top goals this session, but once again lawmakers did not adopt measures to improve conditions in the 3,048 facilities around the state.

It is the third year the Legislature has not passed reforms proposed after a 2011 Miami Herald investigation that revealed the neglect, abuse and death of residents at some in ALFs.

The most recent Senate and House proposals fell apart in the final days when the House attached other health care related bills to the Senate’s ALF bill and they couldn’t resolve their differences.

“We still have the same antiquated, dangerous system that was in place when the Miami Herald wrote its series,” said Brian Lee, executive director of Families for Better Care. The state “has not fixed the abuse and neglect, and residents are still in trouble.”

Getting rid of the “bad apples” in the ALF industry and adding more oversight affects not only the elderly who live in facilities that can house a total of more than 80,000 residents, but also Florida’s economy and future generations, said Jack McRay, advocacy manager for AARP Florida.

“Florida seniors pay more in taxes than they get back in services,” McRay said. “It’s essential that they are able to remain and stay in Florida... We need to get it right.”

What happened this session “is a classic example of politics again trumping policy,” McRay said. “It became part of a healthcare ‘train’ that became a train wreck.”

The Senate unanimously passed SB 248 early in the session. The House passed its version, HB 573, at the end of April. While House Speaker Will Weatherford and Senate President Don Gaetz identified ALF reform as one of their session goals in their “Work Plan 2014” program, it failed to make any progress.

Gaetz blames the House, and the ALF industry, for the bill’s demise.

“It wasn’t the trains that killed the bill. It was the House that killed the bill,’’ he  told the Herald/Times. “Speaker Weatherford gave me his commitment they would try to do this. The ALF industry lobbied very hard against reforms. They lost a lot of credibility. It’s a real shame.”

He said that when the House bill began to be “picked apart” in that chamber, he urged the Senate prime sponsor, Sen. Eleanoer Sobel, D-Hollywood, to start attaching it to several high priority House bills. In retaliation, the House attached language to the ALF bill that the Senate didn’t want -- language about surgery centers and visitation rights for grandparents.

“Healthcare is a complex issue, and we just weren’t able to get agreement between the two chambers,” Weatherford said after the session ended May 2.

Gaetz said he vowed to be Sobel’s first co-sponsor and will work to pass the bill next year.

"Frankly,’’ he said. “Those of us who support her efforts need a little bit more enthusiastic help.”

Sobel and House sponsor, Rep. Larry Ahern, R-Seminole, both vowed to renew their efforts next session.

"I’m very disappointed,” said Sobel, who also blamed “special interests” for the bill’s failure. “I believe we were very close and got further than we have in previous years,” she said.

Ahern said the important thing for next year “is to agree on something the first month of session and get this done early.”

Among the provisions, the ALF bill would have required facilities with one or more, rather than three or more, state-supported mental health residents obtain a limited mental health license; authorized ALF staff members, with increased training, to perform additional medication-related duties; and to assist with the self-administration of medication with increased training.

The most contentious issue was a new rating system for all licensed ALFs, similar to the system used for nursing homes. It would help consumers pick the best home for their loved ones. Family members often find themselves in a quandary when the hospital discharges a patient who cannot go home, McRay said.

“The consumer doesn’t know where to go or which ALFs are good and which are bad. A rating system has worked very well with nursing homes.”

The idea of a ratings system rankled the ALF industry. One industry group, the Florida Assisted Living Association (FALA), raised objections that people could post anonymous, possibly damaging comments on a website that would be managed by the state’s Agency for Health Care Administration.

The ratings system, along with a change in the fine structure that FALA said could affect smaller homes, were among the group’s key objections, said  Shaddrick Haston, its CEO, but he contends that members were not trying to sabotage the bill.

“Actually, most of the bill had great things to help residents age in place,” said Haston, who is AHCA’s former head of licensing for assisted-living facilities. “The industry wanted an ALF bill this year.”

One concern of Lee's, director of Families for Better Care, was a change that would reduce monitoring visits for homes that met certain criteria. Even a home that has had a good reputation can falter, he said.

In the fall, he noted, the state fined the Royal Palm Retirement Centre, an ALF in Port Charlotte, $22,500 for several violations found during a visit. AHCA’s inspection report noted that among resident-care problems, the facility “failed to provide adequate nursing supervision in providing care for four insulin-dependent diabetic residents.”

AHCA, Lee said, “needs to put more boots on the ground in ALFs, not fewer.”

Herald/Times staff writer Mary Ellen Klas contributed to this report. Contact Rochelle Koff at rkoff@miamiherald.com

April 06, 2014

Session at midpoint: Election year squelches controversy, aids harmony and rewards contributors

The Florida Legislature has passed the halfway point of its 60-day session and the fruits of its labor can be summed up in two words: election year.

With Gov. Rick Scott struggling in the polls as he seeks a second term in November, the Republican-led legislature has worked to send him bills to bolster his image while avoiding issues that could complicate the governor’s political prospects.

In one month, lawmakers swiftly passed a repeal of the 2009 auto tag fee that will save most drivers $25 a year and touted it as the largest general revenue tax reduction in a decade. They enacted tuition credits for returning military in an effort to make the state friendly for veterans. They strengthened penalties for perpetrators of sex crimes in response to newspaper reports on repeat sex offenders.

And, in one of many bills pushed by the National Rifle Association, they sent the governor a measure Thursday to allow people to fire warning shots in self-defense.

Before the session began, House Speaker Will Weatherford, R-Wesley Chapel, said his goal was to help Scott “put points on the board” by passing popular legislation.

This week, Weatherford declared that the goal is “not to worry about elections this session. We’re here to do what we think is right.” Story here.


Read more here: http://www.miamiherald.com/2014/04/05/4041743/at-session-midpoint-legislature.html#storylink=cpy

January 22, 2014

House leadership adds hurdle for parents seeking help from marijuana extract

The proponents of a proposal to decriminalize a non-euphoric marijuana strain that helps kids with seizures are winning hearts, but not the support they need from Florida House leadership.

A key legislator, Rep. Dennis Baxley, R-Ocala, fears the idea will get confused by voters who think it’s a sign lawmakers support a proposed constitutional amendment to legalize marijuana for some medical use.

“I don’t want to be the first to start down a slope of approval on the use of illicit drugs under the claim of medical protection,’’ he said. “But I’m not saying I wouldn’t vote for something that would help these families.”

Baxley, chairman of the Judiciary Committee, wants a stand-alone bill that is not tucked into a criminal-justice package as its House sponsor, Rep. Matt Gaetz, has done. Baxley’s approach has the support of House Speaker Will Weatherford but is opposed by supporters of the bill, who say it will make it easier for naysayers to kill it.

The proposal supported by parents with children suffering seizures would allow a marijuana strain known as Charlotte’s Web to be legally developed in Florida.

“I think the supporters make a compelling case for the use of Charlotte’s Web to treat children with severe seizures. There is currently no member bill filed on the matter,” Weatherford said in a statement to the Herald/Times.

Meanwhile, the Florida Sheriff’s Association and the Florida Medical Association, which represents doctors, say they remain vigorously opposed to legalizing marijuana for medical use, but they acknowledge the value of strains high high in cannabidiol (CBD), the ingredient that controls seizures, but is low in tetrahydrocannabinol (THC), the compound that creates a high. More here.


Read more here: http://www.miamiherald.com/2014/01/04/3852689/parents-of-children-with-epilepsy.html#storylink=cpyThose strains have shown promise for stopping or slowing the seizures in children with severe epilepsy and provides other medical benefits for people with other conditions. More here.

Read more here: http://www.miamiherald.com/2014/01/22/3886681/house-leaders-add-hurdle-for-parents.html#storylink=cpy

House speaker 2020? For Eisnaugle, the race is on

EisnaugleEric Eisnaugle, a 36-year-old Republican from Arcadia isn't a member of the Legislature but he is already campaigning to be speaker of the the Florida House in 2020. Sound like a long time away? It is, but it's the latest dance in the term-limits foxtrot politicians in Florida engage in behind the scenes, with little public attention.

Eisnaugle, who stepped aside after serving two years when his district was conflated with Rep. Steve Precourt's under redistricting in 2012, isn't the only candidate for House Speaker 2020. Also on the list is Rep. Mike Hill, R-Pensacola, who was elected in a special election last year, Rep. Shawn Harrison, a Tampa lawyer and Republican who is trying to regain a seat he lost in 2012 to Rep. Mark Danish, a Democrat, and Chris Sprowls, another Tampa lawyer and Republican.

Fundraising for Eisnaugle is happening now. A flyer announcing a mega-fundraiser on Jan. 28 at the Rosen Shingle Creek in Orlando features Reps. Frank Artiles, Ritch Workman, David Santiago, Mike LaRosa and Jason Brodeur and is being promoted as "an event to support Eric Eisnaugle in his Speaker's race." If elected, Eishaugle, like Hill, will have an extra year of seniority over the other legislators elected in November who will also be termed out of office in 2022. 

Rep. Frank Artiles, R-Miami, is a leading Eisnaugle advocate. "He has the most experience. He has the advantage,'' he said.

Precourt resigned earlier this month to take a $175,000 + job at the Orlando-Orange County expressway and Eisnaugle is the leading candidate in a March 11 special election to replace him. 

If elected, Eisnaugle would technically be a "red shirt" freshman, like Hill. Preceding him in the speaker office, if all goes as planned, would be Reps. Steve Crisfulli, Richard Corcoran and Jose Oliva. Obviously, Hill is seen as competition for Eisnaugle, with his name also being mentioned as future House speaker material.