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ISSUE 8 | MARCH 3, 2016
TheEndApproachesThe End Approaches
Last week, Senate President Andy Gardiner and House Speaker Steve Crisafulli broke through the budget stalemate by jettisoning Governor Scott's three top priorities: a $1 billion tax cut, a $250 economic incentive fund, and increased property taxes to fund education.
They agreed instead that tax cuts will total about $400 million, there will be no incentive funds, and state dollars will be used to help fund education increases.  After making these key decisions, they were able to determine how much money would be available for the budget and allocated it to the different budget areas (i.e., transportation, education, health care, etc.).
Joint House/Senate budget conference committees began meeting last Friday at 5:30 PM and met through the weekend.  They completed their business on Monday evening and "bumped" the issues contained in the proposed 2016-2017 House and Senate state budgets that they couldn't resolve to the Appropriations Committee Chairs, Representative Richard Corcoran and Senator Tom Lee.
As this Legislative Link went to press, the Appropriations Chairs had not released any information about their ongoing discussions.
In order to adjourn on time next Friday, next year's final proposed budget will have to be printed by next Tuesday evening.  Next week's Legislative Link will provide details regarding key appropriations in that budget.
FreeTaxPrepFree Tax Preparation for ALICE Families Approved
One important issue that was not bumped to the Appropriation chairs this week is funding to support free tax preparation and financial literacy services for ALICE families.
A $500,000 appropriation that will allow United Ways and their community partners to provide free tax preparation and financial literacy services to more than 20,000 low income workers and their families was approved on Monday evening by the Transportation and Economic Development (TED) Budget Conference Committee.
As a result, ALICE families will receive more than $20 million in tax refunds they have earned, putting a dent in the $1 billion of unclaimed refunds Floridians leave on the table in Washington each year.  Most importantly, they will receive upwards of $10 million in Earned Income Tax Credits (EITC), credits that research shows are one of the most powerful tools available for helping to lift families out of poverty.
"Get your facts first, then you can distort them as you please."  -- Mark Twain
KidCareExpansionRollsKidCare Expansion Rolls!
State law forces immigrant children who are lawfully residing in Florida to wait five years before getting health care coverage through KidCare.

Yesterday, the House bill removing the five year waiting period (CS/HB 89) was placed on third reading, and on Monday its provisions were incorporated into the must-pass Senate Medicaid budget conforming bill (HB 5101).

Most importantly of all, the Health Care/Health and Human Services Conference Committee agreed to provide $28,835,214 to fund the expansion, 100 percent of which are federal funds.  With money in the budget, it's a pretty safe bet the expansion will pass.
After more than five years of advocating for this change, it appears we are on the brink of success.  The result: More than 14,000 children won't have to wait five years to receive the health care they need.
While it is most likely the KidCare change will pass, legislative history is littered with "for sure" things that, in the end, didn't come through.  We look forward to reporting next week that this "for sure" thing actually comes true.
AffordableHousingAffordable Housing
Florida's affordable housing trust funds (i.e., Sadowski Trust Funds) were created more than 20 years ago to ensure funding for affordable housing.
The proposed 2016-2017 Senate budget would have used all $317 million in Sadowski Trust Funds for affordable housing.  Unfortunately, the House proposal followed Governor Scott's lead by sweeping $172 million of the funds for other purposes.
On Monday, the Transportation & Economic Development/Transportation (TED) Conference Committee agreed to appropriate $214.1 million of the Sadowski funds for affordable housing, including $4 million for homeless programs and training.
"Behind every great man is a woman rolling her eyes."
-- Jim Carrey
ConfereesAgreeonMoreConferees Agree on More for Healthy Families Florida
Few programs have as significant an impact across child and family domains as Healthy Families Florida. This voluntary, home visiting program helps parents and caregivers find employment, learn positive age appropriate parenting skills, connect their children to health care, and better nurture, support, and prepare their children for successful, contributing lives.  It is also why 98 percent of children in the high risk families served by the program were free from abuse and neglect one year after program completion, and 95 percent were free from abuse and neglect after three years.
Recognizing its extraordinary results, the Health Care/Health and Human Services Conference Committee agreed Sunday evening to increase Healthy Family funding by $1.9 million next year.  This funding will allow Healthy Families to serve up to 567 new families in the program that currently serves all 67 counties.
HealthCareAccessBillsHealth Care Access Bills Headed to Senate
Good health is fundamental to a child's ability to succeed in school, and adults' ability to provide for their families, contribute to society, and live a full life.  Although the United States leads the world in medical advancements, Americans are not as healthy as they could be.  That is why a key priority for Florida's United Ways is to improve access to health care for all state residents.
On Wednesday, the House passed four bills intended to improve health care access and outcomes. The five bills, which are on their way to the Senate, address:
Direct Primary CareCS/CS/HB 37 provides that a direct primary care agreement (agreement) and the act of entering into such an agreement are not insurance and not subject to regulation under the Florida Insurance Code.  Direct primary care is a primary care medical practice model that eliminates third party payers from the primary care provider-patient relationship.  Through a contractual agreement, a patient pays a monthly fee, usually between $50 and $100 per individual, to the primary care provider for defined primary care services, which may include:
  • office visits;
  • annual physical examinations;
  • routine laboratory tests;
  • vaccinations;
  • wound care;
  • splinting or casting of fractured or broken bones;
  • other routine testing, e.g., echocardiogram and colon cancer screening; and/or
  • other medically necessary primary care procedures.
After paying the fee, a patient can access all services under the agreement at no extra charge.  Some direct primary care practices also include routine preventative services, like lab tests, mammograms, Pap screenings, and vaccinations.
Ambulatory Surgical Centers/Recovery Care Centers - An ambulatory surgical center (ASC) is a facility, that is not part of a hospital, the primary purpose of which is to provide elective surgical care, in which the patient is admitted and discharged within the same working day and is not permitted to stay overnight. HB 85 changes the allowable length of stay in an ASC from less than one working day to no more than 24 hours, which is the federal Medicare length of stay standard.
The bill also creates a new license for a Recovery Care Center (RCC), defined as a facility the primary purpose of which is to provide recovery care services, to which a patient is admitted and discharged within 72 hours, and which is not part of a hospital. The bill defines recovery care services as:
  • postsurgical and post-diagnostic medical and general nursing care to patients for whom acute hospitalization is not required and an uncomplicated recovery is reasonably expected; and
  • postsurgical rehabilitation services. 
Recovery care services do not include intensive care services, coronary care services, or critical care services
Dental Care: Underserved Areas - CS/CS/HB 139 requires the Department of Health (DOH) to develop and implement a dental care access account initiative to benefit dentists employed by a public health program or committed to opening a private practice capable of serving at least 1,200 patients in a "dental health professional shortage area" or medically underserved area.
The bill requires DOH to implement an electronic benefits transfer system enabling selected dentists to spend awarded funds on:
  • repayment of dental school student loans;
  • investment in property, facilities, or equipment required to establish and operate a dental office; and
  • transitional expenses associated with relocation or opening a dental practice.
Each award may not be less than $10,000 or exceed $100,000.
Drug Prescriptions/Advanced Registered Nurse Practitioners & Physician Assistants - Unlike all other states in the U.S., Florida does not allow advanced registered nurse practitioners (ARNPs) to prescribe controlled substances and is one of two states that do not allow physician assistants (PAs) to prescribe controlled substances.
HB 423 authorizes ARNPs to prescribe, dispense, order, and administer controlled substances, but only to the extent authorized under a supervising physician's protocol.  The bill also authorizes PAs to prescribe controlled substances that are not listed on the formulary established by the Council on Physician Assistants, under current supervisory standards. The bill subjects ARNPs and PAs to administrative disciplinary actions, such as fines or license suspensions, for violating standards of practice in law relating to prescribing and dispensing controlled substances.

Telehealth - CS/CS/HB 7087 provides parameters for provision of telehealth services and creates a Telehealth Advisory Council within the Agency for Health Care Administration to make recommendations to increase the use and accessibility of services provided via telehealth, including identification of barriers to implementing or accessing services provided via telehealth, in a report that shall be submitted to the Governor, the President of the Senate, and the Speaker of the House of Representatives on or before December 1, 2018.
(Portions excerpted from Legislative staff analyses.)
JuvenileCivilCitationsJuvenile Civil Citations
CS/CS/CS/SB 408 requires a law enforcement officer to issue a civil citation or require the juvenile's participation in a similar diversion program for the following enumerated first-time "misdemeanor offenses":
  • possession of alcoholic beverages by a minor;
  • petit theft;
  • retail theft;
  • disorderly conduct;
  • possession of cannabis or other controlled substances;
  • use, possession, sale, manufacture, delivery, transportation, advertisement, or retail sale of drug paraphernalia; and
  • resisting an officer without violence.
The bill permits the issuance of a civil citation or similar diversion program for:
  • a first-time misdemeanor offense that is not one of the enumerated "misdemeanor offenses;" or
  • any second or third-time misdemeanor, regardless of whether the offense is considered one of the enumerated "misdemeanor offenses."
A law enforcement officer must provide written documentation articulating why an arrest is warranted if he or she has discretion under the statute to issue a civil citation, but chooses instead to arrest the juvenile.
The bill also provides that the civil citation law, s. 985.12, F.S., does not modify the authority of a law enforcement officer to issue only a simple warning to the juvenile or to notice the juvenile's guardian or parent of the alleged offense.
LAST ACTION: 2/29/16  SENATE  Favorable with CS by Rules.
FloridaCouncilonPovertyFlorida Council on Poverty
CS/SB 556 establishes the Florida Council on Poverty (Council) as an advisory council, administratively housed within the Department of Economic Opportunity.  The Council must:
  • conduct a review of policies and programs that work to move people out of poverty;
  • develop strategies to address the causes of poverty in Florida;
  • develop recommendations to reduce the percentage of people living in poverty in Florida;
  • study the academic outcomes for children in poverty and develop recommendations on how to improve such outcomes; and
  • submit an annual report to the Governor, President of the Senate, and the Speaker of the House of Representatives.
Five members will be appointed to the Council.  The Governor must appoint one member from the Florida Association for Community Action, Inc., and the Chief Financial Officer, the Commissioner of Agriculture, the President of the Senate, and the Speaker of the House of Representative must each appoint one member. The council must meet at least twice a year, beginning August 1, 2016, and may meet by teleconference or other electronic means.
The Council is abolished on July 1, 2019.
LAST ACTION:  2/29/16  SENATE  Favorable with CS by Fiscal Policy.
ChildWelfareChild Welfare
The Department of Children and Families (DCF) implements child welfare services aimed at preventing abandonment, abuse, and neglect of children through community organizations known as lead agencies.  DCF is required to administer a system of care that prevents the separation of children from their families and provides interventions to allow children to remain safely in their own homes.  However, when it is determined that in-home services are not enough to allow a child to safely remain in his or her home, the child is removed from his or her home and placed with a safe and appropriate temporary out-of-home placement.
CS/CS/HB 599 is a comprehensive bill that, among others:
  • requires Community Based Care lead agencies (CBCs) to provide a continuum of care through direct provision, subcontract, referral, or other effective means, and requires DCF to specify the minimum services available through contract;
  • removes the requirement to develop and implement a two-pronged assessment for placement and services, and creates a workgroup to evaluate whether the state should develop an initial assessment to help make appropriate initial placements;
  • requires a quality rating system for group homes and foster homes to be implemented by July 1, 2018; and
  • requires CBCs to develop a plan for managing group home utilization, including specific targets for reductions over a five-year period if the CBC has utilization over eight percent.
LAST ACTION: 3/2/16  HOUSE  Passed as amended.
HealthyFoodFinancingHealthy Food Financing Initiative
Access to quality retail grocers in Florida is strongly linked to a variety of diet-related health outcomes.  Individuals living in places more than a half-mile from the nearest full-service grocer and who lack access to a vehicle are more likely to die prematurely from diabetes, diet-related cancers, stroke, and liver disease than individuals living where grocers are closer and vehicles are more available.  The American Heart Association reports that low income areas have more convenience stores than supermarkets, thus limiting healthy options in those areas, and that 2.5 million Floridians live in areas where fresh food is not readily available.
CS/CS/SB 760 establishes the Healthy Food Financing Initiative to provide financial assistance for development or expansion of grocery retail outlets that operate in underserved, low income, or moderate income communities.
LAST ACTION:  3/1/16  SENATE Favorable with CS by Appropriations.
BehavioralHealthWorkforceBehavioral Health Workforce
The Institute of Medicine has chronicled efforts, beginning as early as the 1970s, to deal with workforce issues regarding mental and substance use disorders, but notes that most have not been sustained long enough or been comprehensive enough to remedy the problems.  Shortages of qualified workers, recruitment and retention of staff, and an aging workforce have long been cited as problems.
CS/CS/SB 1250 expands the behavioral health workforce, recognizes that the need for additional psychiatrists is of critical state concern, integrates primary care and psychiatry, and allows persons with disqualifying offenses that occurred five or more years ago to work under the supervision of certain qualified personnel until a final determination regarding the request for an exemption from disqualification is made.  Among others, the bill also: 
  • authorizes physician assistants (PAs) and advanced registered nurse practitioners (ARNPs) to prescribe controlled substances with certain limitations;
  • requires a PA or an ARNP who prescribes any controlled substance for the treatment of chronic, non-malignant pain, to register with the Department of Health as a controlled substance prescribing practitioner;
  • provides that persons employed directly or under contract with the Department of Corrections in an inmate substance abuse program are exempt from a fingerprinting and background check requirement unless they have direct contact with unmarried inmates under the age of 18 or with inmates who are developmentally disabled;
  • allows persons who have had a disqualifying offense that occurred five or more years ago, and who have requested an exemption from disqualification, to work with adults with substance abuse disorders; and
  • adds human trafficking to the required medical continuing education requirements for allopathic and osteopath physicians, physician assistants, anesthesiology assistants, nurses, dentists, dental hygienists, dental lab personnel, psychologists, social workers, mental health counselors, and marriage and family therapists.
LAST ACTION: 3/1/16 SENATE  Favorable with CS by Appropriations.
FreshProduceMarketsSNAPFresh Produce Markets/SNAP
CS/HB 103 provides that the owner or operator of a market selling fresh produce who is not an authorized SNAP retailer may allow an authorized Food and Nutrition Service group or association of produce sellers that is actively participating in produce sales in the market, or an authorized Food and Nutrition Service third-party organization, to implement and operate an electronic benefits transfer system for purposes of accepting SNAP benefits in the market on behalf of the produce sellers to the extent and manner allowed by federal law and regulation.
LAST ACTION:  3/2/16 Enrolled.
DentalHygieneServicesDental Hygiene Services for Children
The scope of services that dental hygienists can perform without supervision of a dentist was expanded in 2011.  However, the legislation did not specifically permit health care facilities for which the hygienists work to bill Medicaid for those expanded services unless they are performed under the general supervision of a dentist.
CS/SB 580 authorizes the Agency for Health Care Administration to reimburse health care facilities under the Medicaid program for remedial dental services (remedial tasks) delivered by a dental hygienist when provided to a Medicaid recipient younger than 21 years of age.  Remedial tasks are defined as intra-oral tasks that do not create unalterable changes in the mouth or contiguous structures, are reversible, and do not expose the patient to increased risks.
LAST ACTION: 3/2/16 SENATE  Passed as amended.
EligibilityforEmploymentEligibility for Employment as Child Care Personnel
The federal Child Care and Development Block Grant (CCDBG), which was substantially modified last year, provides hundreds of millions of dollars to fund subsidized school readiness services for low income Floridians.  However, some child care personnel are employed by child care facilities that do not receive CCDBG funding and are not subject to new CCDBG requirements.
CS/CS/CS/HB 1125 applies the new CCDBG background screening requirements to all child care personnel regardless of whether their employer receives federal CCDBG funding.  The bill prohibits the Department of Children and Families from granting exemptions for employment as child care personnel to persons who have been:
  • registered as a sex offender as described in 42 U.S.C. s. 9858f(c)(1)(C) and are subject to the registration requirements under the Adam Walsh Child Protection and Safety Act; or
  • arrested for and are awaiting final disposition of, found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, or have been adjudicated delinquent and the record has not been sealed or expunged for certain state felonies and misdemeanors enumerated in the bill that are aligned with the crimes listed in the federal requirements.
Individuals who currently have exemptions allowing employment are now prohibited from such employment, and must be rescreened by August 1, 2016.

LAST ACTION: 3/2/16 HOUSE  Passed.


Session Dates

"I can resist everything except temptation."
-- Oscar Wilde
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