Weeks 4-5 Legislative report
April 3, 2015
Prepared by Alisa LaPolt
Topsail Public Affairs
ADVOCACY DAYS
FNA Advocacy Days 2015 was a huge success at the Capitol, drawing close to 200 nurses and nursing
students from across the state. Participants lobbied legislators on a number of issues including state
employees, health care coverage for Medicaid recipients, nurse practitioner prescribing and hospital
staffing committees. The day of lobbying concluded with a reception at the Governor’s Club, where
participants networked and socialized with legislators.
A special thanks to the staff at Robert M. Levy & Associates, which scheduled appointments for our
nurses and students with almost half of the members of the Legislature. Bob Levy’s office also provided
interns who assisted nurses in getting through the maze of the Capitol in time for their appointments
with legislators.
SESSION HIGHLIGHTS
ARNP scope of practice
For the first time in more than two decades, legislation that would allow ARNPs to prescribe controlled
substances is moving through both chambers of the Florida Legislature.
On April 1, HB 281 sponsored by Rep. Cary Pigman (R-Sebring) passed the House Health & Human
Services Committee in a 13-4 vote. It is now ready to be placed on the calendar for a full House vote. A
day earlier, the Senate version of the bill also passed a key committee, the Senate Regulated Industries
Committee. SB 614, sponsored by Sen. Denise Grimsley, passed in an 8-2 vote. It faces a
hearing in the Rules Committee.
Both bills would allow ARNPs and physician assistants to prescribe medically necessary controlled
substances under the supervision of a physician. They could not, however, prescribe medications in a
pain management clinic. Both bills would require the Board of Nursing establish a committee that would
determine the list of controlled substance medications that ARNPs could or could not prescribe.
HB 281 would also clarify that ARNPs, like PAs, could order controlled substances in a hospital under
physician supervision. Similar language is contained in a separate Senate bill, SB 532, by Sen. Grimsley.
The FNA was among the many organizations that have publicly supported HB 281/SB 614 during their
committee stops. The massive list of supporters includes AARP, the Florida Chamber of Commerce, the
Florida Hospital Association and the Florida Health Care Association.
State employees
Appropriations bills passed last week in the House and Senate once again fail to address pay raises for
state employees, despite efforts from House Democrats. Rep. Alan Williams filed an amendment that
would have given state workers a 3 percent across-the-board pay raise, but it was withdrawn.
A bill (HB 7097) by Rep. Jason Brodeur would direct the Department of Management Services to do a
“right pricing” study to recommend alternatives to current employee insurance plans. There would be
four levels – bronze, silver, gold and platinum -- beginning in the 2018 plan year. If the state’s
contribution for premium is more than the cost of the plan selected by the employee, then the
employee may use the remainder to fund a flexible spending arrangement or a health savings account;
purchase additional benefits offered through the state group insurance program; or increase the
employees’ salary, according to a bill analysis. HB 7097 passed the House Appropriations Committee 188.
Other notes:
 HB 5009 authorizes state group insurance program to include high deductible plans; requires
employees hired after specified date to participate in high-deductible plan; and revises state's
monthly contribution for certain employees under state group insurance program. It was
temporarily postponed on 2nd reading.
 A newly filed Senate Proposed Bill 7082 would revise death benefits paid by the Florida
Retirement System. No text has been filed it. It is scheduled for Governmental Oversight and
Accountability, 04/07/15.
 There are no bills that would change FRS pension plans by moving new hires into 401k-type
plans. Speaker Crisafulli announced earlier during the session that a new study shows the move
would be more costly.
Higher Education
In 2014, the Legislature passed a one-year moratorium on four-year baccalaureate programs at
community colleges due to concerns that such programs duplicated the mission of state universities.
This moratorium adversely affected some institutions that planned to offer nursing degrees.
This year, legislation that would eliminate the moratorium is gaining momentum. SB 1252 realigns the
community college system and also requires a college baccalaureate degree proposal to include a
justification for the proposed program and information about how it will meet the workforce demand
and unmet need. The bill also strengthens oversight of the four-year programs.
The bill unanimously passed the Senate Higher Education committee and faces a hearing April 8 in the
Appropriations Subcommittee on Education.
A similar bill (HB 7127) unanimously passed the House Education Appropriations Subcommittee and
faces one more hearing in the Education Committee before being placed on the House calendar.
House, Senate budgets
The House passed its $76.2 billion budget on Thursday in a predominantly 86-29 party line vote, with
Democrats protesting the House’s refusal to accept federal money for the Senate’s expanded Medicaid
health plan.
The Senate’s budget is roughly $4.2 billion more and is propped up by Medicaid expansion plus $2.2
billion in anticipated federal money for the Low Income Pool Program (LIP). Federal officials have stated
that they will no longer approve funding under the existing LIP program due in part to the way money is
distributed among hospitals that provide charity care.
Last week, Senate President Andy Gardiner issued a press release stating that U.S. Sen. Bill Nelson and
Congresswoman Debbie Wasserman Schultz, the chair of the Democratic National Committee, came to
Tallahassee and stated they are doubtful the federal government will continue LIP funding if Florida
does not expand health care coverage. During a floor debate on the budget, Appropriations Chairman
Mike Corcoran stated the House won’t change its mind on Medicaid expansion.
The uncertainty surrounding the LIP program funding brings into question the Legislature’s ability to
complete the state budget during its 60-day legislative session. Lawmakers would likely return in a
special session of the Legislature to do so. There are three weeks left in the regular session.
On another budget note, the Florida Center for Nursing is earmarked for $50,000 in the proposed House
budget, but there is no money currently allocated in the Senate budget. This is expected to change
during the budget-making process. An amount of $400,000 is being sought. The Center’s funding will be
among the items negotiated between the House and Senate.
Medical Marijuana
Last year, lawmakers passed legislation that allows the medical use of low tetrahydrocannabinol (THC)
and high cannabidiol (CBD) form of cannabis (low-THC cannabis) by patients suffering from cancer or
a physical medical condition that chronically produces symptoms of seizures or severe and persistent
muscle spasms.
SB 7066 (by Sen. Jeff Brandes) would create a new list of conditions includes HIV, AIDS, epilepsy,
amyotrophic lateral sclerosis, multiple sclerosis, Crohn’s disease, Parkinson’s disease, paraplegia,
quadriplegia, and terminal illness. It would also allow the use of low-THC cannabis to treat the listed
conditions, symptoms of those conditions, and symptoms created by treatments for those conditions,
according to a bill analysis.
The bill would also increase the number of medical marijuana dispensers regulated by the state from
five to 20.
“Right to Try” legislation
A bill that would allow terminally ill patients to try experimental drugs and treatments not approved
by the FDA is advancing in the House and Senate.
HB 269 by Rep. Ray Pilon passed unanimously through the House Health and Human Services
Committee. The Senate version, SB 1052 by Sen. Jeff Brandes, has cleared two committees, but an
amendment on the bill is causing concern.
It would allow patients to arrange for a "physician order for life-sustaining treatment," (POLST) which
outlines specific end-of-life procedures. According to the Herald Tribune, the POLST -- which is an
arrangement between the patient and his or her physician -- could determine whether the patient
would receive tube feedings or would opt for medical care for "comfort only" rather than more intensive
treatments. The POLST can carry more legal weight than an "advance directive" or living will -- which are
allowed under Florida law -- because it is a physician order.
Other news

The Senate Health and Human Services Appropriations Subcommittee will consider SB 1040 filed
by Sen. Oscar Braynon, D-Miami Gardens, that would create a pilot needle exchange program in
Miami-Dade County. The program would allow drug addicts to exchange used needles and
syringes for clean needles and syringes as a way to prevent the spread of diseases.
BILLS OF INTEREST
HB 999/SB 1392 Ambulatory/Recovery Care Centers
(Fitzenhagen/Gibson)
HB 999 would allow patients to stay 24 hours in ambulatory care and more significantly, it creates a new
license for recovery care centers. The bill defines recovery care services as postsurgical and postdiagnostic medical and general nursing care provided to patients for whom acute care hospitalization is
not required and an uncomplicated recovery is reasonably expected. The term includes postsurgical
rehabilitation services. The term does not include intensive care services, coronary care services, or
critical care services. Patients released from the hospital could stay at a recovery care center (RCC) for
72 hours. RCCs would have similar regulatory standards rules as hospitals and ambulatory care centers.
 HB 999 passed Health Care Appropriations Subcommittee on March 31 in a 9-4 vote.
 SB 1394 was referenced to three Senate committees and has not been scheduled for a hearing.
It currently does not include language addressing RCCs and could be considered dead for the
year unless the Senate acts on it.
SB 144/HB 0141 Relating to Public Records/Impaired Practitioner Consultants
(Bean/Renuart)
Provides exemption from public records requirements for certain identifying and location information of
impaired practitioner consultants and their employees, and spouses and children of such consultants
and employees. Applies to the Intervention Program for Nurses.
 SB 144 Passed on Third Reading, 03/24/15 (Vote: 38 Yeas / 0 Nays); sent to House.


HB 141 favorable by Health & Human Services Committee; 16 Yeas, 0 Nays; placed on the House
calendar for 2nd reading.
FNA supports this legislation.
SB 950/HB 697 Relating to Public Health Emergencies
(Hukill/Gonzalez)
Creates a new definition for isolation and allows the Department of Health to issue isolation orders
enforceable by law enforcement like it does for quarantine orders. Quarantine means the separation of
an asymptomatic individual or premises reasonably believed to have been exposed to a communicable
disease from individuals who have not been exposed to the disease to prevent its possible spread.
Isolation means the separation of an individual who is reasonably believed to be infected with a
communicable disease from those who are not infected with the disease to prevent the spread of the
disease.
 SB 950 favorable by Health Policy; 9 Yeas, 0 Nays; On Committee agenda - Appropriations
Subcommittee on Health and Human Services, 04/08/15.
 HB 697 Favorable with by Health Quality Subcommittee; 12 Yeas, 0 Nays; Favorable by Health &
Human Services Committee; 18 Yeas, 0 Nays; Placed on Calendar, on 2nd reading.
SB 476/HB 335 Relating to Psychiatric Nurses
(Grimsley/Plasencia)
Defines a psychiatric nurse as an advanced registered nurse practitioner certified under s. 464.012 who
has a master's or doctoral degree in psychiatric nursing, holds a national advanced practice certification
as a psychiatric mental health advanced practice nurse, has two years of post-clinical experience under a
psychiatrist and and performs within the framework of an established protocol with a psychiatrist;
allows psychiatric nurse to release a Baker Acted individual from a hospital- or health system-owned
facility; prohibits a psychiatric nurse from releasing an individual who was Baker Acted by a psychiatrist
unless that psychiatrist approves.
 HB 335 Favorable by Health & Human Services Committee; 18 Yeas, 0 Nays; Placed on Calendar,
on 2nd reading.
 SB 476 Favorable by Health Policy, 03/23/15, 8 Yeas, 0 Nays; Now in Children, Families, and
Elder Affairs.
 FNA is taking a neutral position on this legislation due to the indeterminate effect on psychiatric
registered nurses who would need new ARNP certification, yet FNA also recognizes that
psychiatric ARNPs would have new authority to release Baker Acted individuals under a protocol
agreement with a psychiatrist.
SB 382/HB 1001 Relating to Assisted Living Facilities
(Sobel/Ahern)
Requires regular inspections of ALF facilities; allows; certain facilities licensed as ALFs to be licensed as
extended congregate care facilities; sets administrative fines; imposes a moratorium on any facility that
refuses an agency inspection;; redefines assistance with self-administration of medication and training
hours required; provides certain resident protections.
 HB 1001 removes language that allows the Department of Health to limit by rule what functions
a registered nurse can perform in nursing homes Favorable by Health Innovation Subcommittee;
12 Yeas, 0 Nays; Favorable by Health Care Appropriations Subcommittee; 9 Yeas, 0 Nays;
Favorable by Health & Human Services Committee; 16 Yeas, 0 Nays; Placed on House calendar
for 2nd reading.
 SB 382 on 2/23/15 passed Health Policy; 8 Yeas, 0 Nays; passed Appropriations Subcommittee
on Health and Human Services; 7 Yeas, 0 Nays; is now in Appropriations.
 FNA favors HB 1001 as SB 382 lacks language that removes limitations placed on RNs by the
Department of Health rules.
HB 547 Relating to Advanced Practice Registered Nurses
(Pigman)
Redesignates ARNPs as advanced registered practice nurses (APRNs); provides for independent APRNs
(IAPRNs) to practice advanced or specialized nursing; exempts IAPRNs from requirement that certain
medical acts be supervised by physician; revises APRN certification requirements; authorizes APRNs to
administer, dispense, & prescribe medicinal drugs pursuant to protocol; provides for registration of
IAPRNs who meet certain requirements; specifies acts that IAPRNs are authorized to perform without
physician supervision or protocol; provides for eligibility of IAPRNs for clinical privileges; requires IAPRNs
to maintain medical malpractice insurance or provide proof of financial responsibility.
 Favorable with CS by Health Innovation Subcommittee; 9 Yeas, 4 Nays, 3/25/2015.
 There is no Senate companion for this bill.
 FNA supports.
HB 7047 Relating to Direct Primary Care
Health Innovation/Costello
Allows individuals to enter into a contract with a health care practitioner to provide primary care
services without going through a third-party payor (health insurance). The bill specifies that the
agreement must be in writing; can be terminated by either party; must describe the scope of services to
be provided, etc. The effect of the bill is that nurse practitioners would be able to enter into these direct
primary care contracts as well.
 Favorable by Insurance & Banking Subcommittee; 13 Yeas, 0 Nays; Favorable by Finance & Tax
Committee; 17 Yeas, 0 Nays; Now in Health & Human Services.
 The Senate has added this language to a new Proposed Committee Bill 7084 which will be heard
in Health Policy on 4/7.
 The FNA supports this legislation.
SB 7044 Relating to Health Insurance Affordability Exchange
(Health Policy Committee)
Creates the Florida Health Insurance Affordability Exchange, which is the Senate’s plan to accept federal
Affordable Care Act funding to make health insurance plans available to an additional 800,000 to 1
million residents who currently can’t qualify for Medicaid.
It has unanimously passed all three Senate committees and is ready for placement on the calendar for a
Senate floor vote.
Last week, Bonnie Sklaren, chair of the FNA’s political action committee, participated in a news
conference with a coalition of business leaders, consumer advocates and healthcare professionals from
the St. Petersburg area who support the legislation. Bonnie spoke on behalf of the FNA.
BILLS NOT MOVING
SB 784/HB 863 Relating to Health Care (Gaetz/Harrison)
Creates the Clinical Practices Review Commission within the Department of Health to review prior
authorization, step therapy, or other protocols submitted by health plans that wish limit access to
treatment. The commission would determine if the limitation is supported by sufficient clinical evidence
that does not inhibit timely diagnosis or effective treatment of the specific illness or condition of the
covered patient.
FNA supports.
SB 482/HB 285 Relating to Community Health Worker Certification
(Braynon/Narain)
Requires Department of Health to approve qualified third-party credentialing entities to administer
voluntary community health worker certification programs; defines community health workers a
frontline health care worker who is a trusted member of, or who has an unusually deep understanding
of, the community that he or she serves; allows community health workers to assist and provide
resources to individuals about available services, etc.
FNA supports.
SB 1342 Relating to Nurse Staffing Levels
(Braynon)
Establishing a nurse staffing committee in each hospital; requiring the hospital to post and publicize the
nurse staffing plan and schedule, etc
FNA supports.