The Budget - HB 5001
The legislature passed a 65 billion dollar budget. Budget cutting was a top priority, with health care and education taking the biggest hits since they comprise the largest parts of state spending. Healthcare spending for fiscal year 2008-2009 was trimmed by 1.3 billion dollars, a large chunk of which comes from reduced Medicaid funding (in the range of 6.5 to 7.3 percent) to nursing homes, hospitals, Medicaid HMOs, and county health departments. These cuts will no doubt affect an array of health care programs and services and result in some cut backs in jobs for health care professionals. Likewise, cuts to education will result in reductions for health programs and job positions for public schools and colleges. The vote was split largely along party lines, with many Democrats being opposed to it.
Physical Education - SB 610
Mandates the equivalent of 30 minutes per day of physical education for students in grade 6 through grade 8. Provides for waivers under certain circumstances, etc. EFFECTIVE DATE: 07/01/2008. Notes: This bill passed by a wide margin and was supported by numerous health and medical organizations. FDA actively lobbied for this bill and encouraged lawmakers to also consider the school food environment and nutrition education in future sessions. These areas are addressed by the 2008 report of the Governor’s Council on Physical Fitness, so they will likely come up next year. Thanks to all who contacted their legislators in support of this bill.
School Breakfast - HB 623
Expands school breakfast programs to middle and high schools. Encourages provision of universalfree breakfast. Requires school districts to annually provide information regarding school breakfast programs to all students and parents. Directs OPPAGA to prepare a report on the cost of universalfree school breakfast programs. EFFECTIVE DATE: 07/01/2008. Notes: This bill unanimously passed both House and Senate. FDA actively lobbied for this bill. Thanks to all who contacted their legislators in support.
Food Donation by Public Food Service Establishment - SB 276
Expands the definition of "perishable food" that is donated to charitable organizations to include foods that have been prepared at licensed public food service establishments. EFFECTIVE DATE: 07/01/2008. Notes: This bill unanimously passed both House and Senate. Previously the definition of "Perishable food" included fresh or processed meats, poultry, seafood, dairy products, bakery products, eggs in the shell, fresh fruits or vegetables, and foods that have been non-commercially packaged, or that have been frozen or otherwise require refrigeration to remain nonperishable for a reasonable length of time. Prepared foods were not included and thus had to be thrown out.
Children’s Zones - H3
This bill addresses the needs of communities with unsafe or unhealthy infrastructure and social environments that limit a good quality of life for children and families. It allows for the creation of “children’s zones” in such areas modeled after one in Harlem. Pilot programs will be created in “Magic City” (Miami-Dade/Liberty City), Orlando, and Jacksonville, with planning teams appointed to each area.
Notes: This bill unanimously passed both House and Senate. Nutrition and health-related provisions include: Providing fresh, good quality, affordable, and nutritious food within the children's zone. Eliminating health disparities between racial and cultural groups, improving outcomes and increasing interventions. Facilitating enrollment of eligible children into KidCare (state health insurance program). Healthy Families support to expectant parents and persons caring for infants and toddlers. RDs in the pilot program areas can watch for local news and seek opportunities to work with these programs in their areas.
Transitional Services/Young Adults/Disabilities - S988
Creates the Health Care Transition Services Task Force for Youth and Young Adults with Disabilities within the Department of Health to assess the need for health care transition services for youth with disabilities, develop strategies to ensure a successful transition from the pediatric to the adult health care system, and identify existing and potential funding sources, etc. EFFECTIVE DATE: 07/01/2008. Notes: This bill unanimously passed both House and Senate. It provides an opportunity for input to the Task Force about the importance of RD services to minors who receive nutrition care under Medicaid Waiver programs for chronic medical conditions or disabilities such as diabetes, sickle cell, cystic fibrosis, cerebral palsy, spina bifida, and Down syndrome. We can also advocate for continuation of these services to minors who transition into the adult healthcare system. In order to do this we will need the help of members who work with these children.
Alzheimer's Disease/Medicaid Waiver Program - S1092
Extends the authority to continue the waiver program for patients who have Alzheimer's disease until the close of the 2010 Regular Session of the Legislature. Requires the Office of Program Policy Analysis and Government Accountability to conduct a comparative study of Medicaid home and community-based-services waiver programs to determine their comparative cost effectiveness, etc. EFFECTIVE DATE: Upon becoming law. Notes: The bill preserves the Alzheimer’s disease Medicaid home and community based-services (HCBS) waiver program until 2010. (It was slated for repeal at the end of the 2008 Legislative Session.) It unanimously passed both House and Senate. The waiver program permits certain Medicaid recipients with Alzheimer’s disease to live in the community as long as possible, while avoiding institutional care in nursing facilities, by providing supportive services to beneficiaries and their live-in caregivers. The bill also requires OPPAGA to conduct an evaluation of comparable Medicaid HCBS waiver programs and to determine their comparative cost effectiveness and ability to delay or prevent institutionalization of Medicaid recipients. This provides an opportunity for input during the rulemaking phase, where we could specifically advocate for the benefits of nutrition care provided by RD/LDs in HCBS. In order to do this, we will need the help of members with knowledge of nutrition care for Alzheimer’s patients in home and community-based settings.
Autism Spectrum Disorder - S2654
Requires group health insurance plans to provide coverage for screening, diagnosis, intervention, and treatment of autism spectrum disorder in children who are diagnosed by or before the age of 8 years. Prohibits an insurer from denying or refusing coverage or refusing to renew or reissue or terminate coverage based on a diagnosis of autism spectrum disorder, etc. Notes: This bill was unanimously passed by both Senate and House during the last hours of session. The House wanted a much more comprehensive bill covering all childhood developmental disabilities, while the Senate version was limited only to autism. In the end, the Senate version passed due to budget constraints and lack of data on the fiscal impact of the more comprehensive bill. The bill specifically states that a group health insurance plan shall provide coverage for screening, intervention, and treatment of autism spectrum disorder including speech therapy, occupational therapy, physical therapy, applied behavior analysis, treatment by a psychiatrist, psychologist, or board certified behavior analyst, and any other necessary medical care. The treatment must be prescribed by the insured's treating medical physician in accordance with a treatment plan. It is hard to predict how this might affect insurance coverage for RD services. Diet modification including a gluten-free casein-free diet has been found to benefit some with autism. However, there are currently no definitive evidence-based guidelines in place. Moreover, insurance coverage may be subject to certain exclusions and limitations including participating provider requirements and utilization review of health care services. If your services are prescribed as part of the treating physician’s plan it may be worth the effort to bill insurance. The Governor also recently appointed an Autism Task Force who will hear testimony and generate a report, which is due in March of 2009. We will keep you apprised of any additional opportunities or information that comes out.
Health Insurance - SB 2534
Creates the Cover Florida Health Care Access Program. Requires the development of guidelines to meet minimum standards for quality care and access to care, etc. EFFECTIVE DATE: Upon becoming law. Notes: This bill passed by a wide margin. The intent of the bill, which was strongly supported by the Governor, is to expand the availability of low-cost health insurance products for the uninsured. Basic coverage and catastrophic options will be offered. Basic coverage will include preventive health services such as immunizations, annual health check ups, well-woman services, preventive screenings for cancers, and diabetic supplies. These products are called “bare-bones” policies by some because they are exempt from covering most of the 51 procedures or treatments that are currently mandated of group health insurance plans. Some consumer groups have expressed concern that people may receive inadequate coverage and that employers may drop their current comprehensive policies and replace them with cheaper plans that provide fewer benefits. Others feel that it is a move in the right direction, and some coverage for the previously uninsured is better than none.
The make-up of the final products remains to be seen. FDA can use this opportunity to advocate for access to MNT as a preventive, cost-saving measure in hearings that will arise from this legislation. BILLS THAT DID NOT PASS It often takes many years to pass a bill; therefore bills that did not pass this year may be back in years to come.
Cystic Fibrosis Treatment/Insurance Coverage - S364
Requires that group health insurance policies cover services needed to treat cystic fibrosis which are authorized by a physician and are medically necessary. Notes: The bill was withdrawn early in the session. While it had a good momentum in 2007, it was not moving forward this year as there was no House companion bill and Senator Margolis, who has sponsored this bill for several years, is retiring after this session. It may be back in the future with a new sponsor.
Health Insurance Coverage/Amino-acid-based Formula - S1598
Adds amino acid based elemental formulas, regardless of the method of intake, to list of enteral supplements which are covered by insurance (for an optional additional premium) for treatment of medically diagnosed conditions such as severe multiple food protein allergies, gastroesophageal reflux, eosinophilic disorders, and short bowel syndrome when medically necessary. Limits application to children of certain age, etc. EFFECTIVE DATE: 10/01/2008. Notes: This bill passed the Senate unanimously, but only made it through 1 of 3 assigned committees in the House.
Insurance/Mental & Substance-related Disorders - HB 19 and SB 164
Puts health insurance benefits for mental disorders in parity with other health disorders. The Senate version, which passed 2 of its 3 assigned committees, included eating disorders (bulimia and anorexia) in list of mental disorders covered. The House version, which unanimously passed the House, did not.