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February 16, 2010
George F. Indest III, J.D., M.P.A., LL.M.
Proposed Limit on Dispensing Scheduled Substances
Florida State Representatives John Legg and Joseph Abruzzo have sponsored Florida House Bill 225 that would prohibit dispensing physicians from dispensing more than a 72-hoursupply of controlled substances listed in Schedules II, III, and IV. The proposed legislationamends Section 465.0276, Florida Statutes. The Florida Medical Association is seeking feedbackfrom dispensing practitioners on this proposed bill and how the proposed legislation would impactdispensing practitioners. A copy of this proposed bill is attached as Enclosure (1).
Physicians May Be Required To Report Patients' Disorders To State
Florida State Senator Stephen Wise of Jacksonville has introduced legislation that would require physicians to report patients with mental or physical disorders that could affect a patient'sability to drive safely. Under the proposed law, physicians would be required to report unsafedrivers to the Florida Department of Highway Safety and Motor Vehicles. The report would needto include the full name, date of birth, address and a description of the alleged disability of any person over fifteen (15) years of age having mental or physical disorders that could affect his orher driving ability. The proposed law provides physicians immunity from civil or criminal suitsbased upon filing a report.
Medicaid Overpayments
The Agency for Health Care Administration (AHCA) announced that it will begin withholding payments to Medicaid Providers beginning thirty (30) days following notice being sentto a provider of an alleged overpayment unless the provider has established a satisfactoryrepayment plan with the Agency. Medicaid will begin withholding payments to the providers evenwhen the provider has filed a petition for a formal administrative hearing. The Agency is alsorequired to terminate a provider's participation in Medicaid if the provider has not refunded anentire overpayment to the Agency within thirty-five (35) days of the Final Audit Report, or enteredinto a repayment agreement. Providers cannot appeal a termination based on failure to repay anoverpayment. Medicaid providers should consult their health care attorneys as soon as theyreceive notice of a Medicaid audit so that they do not risk losing their Medicaid provider status.
A notice sent out by AHCA to all Medicaid providers is attached as Enclosure (2).
Seroquel No Longer Approved For Adult Medicaid Patients
Florida Medicaid has removed Seroquel immediate release tablets from the Medicaid Preferred Drug List for patients eighteen (18) years of age and older. Florida Medicaid is askingphysicians and pharmacists to work together to switch adult patients from Seroquel to SeroquelXR. Seroquel immediate release tablets will remain on the Medicaid Preferred Drug List forpatients under eighteen (18), but over six (6) years of age. The Provider Alert is Enclosure (3).
21% Decrease In Physician Reimbursement Delayed
The 21% reduction in Medicare physician reimbursement has been delayed until March 1, 2010, by the Department of Defense Appropriations Act, 2010. House Bill 3961 has beenintroduced in Congress that would restructure the Sustainable Growth Rate (SGR) formula toincrease the fees paid to physicians under Medicare Physician Fee Schedule by about $195billion over the next ten (10) years. Pain Clinic Regulation
The Joint Rule Committee of the Florida Board of Medicine and the Florida Board of Osteopathic Medicine is still working on the proposed standards for physicians practicing inregistered pain management clinics. The Committee has been struggling with, among other issues,the training requirements necessary for physicians to safely practice pain management. Severalphysicians advocated for requiring all physicians practicing pain management in Florida to befellowship trained, while others stated fellowship training was not necessary to provide qualitypain medicine services or medication management. The Committee will have at least one more meeting before submitting a draft rule to the Boards for consideration.
The Joint Commission Continues Efforts to Adopt MS.01.01.01
The Joint Commission (TJC) posted MS.01.01.01 for field review beginning December 17, 2009, and running through January 28, 2010. The posted Standard is identical to the priorMarch 2009, draft. You can obtain the Standard, some useful FAQs and the definitions by goingto www.jointcommission.org/Standards/FieldReviews. You can even take the Field Reviewsurvey if so inclined.
The six week field review for adopting this new standard is shorter than usual. This reduced time frame, coupled with the fact that there has been no organized effort to modify theproposed standard suggests that it will probably be adopted as stated originally. TJC believes thatmaking the changes required in order to bring medical staff bylaws into compliance should not bedifficult for most hospitals and medical staffs. Note that any hospital medical staffs that havedeveloped separate fair hearing plans, credentialing manuals, etc., will now have to make sure thatthese are re-incorporated back into the medical staff bylaws. There are also key changes withrespect to the manner or methodology by which the organized medical staff can bypass the MECas well as the required development of a dispute resolution process.
HIPAA Privacy Rule Violations Being Prosecuted
We continue to receive reports on a regular basis of criminal prosecutions of HIPAA Privacy Rule violations. It is important to treat any complaints of violations of patientconfidentiality seriously and to retain experienced counsel if you receive a complaint from theOffice of Civil Rights (OCR).
Increased Scrutiny of Physicians Involved in Pain Management Practices
Over the past quarter, we have experienced a rise in consultations by physicians who are involved in treating pain medicine patients and are being prosecuted criminally or by investigationby the Florida Department of Health. We are seeing more DOH investigations being opened incases where the physicians are writing or renewing prescriptions for large quantities ofhydrocodone, Percocet, hydromorphone, Darvocet, Vicodin, Xanax, methadone, Soma and othercontrolled substances, especially in combination.
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