Tag Archives: assisted living

Healthcare Providers: Florida Legislature Expands Scope of Practice for Pharmacists and APRNs

On March 11, 2020, just two days before the end of the 2020 Florida Legislative Regular Session, the Legislature passed two bills which have special significance given the escalation of fear related to COVID-19 or Coronavirus disease. House Bill (“HB”) 389 expands the practice of pharmacists by allowing them to test and treat patients for certain chronic medical conditions and minor, uncomplicated acute medical conditions. HB 609 authorizes qualified advanced practice registered nurses (“APRNs”) to independently operate primary care practices without physician supervision.

Both bills were signed within hours of passage by Governor DeSantis, but the new laws will not take effect until July 1, 2020, which could be after the Coronavirus pandemic has hopefully lessened, but too late to respond to the immediate need for additional healthcare providers in those Florida counties which have declared a state of emergency due to Coronavirus. When the new laws go into effect this summer, Florida will join seventeen other states with expanded pharmacist practice, and twenty-one states and the District of Columbia with independent practice status for APRNs.

The new laws will have profound effects upon the delivery of healthcare in Florida, including some good, some bad, as well as the predictable and unpredictable. Looking specifically at senior living facilities, APRN expanded practice should have beneficial effects including the reduction in unnecessary hospitalization of long-term care patients. The hospitalization of elderly patients often causes irreversible decline in function and exposes them to hospital-acquired illnesses and delirium. An expanded practice APRN will allow for more timely diagnosis and medical treatment when a patient has a change of condition in the long-term care facility. The APRN can intervene and treat the patient in place at the facility, instead of transferring the patient to the hospital for assessment. Thus, expanded practice APRNs will play a valuable role in caring for the long-term care patient and reducing costly and unnecessary hospital admissions.

Florida’s new law requires that APRNs have at least 3,000 hours of experience and completion of graduate courses in pharmacology and differential diagnosis to be qualified to autonomously provide services in family medicine, general pediatrics, and/or general internal medicine. Likewise, the new law requires pharmacists to enter into collaborative agreements with physicians before the pharmacist is qualified to treat chronic conditions including asthma, arthritis, and obesity and also to test for and treat patients for minor, uncomplicated acute conditions including influenza, strep throat, lice, ringworm, and athlete’s foot. Accordingly, only subsets of Florida’s 20,175 licensed APRNs and 20,510 licensed pharmacists will benefit from the new law. It is likely that many of those APRNs and pharmacists that are otherwise qualified to expand their practices will decide not to do so because of factors including professional liability costs.

Proponents of the new legislation believe it will improve the timeliness and access to medical care by giving Floridians more options for treatment. For example, Floridians living in rural areas, where they are often underserved, will now have improved access to healthcare in their own communities. Proponents make good points because some experts estimate that by 2030 Florida will have a shortage of 4,671 primary care providers (“PCPs”) unless something is done. Those opposed argue that the new laws authorize pharmacists, which are generally not formally trained in medical diagnoses, to practice medicine. The opposition is also concerned that there will be a dangerous expansion in APRNs’ scope of practice where they will be challenged to properly diagnose and treat life-threatening conditions.

The Florida Medical Association, which represents physicians, opposes the new laws because they allow individuals without sufficient training to practice medicine. In contrast to that position many individual physicians are optimistic about expanded practice because they believe it will allow patients to obtain medical care from more and different sources which in turn will allow physicians to concentrate on the more serious and chronic medical conditions.

Dr. Steven D. Brownlee is a health law attorney with Williams Parker. He focuses on assisting healthcare and senior living providers with their operational and regulatory matters, including professional licensing, compliance planning, Medicare/Medicaid issues and appeals, DEA issues, and provider contracting. Prior to practicing law, Steven practiced medicine and medical management consulting. He can be reached at sbrownlee@williamsparker.com or (941) 552-2567.

Final Section 199A Regulations Provide Little Guidance for Skilled Nursing and Assisted Living Facilities

The final Section 199A regulations, which were promulgated on January 18, 2019, make several clarifications to the rules regarding specified service trades or businesses (“SSTB”). Over certain taxable income thresholds, SSTBs are not eligible for the Section 199A deduction. The performance of services in the field of health is an SSTB and is defined in Section 1.199A-5(b)(2) of the final regulations as “the provision of medical services by individuals, such as physicians, pharmacists, nurses, dentists, veterinarians, physical therapists, psychologists, another similar healthcare professionals performing services in their capacity as such.” The operation of health clubs or health spas, payment processing, or the research, testing, manufacture and sales of pharmaceuticals or medical devices are not within the field of health.

Many commentators to the proposed regulations, including Williams Parker, noted that many of the services provided by skilled nursing facilities and assisted living facilities are unrelated to health care, including housing, meals, laundry, security, and socialization activities. Unfortunately, Treasury declined to issue specific guidance as to whether the owners of skilled nursing, assisted living, and similar facilities are performing services within the field of health, and noted that the issue “requires a facts and circumstances inquiry that is beyond the scope of these final regulations.”

However, the final regulations added an example in Section 1.199A-5(b)(3)(ii) of a senior housing facility that is not engaged in the field of health. In the example, the senior housing facility provides its residents with standard domestic services (including housing management and maintenance, meals, laundry, and entertainment), but all medical and health services (including skilled nursing, physical and occupational therapy, speech-language pathology, medications, medical supplies and equipment, and ambulance transportation) are provided through separate professional healthcare organizations. All of the health and medical services are billed directly by the healthcare providers to the senior citizens even though the services are provided at the facility. Unfortunately, the final regulations do not address a scenario where the facility invoices the senior citizens for the health and medical services on behalf of the healthcare providers.

View the final regulations.

This post is one in a series of posts on the 199A regulations. 

Michael J. Wilson
mwilson@williamsparker.com
941-536-2043