Governor DeSantis Kicks off 2023 Session
Florida’s 2023 Legislative Session is underway in Tallahassee. Governor DeSantis gave his State of the State Address on Tuesday before the legislature officially convened in session.
- Governor DeSantis lauded Florida as a national leader with a focus on our fast-growing population and economy. He discussed key reforms he has led such as tax relief, immigration, education, and infrastructure. On health care, the Governor referenced his support for PBM regulations and record funding for the development of new nurses to meet the existing shortage.
FHA is looking forward to a productive session for hospitals and health systems. As a reminder, you can access key FHA communications, collateral materials, and bill tracking at https://fhacapitolupdate.org/.
Don’t forget – FHA Hospital Days is next week, March 15-16, in Tallahassee! Please register in advance if you plan to attend.
FHA Holds Key Meetings on Workplace Violence
This week FHA and its members worked to secure crucial committee hearings for SB 568 & HB 825 – Assault or Battery on Hospital Personnel– on Monday, March 13. Backed by FHA, the bills would enhance criminal penalties for those who assault any hospital personnel, not just those working in the emergency department. The bills protect hospitals’ ability to provide high-quality care by creating a no-tolerance atmosphere and deterring violent offenders.
FHA and member hospital staff met with sponsors Senator Rodriguez and Representative Berfield to provide briefing materials, show support for the bill, and answer any of their questions. We also organized meetings with committee chairs Senator Martin and Representative Truenow to ensure the bills were introduced for consideration. Both chairmen were supportive of the measure and focused their questions on the intended effects of these enhanced penalties. FHA and its members shared that not only will these bills deter future offenders, but it also creates a legal environment that discourages lenient plea bargains.
FHA encourages members to reach out to [email protected] as we organize attendance and testimony at these key hearings on Monday.
Major Legislation introduced regarding Immigration and Abortion
Tuesday, March 7, was the bill filing deadline for this year’s legislative session. With the deadline came two bills that FHA has been monitoring. The first is a reduction in the permissible time period during which a pregnancy may be terminated. The second requires hospitals to seek information regarding the immigration status of their patients. These rules are summarized below.
An Act Relating to Pregnancy and Parenting Support (HB 7/SB 300) HB 7, among other things, amends the state’s “Termination after Pregnancy” statute (390.0111) by reducing the permissible time period for a physician to terminate a pregnancy from 15 weeks to 6 weeks. With that reduction come a few modifications and additions to the existing exceptions. The bill, which generally prohibits the expenditure of state funds for terminations of pregnancy makes an exception for “medical necessity for legitimate emergency medical procedures…to save the pregnant woman’s life or avert a serious risk of imminent, substantial, and irreversible physical impairment”
An Act Relating to Immigration (HB 1617/ SB 1718) The Immigration bill, filed by Rep Michael and Senator Ingolia, appears to be a codification of the data collection requirements initially implemented in the Governor’s Executive Order on Immigration.
The bill requires all hospitals that accept Medicaid to include a provision on patient registration forms to indicate whether or not the patient is a United States citizen or lawfully present in the United States. Hospitals must also submit to the Governor, Senate and House, the total number of hospital admissions in each of the three categories (U.S. citizen, lawful entrant, unlawful), the cost to care for those patients, and a description of how caring for those patients may have impacted the hospital’s ability to provide other services.FHA will continue to monitor the bills as they move through the committee. We encourage you to review them with appropriate members of your team and reach out to David Mica at [email protected] with any feedback.
FHA Meets with Agency for Health Care Administration Leadership
FHA and Agency for Health Care Administration leadership met this week to continue conversations on key hospital topics of interest. FHA President & CEO Mary Mayhew discussed the role that FHA plays as a convener and communicator to supplement the work of the Agency. Secretary Weida and his newly reorganized staff provided updates on their work ahead of the 2023 session. Deputy Secretary Kim Smoak facilitated a thoughtful discussion on creative methods hospitals are using to attract and retain nurses and other skilled health care professionals such as daycare and housing assistance. FHA looks forward to continuing our work with Agency to ensure hospitals and health systems’ priorities are represented amongst key regulators.
Major Lawsuit Reforms nearing passage in both chambers
FHA-supported legislation seeking major revisions to Florida’s legal climate is nearing passage in the House and moved promisingly through its first Senate Committee this week. FHA supports the bills and continues to ensure that hospitals’ analysis is communicated to the legislature. Among many provisions, HB 837 and SB 236 would:
- Eliminate one-way attorneys fees for all lines of insurance to disincentivize frivolous lawsuits
- Provide transparency in damages that show the amount typically accepted for a medical procedure
- Modernizes “bad faith” laws to balance the scales between the plaintiff’s attorneys and businesses
These bills are closely backed by Speaker Paul Renner and will continue to move swiftly through the legislative process. FHA will continue to keep members informed of their progress.
Nursing Pathway for Military Medics Continues its progress
The FHA-supported bill, SB 274 – Nursing Education Pathway for Military Combat Medics passed by the Senate Rules Committee on March 8th by a unanimous vote. The objective of the proposed legislation is to support pathways and programs for retired military medics that will help with their transition to the civilian healthcare workforce and provide a process for establishing a standardized and uniform protocol for these veterans to receive credit for their training and experience.
The companion bill HB 517 – Nursing Education for Military Combat Medics was presented by Representative Joel Rudman and was unanimously reported as favorable on March 7th. The bill now moves on to the Education & Employment Committee. A closing quote from Representative Rudman made a powerful statement when asking for support of the bill, “So I think of no finer way to show our respect than by allowing our heroes who have proven themselves time and time again on the frontlines of Afghanistan and Syria, let’s allow them to come home and serve on the frontlines of America’s health care system, where they are truly needed.”
Regulatory Bills impacting hospitals make first committee stops
FHA is monitoring two bills concerning hospital regulations that made the first committee stops this week. SB 380 Surgical Smoke by Garcia would require hospitals to implement surgical smoke remediation devices. FHA continues to work with legislators to inform them that many hospitals operate or are implementing these systems. FHA will work to achieve more time for implementation and protect against requirements that could pose financial burdens for rural hospitals.
SB 870 Surrendered Newborn Infants by Burton permits but does not require, hospitals to receive surrendered newborns via an infant safety device. FHA has worked on this issue over the last two sessions and will continue to keep members informed of its progress.
Senate President-backed Affordable Housing Legislation Moving
SB 102 by Senator Calatayud, known as the “Live Local Act,” is an initiative backed by the Senate President to provide rent and tax relief and improve the availability of affordable housing in Florida. This measure has significant legislative and executive support and will be moving quickly through the process early in session.
FHA supports efforts to improve Florida’s housing climate because as large employers, hospitals need to recruit and retain quality personnel to work in our facilities and live in our state. Many hospitals provide housing assistance or work with local developers to facilitate the availability of housing for their staff. FHA will continue to monitor the progress of the bill and keep members informed.
FHA Speaks at Kaiser Nursing Task Force Press Conference
In 2022, FHA President and CEO, Mary Mayhew joined the Keiser University Nursing Advisory Council. This Council is made up of government officials, educational leaders, and healthcare industry experts who would collaborate to help address Florida’s nursing shortage crisis. The purpose of the Nursing Advisory Council was to address the nursing shortages that affect the state of Florida.
Yesterday, FHA proudly represented hospitals in the Keiser University Nursing Advisory Council press conference at the Florida Capitol with key legislators and CFO Jimmy Patronis. Danielle Scoggins, Vice President of Policy and Strategic Initiatives spoke about the importance of building the workforce pipeline with parallel efforts to recruit and retain nurses. FHA’s remarks focused on workforce housing, PIPELINE/LINE funding, and career education pathways through DOE/school district partnerships. We look forward to working with the Florida Legislature to ensure we are strengthening the pipeline of Florida’s health care workers.
Rural Hospital Capitol Improvement
FHA is advocating for funding to be re-introduced to the Rural Hospital Capital Improvement Grant program in 2023. The program exists in statute but has not been funded since 2008. In a survey of rural hospitals across the state, twelve respondents reported a total need of over $66 million during the next three years. This information will help us communicate the need for and future usage of these funds should the legislature appropriate money to the program. Senator Cory Simon and Representative Jason Shoaf are championing this issue and we encourage members to reach out to them in support.
Worker’s Comp Inpatient Reimbursement Rule Upheld by Administrative Court
On Thursday, a Florida administrative law judge (ALJ) upheld a proposed change to the Florida Workers’ Compensation Reimbursement Manual setting maximum reimbursement allowances (MRA) for inpatient hospital care. The final order sided with the state division of workers comp, and multiple hospital interveners including the Florida Hospital Association.
At issue in the case was a per diem fee schedule, setting the inpatient MRA at three reimbursement tiers. The proposed MRAs are as follows: Tier 1 is reimbursed at $7,000/day and includes non-surgical stays; tier 2 is reimbursed at $11,000/day and covers surgical stays; and tier 3 is reimbursed at $13,000/day for intensive and coronary care. Insurance carriers sued the Department of Financial Services (DFS), alleging that the proposed MRAs are arbitrary and capricious.
In his ruling ALJ Darren A. Schwartz, found that “the Proposed Rule is supported by logic, facts, was adopted with thought and reason, and is rational.” With that ruling, the DFS is expected to file the rule for adoption soon. The insurance companies may appeal the ruling, and if they do, they will likely seek an injunction or request that DFS stay under the enforcement of the rule.
FHA Monitors Behavioral Health Legislation
The House Subcommittee on Children, Families, & Seniors heard two bills that will serve as a starting point to strengthen and modernize the current behavioral health system. Representative Trabulsy introduced HB 655: Suicide Prevention, the bill would broaden the purpose and duties of The Commission on Mental Health and Substance Abuse to include assessment and recommendations for Florida’s National Suicide Prevention Lifeline (NSPL) infrastructure, commonly known as, the 988 Suicide & Crisis Lifeline. The bill also expands the Commission’s duties to identify available funding opportunities through the Medicaid program for crisis response services. Lastly, the Commission’s name will be changed to the Commission on Mental Health and Substance Use Disorder and extends the work of the Commission to January 1st, 2025. The final report from the Commission would be submitted to the Florida Legislature and Governor by September 1st, 2026. Dr. Jay Reeve, Commissioner and Chair of FHA’s Behavioral Health Council spoke in support of the bill and commended the implementation of the recent requests of the Commission to continue their work to provide working solutions to the behavioral health system.
Representative Silvers presented HB 829: Operation and Administration of the Baker Act, passed favorably by the committee. The bill serves as a starting point in modernizing the Baker Act by requiring the Department of Children and Families to submit an updated Baker Act User Reference Guide to the department’s website annually by October 1st. The reference guide was last updated in 2014, despite recent revisions to the Backer Act since then.
FHA will continue to monitor these pieces of legislation and advocate for a modernized and data-driven behavioral health system.
January 2023 Revenue Report
The Office of Economic and Demographic Research (EDR) released the Monthly Revenue Report for January. General revenue collections for another consecutive month exceeded the forecast adopted in the summer. This month the gain over the estimate was $748.4 million for a cumulative total since August of over $2.4 billion. Most of the gain (89%) was attributed to sales tax collections. The January 2023 Monthly Revenue Report can be found here.
Salary Surveys Released
For more than ten years, FHA has been conducting comprehensive wage and salary surveys. You are invited to participate in the FHA Salary Survey, including the Management/Department Head and Non-Management surveys. These annual surveys provide the most comprehensive wage and salary data across all hospitals in Florida. The surveys are valuable for human resource executives and non-hospital organizations to keep pace with market fluctuations. The surveys were distributed this week; if you did not receive the survey, please reach out to Stephanie Scanlon at [email protected].
Please coordinate with your team to submit one response per hospital. Please respond to the survey by Thursday, April 14, 2023.
Social Services Estimating Conference: Medicaid Expenditures
The SSEC met on March 1st to adopt a new Medicaid expenditure projection and the results were posted this week. The new forecast accounts for the PHE unwinding and the impact on the current Medicaid caseload. Current Medicaid enrollment as of January 2023 is nearly 5.7 million recipients, and the new forecast drops this number in the next state fiscal year to approximately 4.7 million recipients. This is consistent with what FHA members heard during the statewide call with FHA and DCF on redeterminations. The impact of the decreased caseload combined with additional quarters of the increased FMAP through the end of the calendar year produced the following results:
- For SFY 2022-23: Additional General Revenue Surplus of $564.4 million from the previous estimate in August 2022
- For SFY 2023-24: $195.5 million General Revenue surplus from the base budget for the upcoming year
The new forecast will be incorporated into the upcoming General Revenue Conference next week and used in the House and Senate budget proposals this session.
You can find the materials here.
Hospitals Stand Up Against Violence
On March 3rd, Rick Pollack, President and CEO of the American Hospital Association (AHA) shared alarming statistics on the prevalence of violence in the United States and the impact it has had on the healthcare workforce and communities they serve. He cautions against accepting violence as the norm in our society and our healthcare environment. Last year, the AHA worked with Congress and advocated for legislation to ensure health care workers are given the same legal protections against assault and intimidation that flight crews and airport workers have under federal law. This year, AHA continues working to introduce similar legislation to get passed during this Congress.
Hospitals and health systems have an important role to play in preventing workplace violence in an environment that is intended for the hope and healing of our communities. Learn more about how hospitals are standing up to violence.
President Biden Releases FY 2024 Budget
On March 7th, President Biden released his proposed FY 2024 budget. Notably, the President’s Budget seeks to extend the life of Medicare Solvency by at least 25 years with no benefit cuts while lowering costs for Medicare beneficiaries.
The President’s Budget extends the life of Medicare without cutting benefits by increasing the Medicare tax rate on incomes above $400,000, closing loopholes in existing Medicare taxes, and crediting savings from prescription reforms to the Hospital Insurance Trust Fund.
In terms of lowering costs for beneficiaries, the President’s Budget proposes lower out-of-pocket costs for drugs subject to negation and a $2 cost-sharing for generic drugs for chronic conditions. Additionally, the Budget lowers behavioral health care costs in Medicare.
The President’s budget proposal is an opportunity for the executive branch to identify and amplify its spending priorities. However, given the makeup of congress, many of the President’s proposals to extend the solvency of the trust fund, especially those that would increase taxes or expand the ability of Medicare to negotiate drug prices, are unlikely to be enacted.
New CISA and FBI Cyber Advisories
The Cybersecurity and Infrastructure Security Agency (CISA), in partnership with the Federal Bureau of Investigation (FBI), published a joint Cybersecurity Advisory with recommended actions and mitigations to protect against Royal Ransomware used by threat actors. Attacks have spread across numerous critical infrastructure sectors including health care and public health providers.
CISA also released CISA Red Team Shares Key Findings to Improve Monitoring and Hardening of Networks. This advisory describes a red team assessment of a large critical infrastructure organization with a mature cyber posture. CISA is releasing this Cybersecurity Advisory (CSA) detailing the red team’s tactics, techniques, and procedures (TTPs) and key findings to provide network defenders with proactive steps to reduce the threat of similar activity from malicious cyber actors.
Hospitals and health systems are encouraged to apply the recommendations in the Mitigations section to ensure security processes and procedures are up-to-date and effective and enable timely detection and early mitigation of malicious activity.
ASPR Releases Cybersecurity Guide
The Administration for Strategic Preparedness and Response (ASPR) released the Cybersecurity Framework Implementation Guide, which provides specific steps that health care organizations can take immediately to manage cyber risks to their information technology systems. The guide provides recommendations, best practices, and resources to help the public and private health care sectors prevent cybersecurity incidents.
The cybersecurity implementation guide was jointly developed by ASPR and the Health Sector Coordinating Council (HSCC) Cybersecurity Working Group, elements of the Healthcare and Public Health Sector, a public-private partnership under Presidential Policy Directive 21. The National Institute for Standards and Technology (NIST) and other federal agencies contributed substantially to its content.
FHA President and CEO Mary Mayhew spoke with the State of Reform regarding FHA’s efforts to increase awareness about the Medicaid redetermination process. President Mayhew said, “FHA is working with our member hospitals, state agency partners, and community-based organizations to ensure that all individuals are aware of the impending changes to Medicaid eligibility redeterminations as a result of the end of the COVID-19 PHE and understand their options for coverage.”
FHA President and CEO Mary Mayhew discuss the crucial need for an increase in Medicaid reimbursements when speaking with the Florida Trend. President Mayhew said, “It’s really important to understand that the Medicaid program is a core part of this state budget, and it is supporting the purchase of care for the elderly, for the disabled, for low-income children and extremely low-income parents.”
FHA President and CEO explains the importance of timely access and increased funding for community-based mental health services when speaking with South Florida Sun Sentinel. President Mayhew said, “We know when people get timely access to community-based behavioral health services, it reduces preventable high-cost utilization of emergency rooms, along with hospital admissions and readmissions.”
Hospital Days 2023
The Florida Hospital Association’s (FHA) Hospital Days are returning to the state capitol on March 15-16, 2023. Join us in Tallahassee to show support for Florida’s health care heroes and engage with state lawmakers. Participants will engage directly with key state lawmakers, participate in our political briefings, and connect with the larger Florida hospital community. Special hotel block reservations can be made here through February 21, 2023. Register to attend Hospital Days now to reserve your spot!
Miami Open Offers Health Care Professionals a Special Invitation
One of the largest tennis tournaments in North America, the Miami Open will be hosted at the Hard Rock Stadium in Miami Gardens from March 22 through April 2, 2023. On Wednesday, March 29 and Saturday, April 1, all hospital staff are invited to attend the Health Care Professionals Day event. Tickets start at $50 each for the weeknight session or $65 for the daytime weekend session. Every health care professional who purchases a ticket and attends will receive a special Miami Open branded scrub top.
Infection Prevention Hot Topics: The Role of the Infection Preventionist in Addressing Health Care Disparities
March 14, 2023, 2:00 p.m. – 3:00 p.m. ET
Nursing Leadership: Building Partnerships to Build a Nursing Pipeline
March 23, 2023, 3:00 p.m. – 4:00 9.m. ET
Antidote Safety Pearls: Don’t Be A Fool, Use Your Antidote Tool: Quick Action Saves Lives
March 31, 2023, 2:00 p.m. – 3:00 p.m. ET
Infection Prevention Series: Fundamentals for the Novice Infection Preventionist
April 11-13, 18-20, 2023, 2:00 p.m. – 4:00 p.m. ET
Responding to a Crisis: An Overview of Lee Health’s Response to Hurricane Ian
April 17, 2023, 12:00 p.m. – 1:00 p.m. ET
Infection Prevention Hot Topics – Antibiotic Stewardship and What We Can Learn from Antibiograms
May 17, 2023, 2:00 – 3:00 p.m. ET
Infection Prevention Hot Topics – Ventilator-associated Events
June 20, 2023, 2:00 – 3:00 p.m. ET
Other Educational Programs of Interest
Recognizing Patient Safety Awareness Week (PSAW): Join the Institute for Healthcare Improvement (IHI) for free webinars in honor of PSAW, including “Back to Our Purpose: The Reboot of Safety” on March 14 and “Partnering with Patients to Improve Diagnostic Safety” on March 15.