KEY STORY

House and Senate Release 2023-2024 Budgets

Week 3 of the legislative session saw the release of the House and Senate’s proposed budgets for the coming state fiscal year. In case you missed them, FHA provided alerts earlier this week on the House Health Care budget proposal and Senate Health Care budget proposal. We are extremely pleased to see no cuts to hospital Medicaid reimbursements, exciting investments in our nurse and physician workforce, significant resources for community mental health, and several targeted provider funding initiatives that are in the works. Hospitals are positioned strongly in the initial phase of the budget process because of the unified advocacy of our Association – read more below.

The Senate has released SB 2500 – General Appropriations Act, and we now have additional information on key funding issues that pertain to hospitals. The Agency for Health Care Administration budget totals $36.0B, of which $10.2B comes from General Revenue, accounting for 23.1% of the state’s General Revenue expenditure. Similarly, the Health & Human Services budget is $47.3B, with $14.8B from General Revenue, which makes up 33.6% of the state’s General Revenue spending. In contrast, the Education budget stands at $25.6B, with $19.7B derived from General Revenue, constituting 44.7% of the state’s General Revenue expenditure.

• No cuts to hospital Medicaid reimbursement for the care provided to Florida’s most vulnerable patients. – Continues to fund the LINE ($25 M) and PIPELINE ($100 M) nursing education programs at $125M total, ensuring that higher education institutions have the resources to train the next generation of nurses.
• Preserves supplemental payment programs including DSH, DPP, IME, and GME (more on GME below). The low-income pool has been shifted out of the budget and will require AHCA to submit a budget amendment.
• Medicaid Rate Increases included in the Senate Budget:
  • $76 M for children’s hospital’s rate increase
  • $29.7M representing a 15 percent rate increase for Community Mental Health and Substance Abuse Services
  • $15M for Medicaid Pediatric Behavioral Health Services Provider Rate increase
  • $92 M nursing homes quality component rate increase
• Significant Investments in Medicaid Graduate Medical Education
  • $93 million total for Statewide Medical Residency Program
  • Slots for Doctors – FHA is extremely encouraged by a newly proposed program related to Florida’s Medicaid GME. If SB 2510 is approved, a sum of $30 million, comprising $12.2 million from recurring General Revenue and $17.8 million from Federal Trust Funds, will be allocated towards the creation of the Graduate Medical Education Slots for Doctors program. As part of the program, qualifying institutions and hospitals that create new residency slots will receive a grant of $100,000 for each slot created. This initiative is expected to augment the state’s medical workforce and improve medical care and outcomes for Florida residents.
• Continues substantial investments in community mental health, including:
  • More than $1.3 B (including $523 M General Revenue) to the Agency for Health Care Administration for community mental health services
  • $294 million General Revenue for grants and aids for community mental health treatment
  • $117 million from the American Rescue Plan Act to reduce the cycle of hospitalization, homelessness, and incarceration by providing a comprehensive array of behavioral health services prioritizing those without health insurance.
  • More than $80 million for FACT Team reimbursement
  • $41 million for Community Action Teams that provide community-based services to children ages 11 to 21 with a mental health or co-occurring substance abuse diagnosis.

On Friday, the House releases HB APC1 – General Appropriations Act. See key hospital funding issues below. The Agency’s overall budget amounts to $35.2B, out of which $10.2B comes from General Revenue, making up 23.5% of the state’s General Revenue expenditure. In comparison, the Health & Human Services budget is $46.8B, with $14.7B of it from General Revenue, accounting for 34.0% of the state’s General Revenue spending. Lastly, the Education budget totals $28.5B, out of which $19.0B is funded by General Revenue, representing a substantial 44.2% of the state’s General Revenue expenditure.

• No cuts to hospital Medicaid reimbursement for the care provided to Florida’s most vulnerable patients.
• Continues to fund the LINE ($25 M) and PIPELINE ($100 M) programs at $125 M total ensuring that higher education institutions have the resources to train the next generation of nurses.
• Preserves supplemental payment programs including DSH, DPP, IME, and GME (more on GME below). The low-income pool has been shifted out of the budget and will require AHCA to submit a budget amendment.
• Medicaid Rate Increases included in the House Budget o $76.1M Rate Increase for Medicaid Pediatric Physician Services o $9M Rate Increase for ICF/IID level three individuals
  • $5.4M Medicaid Behavioral Health Services Rate Increase
  • $95.5M Nursing Home Quality Component Rate Increase
• Graduate Medical Education o $97.3 M for Statewide Medical Residency Program
  • $30 M for new Slots for Doctors program – matching the Senate’s investment
• Continues substantial investments in community mental health, including:
  • More than $1.3 B (including $523 M General Revenue) to the Agency for Health Care Administration for community mental health services
  • $280 M general revenue for grants and aids for community mental health treatment
  • Provides a lump sum of $21 M general revenue for expanded community-based supports including CAT, FIT, and FACT teams
  • More than $80 million for FACT Team reimbursement
  • $41 million in general revenue for Community Action Teams that provide community-based services to children ages 11 to 21 with a mental health or co-occurring substance abuse diagnosis.

STATE ADVOCACY

Capitol Update

Visit https://fhacapitolupdate.org/ to access FHA materials and communications during the 2023 legislative session.

• One Pagers & Issue Briefs on key hospital priorities
• Access our session-related alerts and newsletters archive
• Bill-tracking report

Legislation Protecting Hospital Employees from Violence Continues Moving

FHA-sponsored legislation that would enhance criminal penalties for those who assault or batter any hospital employee is still moving promisingly through the legislative process. SB 568 by Senator Ana Maria Rodriguez was reported favorably by the Senate Health Policy Committee on Monday – the bill needs to clear one more committee to reach the full Senate for a vote. FHA continues to organize meetings with the bill’s sponsors, key committee chairs, and legislative leaders to educate on the severity of existing workplace violence and create a path forward for the bills. The Justice Appropriations Subcommittee will hear the companion bill, HB 825 by Representative Berfield, on Monday, March 27.

Year 2 Directed Payment Program (DPP) Disbursements

FHA has received notice that DPP funds for year two will be disbursed to health plans by the end of March. This will allow the Agency to benefit from the enhanced FMAP of 6.2 percent. Upon receiving the funds from the Agency, health plans will have 30 days to distribute them to hospitals. Initially, the payments will cover 94 percent of the total DPP payment and will exclude the six percent quality measure withhold. The additional six percent quality measure funds will be disbursed by June 30th.

To ensure timely receipt of the DPP payments, hospitals that have not received such payments in the past are advised to contact both the Agency and the health plans they contract with.

Governor Signs Tort Reform Legislation

A major piece of legislation aimed at addressing frivolous litigation was signed into law by Governor DeSantis today. Earlier this week the Florida Senate passed SB 236 Civil Remedies by Senator Hutson the House version (HB 837) was passed by that chamber last week.

The bill, a major priority of Speaker Paul Renner, has several implications for hospitals, both as providers and businesses, though it does not generally seek to address medical malpractice law. Some of the provisions FHA members should be aware of include:

• The elimination of one-way attorney’s fees in the context of PIP payments
• New rules regarding evidence that may be introduced to prove damages
• Consideration of the fault of intentional actors in premise liability cases
• Revised contributory negligence rules that exclude medical malpractice cases.

For more information, we encourage you to refer to the FHA member alert sent Monday.

Coverage Increases for Florida KidCare Program

FHA-supported legislation is moving that would increase the income eligibility threshold for the Florida KidCare program, allowing some of the individuals who are soon to be disenrolled from Medicaid to find coverage through this critical safety net. Specifically, the bill raises the eligibility threshold for children aged 1-18 from 250% of the federal poverty level to 300% of the federal poverty level. FHA EVP of Public Affairs David Mica, Jr. testified in support of HB 121 by Representatives Trabulsy and Bartleman as it passed favorably through the House Health Care Appropriations Subcommittee this week.

Medicaid Redeterminations are set to resume at the beginning of April when the state will reevaluate Medicaid eligibility for hundreds of thousands of Floridians who have enrolled in the program since the beginning of the COVID-19 pandemic. It has been reported that as many as 900,000 individuals will be removed from the Medicaid rolls. Additionally, the federal government will begin to phase out the enhanced federal match that states have received for several years.

Coming Soon: PBM Legislation to Be Taken Up by House and Senate Committees

SSB 1550 – Prescription Drugs by Senator Brodeur has been placed on the Senate’s Health Policy Committee agenda and is set to be heard on Monday, March 27th, at 3:00 p.m. Its companion bill, HB 1509- Prescription Drugs by Chaney, has not yet been placed on the House’s Healthcare Regulation Subcommittee, but FHA expects it to be heard on Wednesday, March 29th. FHA is closely monitoring the progress of SB 1550/HB 1509 as this legislation backed by the Governor is crucial to prohibit white bagging practices by insurers and institute necessary transparency within prescription drug pricing.

FHA-supported Workforce & Behavioral Health Bills Pass Key Milestones

SB 274 – Nursing Education Pathway for Military Medics by Senator Avila was passed by the full Florida Senate this week. The bill provides educational and training equivalencies so that military personnel can make the transition into Florida’s civilian health care workforce. Hospitals and health systems are contending with severe turnover and vacancy rates amongst nurses, and FHA welcomed the opportunity to work with Senate leaders to pass this important legislation.

SB 914- Suicide Prevention by Senator Garcia (I) was reported favorably by Senate Health Policy this week. Specifically, the bill extends the Commission on Mental Health and Substance Abuse’s statutory repeal date from September 1st, 2023, to September 1st, 2026. The Commission’s extended statutory repeal date allows the members of the Commission to provide extensive findings and recommendations on how to provide and facilitate mental health and substance abuse services in Florida. FHA was also pleased to see HB 655, the companion bill by Rep. Trabulsy, passed through its second committee on Friday.

6-week Ban on Termination of Pregnancies Heard by Senate Health Policy Committee

Legislative leaders and the Governor have indicated their support for adjusting the existing ban on termination of pregnancies from 15 weeks gestational age down to 6 weeks gestational age. SB 300 Pregnancy and Parenting Support by Senator Grall was approved by the Senate Health Policy Committee on Monday – the House version has received only one hearing so far. FHA has been gathering feedback from member hospitals regarding this legislation and we encourage you to reach out to us with comments.

Legislation on Gender Clinical Interventions Makes First Committee Stops

Legislation moving in both chambers would define and prohibit gender clinical interventions for minors. Under SB 254 & HB 1421, gender clinical interventions mean procedures or therapies that alter internal or external physical traits, including sex reassignment surgery and hormone-altering drugs. The bills exclude treatment for medically verifiable genetic disorders of sexual development or treatment of injuries caused by a gender clinical intervention. The bill also adds informed consent requirements for adult patients who undergo gender clinical interventions. The bills also prohibit health insurance coverage for gender clinical interventions and prohibit individuals from modifying the sex on their birth certificate.

FHA is closely monitoring this legislation for any impacts on hospitals.

FHA to Launch Survey to Support Payer Accountability Initiatives

Last week, the FHA Board of Trustees approved partnering with the Ohio Hospital Association to use their Payer Scorecard survey platform to collect data on Florida health plan performance from FHA member hospitals. They also strongly recommend all FHA member hospitals participate and approved FHA will be underwriting the cost so there is no financial barrier to participating. Having data on the timeliness of payment, denials, prior authorizations, appeals, and other operational issues is crucial for FHA to address the health plan abuses being experienced by Florida hospitals.

Please join us on April 5, 10:00 -11:00 a.m. (ET) to learn more about this new initiative.

Higher Education Appropriations Subcommittee Meeting

On March 21st, the Higher Education Appropriations Subcommittee, Chaired by Representative Jason Shoaf, released the initial House budget proposal. Below are some highlights of the committee’s budget proposal on workforce education, recruitment, and retention.

The proposal includes $23,881,269 for workforce education to provide increased funding to school district career colleges and technical centers to support career and technical education, apprenticeship and pre-apprenticeship programs, and other workforce workload needs. The proposal includes $5,000,000 for Student Success In Career and Technical Education (CTE) Incentive Funds to provide funds for a new performance incentives program, based on Career and Technical Education, for school districts and technical colleges. The proposal also includes $50,000,000 for a new State University System performance-based recruitment and retention incentive program.

Appropriations Committee on Education March 21st

On March 21st, the Appropriations Committee on Education, Chaired by Senator Keith Perry, released the initial Senate budget proposal. Below are some highlights of the committee’s budget proposal on workforce education, recruitment, and retention. The proposal includes $44,511,230 for workforce development and $5,000,000 for Student Success in Career and Technical Education (CTE). The CTE incentive program provides funds for a new performance incentives program, based on Career and Technical Education, for school districts and technical colleges. The proposal also includes $295,000,000 for a new State University System performance-based recruitment and retention incentive program.

DCF Announces $21 Million in Available Grant Funding to Enhance Florida’s Behavioral Health Systems

On Monday, The Department of Children and Families announced $21 million in available grant funding to invest in the mental health crisis in Florida for select managing entities with the purpose to enhance the state’s behavioral health system. The funding will assist in recruiting and maintaining behavioral health professionals. The grants are aimed at psychology and social work professionals, such as social workers, marriage and family therapists, mental health therapists, psychiatrists, and certified peer specialists.

Additionally, the funding will assist in addressing community needs for crisis services by deploying a three-pronged approach focused on prevention, intervention, and recovery. The goal is to ensure that individuals receive appropriate and quality care within their communities by supporting the workforce that delivers these critical services.

The grant will be implemented through Northwest Florida Health Network, Southeast Florida Behavioral Network, and Central Florida Behavioral Health Network Managing Entities, and available for providers in their service area to apply and be awarded based on the development of sustainable strategies, plans, and actions to address the workforce challenges in the behavioral health labor force.

FHA continues to advocate for the expansion of our workforce across the state by investing in recruitment and retention initiatives. DCF grant provides opportunities for more individuals in the behavioral health system to access high-quality and appropriate care by trained professionals.

For more information please visit: Click Here.

FHA Hosts Call on AHCA Patient Safety Survey Requirement

This week, FHA hosted a webinar with AHCA to review the new requirement for hospitals to conduct and submit patient safety culture data. AHCA staff reviewed the rule, the survey instrument, and the process for submitting data, starting in June 2025. There are still outstanding issues, which FHA will work with AHCA staff to get resolved. You can access a recording of the call here and the slides here.

MQA Provides Information to Practitioners on Fraudulent Emails

The Florida Department of Health, Division of Medical Quality Assurance (MQA), warned Florida health care practitioners about a fraudulent email and phishing attempt sent to Florida healthcare practitioners.

Scammers are posing as the Department and offering to provide licensees with “important information” concerning a temporary change to your license status. MQA informed practitioners this email did not originate from the Department. Healthcare practitioners will never receive unsolicited calls or emails from the Department where personal information is requested, payments are demanded, or threats against your license are made. If a practitioner received an email that looks suspicious, they are advised not to click on any links or attachments or provide any personal information. If you have any questions, please contact MQA’s customer contact center at (850) 488-0595.

FHA Hosts Call on Building Partnerships to Build a Nursing Pipeline

FHA and the CNO Leadership Council of the Florida Organization for Nurse Leaders (FONL) partnered in bringing together hospital nursing leaders and nursing academia to share strategies and “best practices” for strengthening partnerships to help build a nursing pipeline of qualified and competent nurses. A panel of nurse executives and educators statewide joined in a panel presentation to share their strategies and outcomes.

Key takeaways from the program included:

• The importance of partnering with Nursing education programs to help align clinical and preceptor capacity in the hospital and the academic environment.
• Leveraging technology to help attract experienced nurses back to the workforce and help optimize the clinical experience for students and transition to practice for newly licensed nurses.
• The strength of partnerships between hospitals and nursing program institutions will enhance the quality, competency, and capacity of the next generation of nurses.

If interested in hearing what nurse executives and nursing program leaders had to say, you may access the slides here and recording here.