Key Story-Legislative budget proposals clear House & Senate Appropriations Committees
The House and Senate Appropriations Committees have unanimously approved their respective budget proposals, which will be considered by the full legislature during floor sessions next week. These budgets reflect a healthy Florida economy and recognize the crucial role of hospitals by maintaining Medicaid reimbursement for care provided to Florida’s most vulnerable, addressing the health care workforce shortage, and meeting the behavioral health needs of Florida’s communities. During the hearings, health care-related questions from legislators centered around the reduction in the Medicaid budget due to lower enrollment following upcoming Medicaid redeterminations and the change in LIP funding process which requires AHCA to submit a budget amendment to access the funds. Highlights from the House & Senate budgets as they stand:
- The House Budget ($113 B) totals $700 M less than the Senate’s Budget ($113.7)
- No cuts to hospital Medicaid reimbursement
- Protects hospital supplemental payment programs
- Both budgets fund LINE & PIPELINE for nursing education at $125 M
FHA is working on several important proactive budget items in order to secure crucial funding programs and resources for Florida’s hospitals.
- Rural hospital Capital Improvement – FHA has been communicating closely with Senator Cory Simon and Rep. Jason Shoaf to champion new funding for this existing DOH program. FHA continues to ask for $10 million recurring and $10 million nonrecurring funds to assist rural hospitals across the state.
- Rural Emergency Hospital – FHA is working with AHCA and the legislature to pave the way for a new ‘rural emergency hospital’ designation under Medicaid. This presents another option for rural hospitals to address any financial constraints.
- Florida Medicaid Hospital At home – FHA is advocating for AHCA to promulgate rules and provide reimbursement policies for hospital-at-home care. Florida hospitals who operate this program under the federal waiver would also benefit from state-level policymaking in this new innovative space.
Links to most recent budget bills and documents:
FHA-Sponsored Workplace Violence Legislation
HB 825 Assault or Battery on Hospital Personnel was reported favorably by the House Justice Appropriations Subcommittee this week. Nurse leaders from Baptist Health and FHA Executive Vice President of Public Affairs David Mica testified in support of this legislation. Questions from committee members continue to focus on circumstances where an individual acts violently due to a mental health crisis – but testimonials from the sponsor and FHA members ensured the committee understood the intent of the bill and voted favorably.
This legislation and its companion (SB 568) need one more hearing to reach the full chamber floors. FHA continues to work with Chairs of the next committee stops Rep. Gregory and Senator Mayfield to secure these hearings and we encourage members to share support for the bills with your local delegations.
PBM reforms receive first hearings
This week, SB 1550 and HB 1509 were both approved by their first committee references in high-profile hearings. The bills would address Pharmacy Benefits Managers’ drug pricing offenses (spread pricing, claw-backs, etc.) and prohibit harmful insurer policies such as “white bagging” and “brown bagging” of prescription drugs. FHA has worked closely with lawmakers to educate on the consequences of white bagging prohibitions over multiple years and are extremely encouraged by the language included in both bills. These policies can delay or disrupt crucial treatment for individuals with complex illnesses and were a key topic of discussion during this weeks’ hearings.
FHA supports the legislation and will continue to monitor for amendments that could impact hospitals.
ProPublica Uncovers Cigna Physicians Reject Claims by Click and Submit
Addressing health plan accountability is a strategic focus of the FHA, especially as challenges with health plans escalate. Claims denials create issues for both patients and providers, with little recourse to get them overturned. Last week, ProPublica reported on the egregious practice being used at Cigna which allows their medical directors and physicians reviewers to reject claims based on medical necessity without opening the patient file. Data uncovered revealed a practice of Cigna tracking the number of patient claims reviewed by their medical directors each month, noting one physician denied 121,000 claims in a two month period, with one former medical director noting it took 10 seconds to do 50 claims at a time. You can read the article at How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them — ProPublica. This article highlights the need for good data on health plans.
Please join us on April 5, 10:00 -11:00 a.m. EDT. Register here to learn about a new FHA initiative to support our efforts to address health plan abuses and issues.
Workforce Housing Bill Signed Into Law
On March 29th, Governor DeSantis signed SB 102, the Live Local Act, into law. This bill invests $711 million in multiple programs to expand the availability of housing, downpayment assistance, and focused support for military communities. The bill includes $100 million for the Florida Hometown Heroes Housing Program to provide down payment and closing cost assistance to first-time home buyers with a focus on health care professionals, law enforcement, first responders, teachers, active duty military, and military veterans.
Health Care Regulations Subcommittee Meeting 3/28/2023
The following hospital-impact bills were approved by the Healthcare Regs Subcommittee for their first hearing on Tuesday. This committee will meet for its final hearing on April 3rd.
Payment of Health Insurance Claims (HB 1335) – FHA appreciates and supports this legislation by Rep. Rudman which would prohibit the practice of retroactive denial of claims by health insurers – except in the case of a fraudulent claim. Reducing plan policies that withhold critical resources or create administrative delays is a key focus of FHA. The bill was amended to exclude Medicaid Managed Care Plans – however, Rep. Rudman indicated he intends to address them with a future amendment to the bill.
Foreign Licensed Physicians (HB 1145) – FHA continues to monitor this legislation which would exempt graduates of foreign medical schools from completing an approved residency in certain instances. A comprehensive amendment passed by sponsor Rep. Snyder reduces the complexity of the bill – which was opposed by several medical groups in attendance at the hearing.
Health Care Expenses (HB 1413) – FHA has been communicating with legislators on health care transparency for many years – with the aim of providing consumers with meaningful information about the price and quality of health care services. Rep. Tramont’s bill contains provisions requiring the posting of shoppable services, a good-faith estimate for each service, and regulations on hospital debt collection practices. As we have explained in the past – this legislation is largely duplicative of federal laws and is unnecessary to the delivery of quality care in Florida. The Senate companion bill will be heard on Tuesday, April 4th.
Telehealth Legislation (HB 267) – FHA-supported legislation that reduces the regulatory and administrative burden that detracts from patient care is moving through the Florida House. HB 267- Telehealth Practice Standards by Representative Fabricio was reported favorably by its first committee stop, Healthcare Regulation. Specifically, telehealth is not a type of health care service but rather a mechanism for delivering health care services in a non-traditional manner. Current healthcare practitioner licensure law broadly defines telehealth as a telehealth provider’s use of synchronous or asynchronous telecommunications technology to provide particular healthcare services. Despite past legislation, this bill aims to revise the definition of telehealth to include telephone calls in the licensure authorization. FHA strongly supports HB 267 and its companion SB 298.
Florida Kidcare Program Eligibility
HB 121- Florida Kidcare Program Eligibility by Representative Bartleman was reported favorably by its final committee, House Health & Human Services. The House Chamber will vote on it in the coming days. 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 strongly supports this bill as it would increase the income eligibility threshold for the Florida KidCare program, allowing some individuals who will soon be disenrolled from Medicaid to find coverage through this critical safety net.
FHA staff meets with lawmakers each week to build relationships and advocate for member hospitals and health systems. This week FHA staff, David Walker CEO of George E. Weems Memorial Hospital, and Chris Schmidt CEO of Doctors’ Memorial Hospital met with Senator Corey Simon. The Rural Hospital CEOs discussed vital issues such as Rural Hospital Capital Improvement Grant Program and Rural Emergency Hospital Designation.
Additionally, FHA staff and Baptist Hospital Nurses met with Representative Berfield this week to discuss workplace violence issues that are constantly present in the healthcare workforce.
Other key legislators FHA met with this week include Senator Bradley, Senator Rouson, Rep. Campbell, Rep. Payne, and Rep. Waldron.
Legislation Moving on Group Health Plans
SB 940 & HB 897 would make it easier for bona fide groups to qualify as multiple-employer welfare arrangements by outlining the structure, purpose, and intended recipients for these entities. FHA appreciates opportunities in the legislature to expand access to commercial health insurance coverage and provide more access to care for Florida’s residents. Both pieces of legislation were approved by their first committee of reference, and FHA will keep members informed of their progress.
Gender Clinical Interventions & Termination of Pregnancies
Legislation prohibiting gender clinical interventions for minors and requiring informed consent for adults will be voted on by the full House and Senate chambers in the coming days. 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 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.
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. The bills maintain certain exceptions at 15 weeks gestational age and do not change statute related to exceptions for the life or health of the mother in emergencies and nonemergencies (lines 139-152). HB 7 Pregnancy & Parenting Support by Persons-Mulicka was approved by the House Health & Human Services Committee on Thursday – which means both versions will head to the chamber floors in the coming weeks. FHA has been gathering feedback from member hospitals regarding this legislation and we encourage you to reach out to us with comments.
FHA Joins Other Provider Groups in Letter to Florida Congressional Delegation on DPP
On March 20, the Florida Hospital Association joined the Safety Net Hospital Alliance of Florida and Florida’s Essential Healthcare Partnerships, in a letter urging Florida’s congressional delegation to call for the Centers for Medicare and Medicaid Services (CMS) to rescind its February 17 bulletin regarding funding of Medicaid programs like the state’s directed payment program (DPP). The CMS bulletin interprets federal law to prohibit certain private arrangements between providers related to the funding of the non-federal share of DPP style programs, regardless of state involvement. The bulletin charges states to take steps to curtail applicable arrangements. In FHA’s letter we noted that the bulletin “represents sudden and unexpected new federal policy, and it creates uncertainty around a program that provides a lifeline to the hospitals who care for those most in need.” We asked our members of Congress to “join our call for CMS to abandon this policy shift and to withdraw the bulletin immediately… [and] to join us in seeking swift reapproval of Florida’s hospital directed payment program.”
FHA Comments on DEA Proposed Rule on Telemedicine Prescribing of Buprenorphine
This week the FHA submitted comments to the Drug Enforcement Administration’s (DEA) proposed rule on “expansion of induction of buprenorphine via telemedicine encounter.” In its comments, FHA highlighted the importance of access to buprenorphine and warned that restrictive telemedicine rules, such as limits on the number of days a prescription may be written, could negatively impact patient care. FHA asked the agency to establish a provider registration process to allow for telemedicine in-person waivers and commented on a proposal to require prescribers to consult prescription drug monitoring programs.
FDA Approves Over-the-Counter Naloxone Nasal Spray
On March 29th, the U.S. Food and Drug Administration announced the approval of Narcan, a 4 milligram (mg) dosage of naloxone hydrochloride nasal spray to be sold over the counter without a prescription. Naloxone is an emergency opioid antagonist that can help rapidly reverse the effects of an opioid overdose and is an essential tool to curb overdose deaths. The life-saving medication will be easily available for Floridians at drug stores, convenience stores, grocery stores, gas stations and online. The FDA is working with stakeholders to adjust the status of the medication from prescription to over the counter. The price and availability are reliant on the manufacturers. For continued updates, please visit here.
Although this action will make the opioid reversal medication easily accessible, it should not replace the need for free Naloxone kits and community-based distribution programs to reduce the cost associated to obtain the medication. This change is a starting point to help eliminate the stigma attached to individuals with substance abuse disorders and provide broader access to Naloxone in rural or urban communities. Increasing access to Naloxone is an important component in battling the opioid epidemic across the state and country.
In 2022, The Florida Medical Examiners reported 8,411 opioid-related deaths and 6,442 opioid-caused deaths. Opioid use and deaths from overdose are rapidly increasing each year. FHA supports widespread education efforts on the availability, use and effectiveness of Naloxone as one path of reducing overdose deaths.
FDA Press Release, click here.
Senate Approves Resolution to End the COVID-19 National Emergency, PHE Waivers Remain
On Wednesday the U.S. Senate approved a resolution to end the COVID-19 national emergency declaration initiated by Donald Trump in 2020, and maintained during the Biden presidency. The 68-23 Senate vote comes after the House passed a similar measure in February. The President has indicated that he will not veto the resolution and has ten days to sign.
The immediate end of the national emergency declaration should have little impact on hospitals, as the COVID-19 public health emergency declaration remains in place through May 11. However, members should be aware that certain waivers do expire with the national emergency. This includes waivers related to hospice, and special purpose renal dialysis facilities and a limited EMTALA waiver that, in accordance with state emergency preparedness plans, permitted hospitals, psychiatric hospitals, and CAHs to screen patients at an offsite location.
FHA President and CEO Mary Mayhew explains the need to prioritize Florida’s health care workforce in this year’s budget proposals when speak with South Florida Hospital News. “Florida hospitals deliver the high-quality care that Florida residents and visitors expect and deserve,” said President Mayhew. “But with hundreds of people moving to Florida daily, the demand for health care services is skyrocketing. As we think about the future of Florida, we must have strong and financially stable hospitals with a robust health care workforce.
FHA President and CEO Mary Mayhew spoke with Click Orlando regarding the admission of Baker Act and involuntary psychiatric holds. “When someone needs to get into a mental health practice, that door needs to be immediately opened. Not six weeks, six months from now. They are in crisis, and they need access to those services,” President Mayhew said.
EDUCATION & EVENTS
FHA Health Plan Accountability Data Initiatives
April 5, 2023, 10:00 a.m. – 11:00 a.m. ET
Quality Hot Topics
April 5, 2023, 1:00 p.m. – 2:00 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
Readmissions Webinar Series – Leveraging Your Area Agency on Aging to Prevent Readmissions
April 17, 2023, 2:00 p.m. – 3:00 p.m. ET
Community Benefit Forum
April 20, 2023, 1:00 p.m. – 2:00 p.m. ET
FHA Managed Care Monthly Call
April 20, 2023, 9:00 a.m. – 10:00 a.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 Education of Interest
HFMA | Healthcare 2023: Dancing to a Different Beat
May 14–17, 2023