Key Story – 2023-2024 State Budget Clears House & Senate Chambers
FHA continues to advocate for equitable Medicaid reimbursement, health care workforce funding, and other critical resources for hospitals as lawmakers craft the 2023– 2024 state budget. This week, the House and Senate full chambers passed SB 2500 – General Appropriations Act as they now head to “budget conferencing” to negotiate the final details.
While we are encouraged by the budget proposals introduced by the House and Senate – FHA is advocating for several important programs in the final phase of negotiations:
- 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 in recurring and $10 million in nonrecurring funds to assist rural hospitals across the state. We have received positive initial feedback from the Senate chamber.
- Rural Emergency Hospital – FHA is working with AHCA and the legislature to pave the way for a new ‘rural emergency hospital’ designation under Medicaid. We recently worked with Agency staff to craft statute language and present it to key legislative leaders and staff. 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 that operate this program under the federal waiver would also benefit from state-level policymaking in this new innovative space.
Please review FHA’s Legislative Tracking Report to stay updated on key bill movements during session.
FHA-Monitored COVID Legislation
Protections from Discrimination Based on Health Care Choices SB 252
This legislation has been closely monitored by FHA since its introduction and was extensively reviewed by the FHA Policy Committee and Board of Trustees. SB 252 prohibits hospitals from interfering with a patient’s right to choose alternative treatments for COVID-19 by allowing practitioners to obtain informed consent and provide these services. It also contains language related to facial coverings in health care facilities which require AHCA and DOH to develop new standards, requires hospitals to develop facial covering policies that include the clinical reasons under which they are required, and prohibits mask requirements for visitors unless it is clinically necessary. The Senate bill was approved by the Health Policy Committee this week and the House companion could be heard on Monday, April 10.
Protections of Medical Conscience (SB 1580 & HB 1403)
Both SB 1580 & HB 1403 passed their first committee stops this week. Specifically, this legislation establishes a health care provider’s or health care payor’s right to decline to participate in any health care service, including treatment and research, based on a conscience-based objection (CBO). Further, this legislation prohibits any person, governmental entity, business entity, or educational institution from discriminating against a provider or payor for declining to participate in a health care service based on a CBO. The bill also prohibits a board, or the Department of Health (DOH) if there is no board, from taking disciplinary action against a health care practitioner they spoke or wrote publicly about a health care service, as long as the speech or written communication does not provide advice or treatment to a specific patient or patients and does not separately violate any other applicable law or rule. Similar bills were proposed in the 2022 Legislative Session but died in committee. FHA will continue to monitor this legislation as one of our concerns is denying patients access to quality and affordable care.
Declarations of a Public Health Emergency (HB 1487)
In the event of a statewide public health emergency, the bill requires the legislature to meet in person to renew the declaration every 60 days. Allows an individual to refuse treatment, testing, or examination by submitting written notice to the State Health Officer. FHA is mindful of any legislation that seeks to address Florida’s public health policy and will keep members informed of its progress.
Hospital Pricing Transparency Heard by House and Senate Committees
Health Care Expenses SB 268 by Brodeur was approved by the Senate Health Policy Committee this week after the House version cleared its first committee the previous week. FHA has been working with legislators on this topic for multiple years to help educate on existing transparency laws and what it means to provide meaningful pricing information to consumers. We continue to discuss this legislation with legislative leaders and sponsors to stay informed on its progress.
FHA views the bills as duplicative of federal requirements and largely unnecessary. While we support consumer access to pricing information, the practices in the bill are already required by the 2021 CMS transparency rules. Additionally, the bill requires hospitals to provide a good faith estimate of charges before scheduling a patient’s service. This creates a significant administrative burden and does not account for what the patient would pay out of pocket. FHA is also monitoring several concerns related to debt collection regulations that are included in the bill.
Behavioral Health Legislation
Medicaid Step-Therapy Protocols for Drugs for Serious Mental Illness Treatments (HB 183)
FHA is encouraged to see this House bill receive a hearing which removes the requirement for step therapy protocols for drugs that treat serious mental illness. We are supportive of the bill as we continue to work with the legislature to reduce burdensome insurer practices that detract from quality, accessible health care services. The bill needs to clear two more committees before consideration on the House floor.
Mental Health & Substance Abuse
Sponsored by Senator Rouson, SB 1016 would require an analysis by DCF every three years regarding the use of funding designations and contract deliverables with Florida’s Managing Entities. The bill was reported favorably by its first committee and its House companion will need to be swiftly placed on agendas to be considered for passage this session. FHA continues to monitor for any policy changes that affect the delivery of behavioral health care in Florida.
Gender Clinical Interventions & Termination of Pregnancies Pass Senate Floor
The Florida Senate has passed legislation on gender clinical interventions and the termination of pregnancies. The bills would prohibit gender clinical interventions for minors and restrict termination of pregnancies to six weeks of the gestational age of the fetus. These bills now sit with the full House floor for final passage.
Medical Treatment Under the Workers’ Compensation Law
SB 1344 by Senator Bradley was reported favorably this week by the Banking & Insurance Committee. Particularly, this bill increases the maximum medical reimbursements for physicians and surgical procedures and the maximum fees for expert witnesses under ch. 440, F.S., “Workers Compensation Law.” In regard to expert medical witnesses, the law currently limits the amount a health care provider can be paid for expert testimony during depositions on a workers’ compensation claim to $200 per hour. The bill increases the maximum hourly amount allowed for expert witnesses to $300, per hour.
FHA Provides Comments on AHCA Quality/Patient Safety Form
Last week, the Agency for Health Care Administration held a rule workshop on proposed changes to the AHCA Hospital Quality Measures/Patient Safety Information Form, AHCA Forum 3190-2001OL. While the Agency was proposing minor changes, FHA took the opportunity to suggest additional changes to the form to make it clearer and more accurate. To review FHA’s Comments click here.
Passed in the 2019 legislative session, hospitals are required to provide patients before admission or upon stabilization, a copy of the AHCA-generated form, which includes data from Care Compare on health care-associated infections and patient experience surveys plus AHCA-generated 15-day readmission rates. The forms can also be found on FloridaHealthFinder.
FHA and Cyber Florida Work to Promote CyberSecureFlorida
The FHA is working with The Florida Center for Cybersecurity (Cyber Florida) to promote the CyberSecureFlorida initiative, a first-of-its-kind effort to assess the cybersecurity strengths and weaknesses of Florida’s collective critical infrastructure. Together, FHA and Cyber Florida seek to provide hospitals and health systems with important information, education, risk analysis, and expertise on the cybersecurity risks facing Florida’s critical infrastructure community – including hospitals and health systems.
Cyber Florida was established by the Florida Legislature in 2014 to help position Florida as a national leader in cybersecurity through education, research, and outreach. Hosted by the University of South Florida, Cyber Florida leads a spectrum of initiatives to inspire and educate future and current professionals, support industry-advancing research, and help people and organizations better understand cyber threats and what they can do to stay safer in cyberspace.
Information gathered through the CyberSecureFlorida Initiative will be critical to helping Florida’s elected leaders determine how best to allocate resources and enact appropriate legislation to create a more secure Sunshine State!
Led by Cyber Florida in consultation with the Florida Cybersecurity Advisory Council, the initiative will:
- Establish a baseline of current critical infrastructure cybersecurity protections.
- Provide actionable solutions to increase the state’s preparedness and resilience to cyberattacks.
- Reduce the vulnerabilities of critical systems, assets, and networks.
- Increase resiliency and security to protect the people, property, and prosperity of Florida.
The assessment consists of an online survey of about 150 questions that address a range of cybersecurity concerns as outlined by the National Institute of Standards and Technology’s Cybersecurity Framework. The survey should be completed by each organization’s IT/OT cybersecurity systems and applications lead and their team members. Responses are confidential, and all data will be aggregated and anonymized before public release to ensure respondents’ privacy and security. Data will be synthesized into a concise, actionable report to inform future resource allocation and legislation.
CyberSecureFlorida is open to all public- and private-sector critical infrastructure entities and FHA encourages all hospitals and health systems to lend their voice to this important undertaking. Each participant will be able to print or download their risk assessment from the CSET tool for internal use.
Take advantage of this tremendous opportunity and access the online risk assessment tool now!
Albuterol Solution Shortage Update
Shortages of albuterol inhalation solution, first seen in October 2022, are continuing to impact the healthcare supply chain. There remains a shortage of albuterol sulfate inhalation solutions across numerous companies listed in the ASHP and FDA drug shortage lists. Healthcare facilities are beginning to report impacts, with some health systems implementing conservation protocols. Wildfires and hurricane events may further impact the albuterol supply, with a variety of albuterol formulations potentially rising in demand in response to natural hazards over the next several months. There is currently no estimated timeframe for restoring albuterol inhalation solution supply to typical levels, and current impacts to domestic manufacturers ( closure and other companies) may further worsen the situation. Some entities are working together to develop a continuous domestic supply of albuterol for pediatric patients (see the section on ) but a coordinated response from industry and government is yet to be seen. Healthcare Ready will continue monitoring the situation and is ready to coordinate discussions between public and private sector partners. Read the latest update from Healthcare Ready.
Update: Operation Nightingale
The Florida Board of Nursing (FBON) continues to work with Federal and State authorities in the ongoing investigation of a fraudulent scheme by three Florida nursing programs to sell fraudulent transcripts and nursing degree diplomas. To date, the FBON has identified approximately 34 individuals. As a reminder, these updates are being made to the licensure status of the identified individuals in Florida. Employers can monitor and verify licensure status online at https://www.nursys.com/ or an employer can sign-up for e-Notify through NCSBN and receive notifications when licensure statuses change.
The next FBON meeting is scheduled for April 12-14, 2023. Meeting materials and agenda can be found here. The FBON agenda includes acceptance of voluntary relinquishments of LPN and RN licenses from involved individuals.
If you have any questions, please contact me at [email protected] or 407-376-2755.
CMS Finalizes 2024 Medicare Advantage, Prescription Drug Plan Rule
The Centers for Medicare & Medicaid Services today released a final rule that would increase oversight of Medicare Advantage plans and better align them with Traditional Medicare, address access gaps in behavioral health services, and further streamline prior authorization processes.
The rule also establishes additional health plan utilization management oversight processes to include required annual reviews of MA plans’ policies and coverage denial reviews by health care professionals with relevant expertise. In addition, the rule would tighten MA marketing rules to protect beneficiaries from misleading advertisements and pressure tactics; expand requirements for MA plans to provide culturally and linguistically appropriate services; make changes to MA star ratings to address social determinants of health; and implement Inflation Reduction Act provisions to make prescription drugs more affordable for eligible low-income individuals. Notably, it appears the proposal to change the legal standard for identifying an overpayment, which was of concern to hospitals and health systems, was not codified in the final regulation.
FHA will conduct a thorough review of the final rule and provide our members with more information. For more details, see the CMS fact sheet on the final rule.
Series of Proposed PPS Updates Released by CMS
Throughout the week, the Centers for Medicare and Medicaid Services (CMS) has released proposed annual updates to various components of its prospective payment systems (PPS). To date, the agency has issued proposed updates to the: inpatient psychiatric facility (IPF) PPS, inpatient rehabilitation facility (IRF) PPS; and skilled nursing facility (SNF) PPS.
Each proposed rule includes a positive payment adjustment – net 3.7% for SNFs, 1.9% for IPFs, and 3.2% for IRFs. The proposals each update quality measures including a measure on COVID-19 staff vaccination rates. A couple of preliminary notes:
- The IRF rule does not include a proposal to expand the transfer policy to include certain discharges under the care of home health. The agency included a request for information on this topic in last year’s update.
- The SNF rule suggests that CMS is using comments submitted last year to craft a minimum staffing policy. In its comments to last year’s proposed rule, FHA strongly discouraged a minimum staffing policy noting the effect it could have on the entire health care system.
- The IPF and IRF proposed rules will allow hospitals to open and bill Medicare for distinct part units throughout the year, as opposed to the start of the cost reporting period.
FHA anticipates that the inpatient acute hospital PPS update will be published imminently. We will provide an in-depth review of each of these rules, work with our members on a response, and submit comments to the Agency as appropriate.
Joint Commission 2022 Sentinel Event Data Available
The Joint Commission has released its Sentinel Event Data 2022 Annual Review on serious adverse events from January 1 through December 31, 2022. A sentinel event is a patient safety event that results in death, permanent harm, or severe temporary harm. Data supports the importance of establishing National Patient Safety Goals and focusing on addressing serious errors within health care organizations..
DPP Lawsuit: Texas Asks Court to Declare CMS Informational Bulletin Unlawful
On Wednesday, the state of Texas filed a lawsuit against CMS and HHS to permanently enjoin enforcement of its February 17 bulletin, which declared that private redistribution arrangements, in the context of local tax programs to fund the state’s share of a Medicaid match, are illegal.
The lawsuit alleges that the bulletin is outside of the Agency’s statutory authority, and even if it were not, it would violate the Administrative Procedures Act. The lawsuit quotes 2020 comments from Medicaid Administrator Daniel Tsai (then serving as the Massachusetts Medicaid Director) that call the Agency’s interpretation “an unprecedented federal overreach…[that] exceeded CMS’ statutory authority.” This is consistent with FHA’s understanding of the applicable provisions of the Social Security Act.
The suit asks the court to “declare unlawful and set aside the February 17 bulletin” and issue a preliminary and permanent injunction, prohibiting enforcement of the February 17 bulletin.
Salary Survey – Management/Department Head & Non- Management
For more than a decade, 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 serve as a valuable resource for human resource executives and non-hospital organizations to keep pace with market fluctuations.
To submit your hospital’s data, please use the attached templates. Hospitals are encouraged to submit as individuals, but if they must submit as a system, both surveys include an area to list all hospitals included in the submission. Instructions for completing and submitting the survey are located in Tab 1 of each template. Please send your submission to [email protected] by next Friday, April 14, 2023. Please ensure only one submission per hospital.
Hospitals have a commitment and plan to preserve and protect their own foundational infrastructure – their workforce. While seemingly obvious, the hospital workforce is indispensable to hospitals’ core work, the delivery of patient care. The much-needed focus on addressing workforce challenges also needs to incorporate a focus on the priority of supporting and retaining the current workforce. Solving the health care workforce crisis requires a multi-faceted response. Recruitment support and growing the workforce education pipeline are critical. Just as critical is supporting and retaining the experienced and dedicated workforce who have given so much to our communities and our state. (Column by Mary Mayhew)
EDUCATION & EVENTS
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