KEY STORY

Key Story- Successes For Hospitals during the 2023 Legislative Session

Budget Success: $269.9 M in additional Medicaid funding for hospitals in the state budget (includes $103 M General Revenue) – Hospitals and health care systems have contended with legislative proposals to cut Medicaid funding for many years. This year was different, as our successful hospital advocacy and healthy state coffers led to a budget that prioritizes equitable reimbursement for the quality of care hospitals provide. From educating lawmakers in the off-season to countless meetings and hearings at the capitol, legislators were in the know on key hospital challenges in 2023. FHA is extremely encouraged by several key wins for hospitals in this year’s budget and thanks our membership for your dedicated work.

• $76 M for complex pediatric care – Initially proposed by the Florida Senate, FHA advocated strongly for the inclusion of this enhanced funding for hospitals that treat complex level III & IV pediatrics. This is a significant shift in the narrative as FHA has moved away from conversations about Medicaid cuts to working with legislators to explore Medicaid funding increases for certain services and populations.
• $93.8 M for Graduate Medical Education Statewide Residency / $30 M for new Slots for Doctors GME Program / $15 M additional GME increase – A 2021 FHA report projects Florida will experience a shortage of 36,000 physicians by 2035. . FHA was proud to work with appropriations leaders and staff to secure a 48% increase in overall funding for GME, including statewide residencies and a new slots for doctors program that rewards the expansion of residency slots.
• $54 M in Non-Recurring General Revenue for Standalone Specialty Children’s Hospitals

Budget Success: $10 M for Rural Hospital Capital Improvement Program

• FHA led the way to reinvigorate this program which provides grants to rural hospitals to upgrade and harden facilities, invest in technology, and more. Health Care Appropriations Chair Gayle Harrell referenced the importance of this budget provision during her final floor presentation of the budget. Rural hospitals are a key part of the health care delivery system in Florida and FHA will continue to advocate for resources to address their unique needs.

Budget Success: Renewed $125 M for LINE & PIPELINE Nurse Education Programs

• Florida is projected to face a shortage of nearly 60,000 nurses by 2035, and Florida’s hospitals experienced a 32% turnover rate amongst nurses last year. While there is no immediate fix, investing in the nursing talent pipeline will set Florida on a better path for the future. FHA was once again pleased to secure $100 Million for PIPELINE & $25 million for LINE programs to increase the number of nurses entering the health care system.

Policy Success: Assault or Battery on Hospital Personnel (HB 825 Passed)

• People working in hospitals are six times more likely to experience violence in their line of duty than in traditional private sector industries. The passage of HB 825 demonstrates the legislature’s and hospitals’ dedication to protecting our front-line workers and recognizing their unique sacrifice. By providing enhanced penalties on those who assault or batter a hospital employee or volunteer anywhere in the facility, our health care heroes can be better protected from violent incidents and repeat offenders. FHA was proud to lead this effort throughout session and will be communicating its support for the bill to Governor DeSantis. We hope to receive his approval in the coming weeks and encourage members to echo their support.

Policy Success: White Bagging Protections (SB 1550 Passed)

• FHA has engaged with legislators in support of white bagging protections for multiple years – filing a standalone bill in 2022 and working with Governor DeSantis to craft his priority legislation for 2023. Throughout the bill’s legislative path, we strongly supported the provisions protecting hospitals in instances of in-person administration of covered prescription drugs. We are extremely pleased that Governor DeSantis signed these provisions into law alongside regulations on PBM and insurer drug pricing practices.

STATE ADVOCACY

State Budget Overview

The final budget approved by lawmakers and to be presented to the Governor totals $117 B, of which $46.5 B is general revenue. Please note – the Low Income Pool, the Directed Payment Program, and other hospital supplemental payment programs authorized through budget amendments do not reflect in this total ($121 B in total with these supplemental payment programs). Medicaid has been allocated $34.5 B ($38.5 B including supplemental payments) including $10.1 B in general revenue. Health and Human Services represent 42.4% of all spending but only 32.7% of general revenue spending. The Education budget, by comparison, totals $30.3 B including $20.4 B in general revenue, making up 25% of all spending and a major 43.9% of general revenue spending. Across the entire state budget – Medicaid payments to hospitals make up approximately 8% of all spending and only 4% of general revenue spending.

Budget Highlights:

GME Increases – FHA is extremely pleased that the House and Senate included increases in funding for Medicaid Graduate Medical Education as Florida continues to face a physician shortage. This includes a total of $93.8 M for the statewide residency program and $30 M for a new Slots for Doctors Program.

Pediatric Physician Rate Increase – $76.1 M

Behavioral Health – FHA continues to support meaningful investments in community mental health models and Florida’s psychiatric bed infrastructure. DCF’s community mental health budget has increased by 47% and includes $31 M for central receiving facilities, $77.9 M to expand bed capacity at state mental health facilities, and a substantial $156.3 M block grant for community-based mental health services. FHA thanks the legislature for these critical investments in the mental well-being of Floridians.

Workforce/Education – In addition to the aforementioned LINE & PIPELINE investments, the Florida legislature has also renewed $100 M for the Hometown Heroes Housing Program to assist nurses in buying a home as well as $100 M for University incentives that will support increased nursing faculty at Florida’s schools

Bills Defeated

While over 1600 general bills were filed this session – rarely are that many new laws needed. FHA is constantly monitoring for hospital impact legislation that adds duplicative or burdensome regulatory requirements, detracts from quality patient care, or disrupts hospitals’ business operations. FHA worked alongside our member hospital experts to educate lawmakers and successfully defeat several bills that could have impacted hospitals.

Health Care Expenses (SB 268 / HB 1413 Failed) – While we appreciate efforts to provide consumers with meaningful pricing information, the bills are duplicative of existing federal rules that are still in their infancy. A priority of the Florida House for several years, FHA worked with the Senate to stall this bill’s progress and prevent any negotiations that could have seen it move further in the process.

Protection of Medical Freedom (SB 222 / HB 305 Failed) – This legislation would have interfered with a provider’s ability to withhold services from an individual suffering from, not having been vaccinated from, or recovering from an illness. The bill would have also prohibited certain immunization tracking by the state. FHA worked with other stakeholders to communicate these concerns and prevent the bills from receiving a hearing.

Sovereign Immunity (SB 604 / HB 401 Failed) – For the last several years lawmakers have considered proposals to increase the statutory limits of liability in claims against the state or its agencies. This affects many of Florida’s public and rural hospitals and could negatively affect their ability to provide the highest quality of care to the patients they serve. After initial conversations early in session, this bill was stalled.

Surgical Smoke (SB 380 / HB 587 Failed) – The bills would require Florida hospitals to implement smoke evacuation systems during surgical procedures. Many hospitals already operate or plan to include them in any future facilities and the bills did not sustain their momentum, failing after a pair of committee hearings.

Motor Vehicle Insurance (SB 586 / HB 429 Failed) – PIP repeal was not considered by the Florida legislature this year but FHA will continue to monitor these discussions and the associated financial impact it could have on hospitals and health systems.

Workforce Legislation

Physician Assistant Licensure (HB 1133– Passed)

FHA is pleased by the passing of this legislation as it revises the eligibility requirements for physician assistants (PAs) seeking licensure, ultimately addressing PA workforce shortages. Notably, these changes reinstate the licensure eligibility for PAs who graduated from accredited PA programs with a bachelor’s degree and who were negatively impacted by the Legislature’s 2021 revisions to the PA licensure statutes.

Psychology Interjurisdictional Compact (HB 33– Passed)

Senator Harrell and Representative Hunschofsky are hospital champions with whom FHA has worked continuously to educate them on hospitals and their needs. FHA is pleased by their work this legislative session to enact the Psychology Interjurisdictional Compact and authorizes Florida to enter into the compact with all other jurisdictions that have legally joined the compact. This allows an eligible Florida licensed psychologist to provide services to out-of-state patients through either telehealth or temporary authorization to practice.

Live Local Act- Housing (SB 102– Passed & Approved by Governor)

As a 2023 legislative priority of Senate President Passidomo, FHA is delighted with this legislation which provides a significant investment of $711 million to workforce housing to increase opportunities for our workers to find attainable housing close to the communities they serve.

Nursing Education Pathways for Military Combat Medics (SB 274– Passed)

This bill addressed the nursing shortage present in Florida as it promotes uniformity in the application of military combat medic training and education toward creditor clock hours by public postsecondary educational institutions.

Payer Accountability Legislation

Florida KidCare Program Thresholds (HB – Passed)

FHA has worked closely with Representatives Bartleman and Trabulsy since they took office to educate them on the state of health care coverage in Florida. We were pleased to work alongside them to pass income eligibility changes that will assist more than 70,000 Floridians in these health insurance programs in the first year by increasing the threshold to 300% of the FPL. FHA thanks the bill sponsors and House Speaker Renner for championing this critical victory for Florida’s health care delivery system.

Group Health Plans (HB 897 Passed)

This legislation was supported by FHA and better align Florida with existing federal law by amending the requirements and processes by which group health plans may operate in Florida.

Behavioral Health Legislation

Operation and Administration of the Baker Act (HB 829 – Passed)

This bill requires the Department of Children and Families to update and maintain key information resources such as a Baker Act handbook and a frequently asked questions repository, as the handbook has not been updated since 2014.

Suicide Prevention (SB 914 – Passed)

This legislation extends the work of the Commission to January 1st, 2025, as the final report from the Commission would be submitted to the Florida Legislature and Governor by September 1st, 2026. SB 914 also broadens the purpose and duties of The Commission on Mental Health and Substance Abuse to include assessment, recommendations, and Medicaid funding opportunities for Florida’s National Suicide Prevention Lifeline (NSPL) infrastructure, commonly known as, the 988 Suicide & Crisis Lifeline.

Regulatory Legislation

Civil Remedies (HB 837 – Passed & Approved by Governor)

These Governor & Speaker-backed lawsuit reforms were quickly passed by the legislature and signed by the Governor in March. The bills eliminate one-way attorneys fees and make other substantive legal reforms to curb the number of frivolous lawsuits driving up insurance rates.

Telehealth Audio-only (HB 267 – Passed)

A simple bill that changes the definition of telehealth to allow audio-only phone calls, FHA was encouraged to support this bill over the finish line in 2023.

Hospital Impact Legislation

COVID-19 Mandates (SB 252 – Passed)

A priority of Governor DeSantis, SB 252 has been passed and will present to the Governor in the coming weeks. The bill prohibits hospitals from interfering with a patient’s right to choose COVID treatment alternatives and requires health care practitioners to obtain informed consent about alternative COVID treatments. Additionally, FHA worked to amend the language to permit the use of masks by hospitals with review and approval by the state. FHA will convene our members to discuss any questions or comments about the implementation of these provisions should it be signed into law.

Immigration (SB 1718 – Passed)

The Governor-backed immigration legislation affects hospitals by requiring them to ask each patient for their immigration status upon a hospital admission or an emergency department visit. FHA worked to successfully amend the language to narrow the circumstances in which hospitals must ask for immigration status. The bill as passed still allows the individual to decline to provide their immigration status. FHA will be working closely with members, AHCA, and the legislature to create an appropriate strategy for hospitals to implement these regulations.

Protection of Medical Conscience (SB 1580 – Passed)

SB 1580 was closely monitored by FHA as it allows health care providers and payers to refuse to provide or pay for a given service based on a conscience objection. The bill was heavily debated by the minority party as they argued health plans will use this to deny a greater number of health care claims. As passed, the bill does not allow payers to deny payment for a service that is covered under the current contract year. FHA worked with lawmakers to ensure emergency medical treatment under EMTALA was clearly exempted from the provisions of the bill.

Gender Clinical Interventions (SB 254 – Passed)

This effort was led by House Health & Human Services Committee Chair Randy Fine as the bill prohibits prescriptions or procedures for sex reassignment for individuals under 18 years of age. The bill was held in the Senate late during session as the chambers worked towards agreements on other pieces of health care legislation. In the final days, the bill was amended to remove a provider attestation and passed by both chambers.

Pregnancy & Parenting Support (SB 300 – Passed)

Signed by Governor DeSantis during session, Florida has moved to criminalize the performance of a termination of pregnancy beyond 6 weeks gestational age of the fetus. While FHA did not take a position on this legislation, we encourage members to reach out to us if you have questions or concerns about the passage of this legislation.

Florida Hurricane Preparedness Week

Governor Ron DeSantis has proclaimed the first week of May as Florida Hurricane Preparedness Week in coordination with the National Weather Service Hurricane Preparedness Week. All Florida residents are urged to take time now to make family and business emergency plans and stock disaster supply kits ahead of the 2023 Atlantic Hurricane Season.

National Preparedness Week and Florida Preparedness Week are observed every May to educate families and communities on the importance of disaster mitigation, preparedness, and response. More information on National Preparedness Month can be found here.