On August 15, FHA was extended the honor to present at the 2nd in-person meeting of The Florida Commission on Mental Health & Substance Use Disorder. President & CEO Mary C. Mayhew presented a data-driven perspective on how hospitals play a vital role in the behavioral health system. President Mayhew shared that “it is unacceptable that many children and adults are stuck in the revolving door of emergency departments and hospital psychiatric units because they cannot timely access critical mental health and substance use disorder services in their communities.” With state agency collaboration and community engagement by providers, we can move the needle in improving the behavioral health system by implementing data-driven solutions to close the gaps in care for children and adults. Thank you to the Florida Commission on Mental Health and Substance Use Disorder for inviting FHA to contribute to the larger conversation on how to better designate resources for our vulnerable populations, invest and expand community response teams, and engage and encourage our workforce to support the proposed changes to the system. Florida’s hospitals are committed to being a partner in supporting the Commission’s work and initiating change in the behavioral health system.
President Mayhew presented on data such as the preventable use of emergency rooms for those with mental illness. View this full slide in your browser.
FHA Holds Briefing with Senate President Kathleen Passidomo
FHA staff met with Senate President Passidomo this week to continue preparing for the 2024 legislative session. President Passidomo has been a stalwart leader on hospital and health care issues, and for 2024 she has set her sights on the “Live Healthy Act” expected to be her priority health care legislation.
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FHA has been closely working with President Passidomo and her staff to craft meaningful reforms and funding initiatives for inclusion in the legislation. Given the Senate President’s focus on reducing unnecessary or preventable emergency department use, FHA was able to present data using the hospital discharge data on the volume of nonemergent Medicaid ER use and potentially preventable ER use for those with mental illness and substance use disorder. We specifically discussed the potential for Medicaid incentivizing hospital care coordination teams for Medicaid super utilizers. The Senate President continues to be focused on the healthcare workforce and especially interested in innovative career ladders that encourage Florida to “grow our own.” We shared the very encouraging progress that our hospitals have made in reducing the extremely high vacancy and turnover rates from last summer. The Senate President was very pleased with that data. Finally, FHA staff also highlighted some key initiatives related to payor accountability and increased transparency in the Medicaid program regarding access and outcomes. FHA had an opportunity to share with the President’s staff areas of opportunity within the Medicaid budget to support improved rates for labor and delivery and for complex adults. FHA thanks President Passidomo for taking time for this discussion.
State of Florida and AHCA Sue CMS Over Directed Payment Program Informational Bulletin
On Friday, August 18, 2023, the state of Florida and the Agency for Health Care Administration (AHCA) filed suit against the Centers for Medicare and Medicaid Services (CMS) seeking a declaration from the court that CMS’s February Informational Bulletin, regarding the directed payment program, is unlawful. The Informational Bulletin, and subsequent Financial Management Review, state an opinion by the Agency that hospitals may not privately contract to hold each other harmless for taxes collected to finance the state’s share of a directed payment program. The Florida lawsuit alleges that this interpretation by CMS, which has already been rejected twice by Texas, contravenes the authorizing statute. FHA has supported Florida’s theory of this case through congressional outreach, and letters to CMS responding to a proposed rule that would create a federal regulation consistent with the opinions stated in the informational bulletin. If the state wins, they have asked the Court to declare the policy unlawful and enjoin CMS from “enforcing, implementing or otherwise relying on the interpretation of the scope of [the statute] and the associated substantive policy regarding redistribution arrangements.”
Behavioral Health Retreat in Collaboration with the Florida Behavioral Health Association
This past Wednesday, the FHA Behavioral Health Council hosted the first Behavioral Health Retreat in collaboration with the Florida Behavioral Health Association (FBHA). This joint meeting initiated insightful and proactive conversations surrounding the retainment and recruitment of behavioral health professionals, the importance of advocating for the investment of community care models, pinpointing the role data has in shaping the pathway to accessible care, and the barriers behavioral health providers face in providing services to the growing population of children and adults experiencing mental illness and substance abuse. This meeting involved behavioral health leaders across the state and demonstrated the importance of collaboration with a shared purpose in the pursuit of increasing the understanding of the behavioral health system, by using proven models that can improve the behavioral health landscape for all Floridians. We appreciate the thoughtful engagement of FBHA board members and staff; we look forward to continuing the conversation and collectively advocating for the betterment of Floridan's’ behavioral health needs.
Medicaid Social Services Estimating Conference
The Office of Economic & Demographic Research (EDR) released the results from the July 19th and August 14th Medicaid Caseload and Expenditure Conferences. The caseload for FY 2022-23 increased by 96,149 (1.75%) from the March 2023 forecast, reaching 5,575,548. The caseload is projected to decline by 9.98% in FY 2023-24 to 5,019,308, then further to 4,701,840 by FY 2028-29. Caseload estimates are higher than previous estimates for the forecasted period, with SFY 2023-24 projected at 304,424 more this fiscal year. Additional county enrollment changes through June can be found here.
FY 2023-24 program expenditures are forecasted at $35.04 billion with a General Revenue deficit of $218.0 million (total funds $560 million); FY 2024-25 expenditures are expected at $35.4 billion with a General Revenue deficit of $211.8 million (total funds $916 million). The updated expenditure projection reflects the decline in Medicaid caseloads and considers that the Medicaid caseload is not dropping as quickly as originally anticipated—nearly 304,000 additional individuals above the prior 2023-2024 estimate. The state projections consider the continued step-down of the enhanced FMAP, expiring in its entirety on December 31st of this year as the Public Health Emergency ends. Additionally, the federal contribution towards the Medicaid program continues to decline as Florida’s per capita income continues to rise. You can find the summary here.
General Revenue Conference
The Office of Economic & Demographic Research (EDR) released the results from the August 18, 2023, General Revenue conference. State Fiscal Year (SFY) 2022-23 General revenue collections totaled $1.08 billion or 2.3% over the previous state fiscal year projections.
The forecast for the current year and out year were adjusted to reflect an increase over the 2 years of $2.77 billion being added to the projection. Sales Tax continues to be the largest source of the overages, as it is affected by higher inflation. Of the $2.77 billion, $907.6 million (FY 2023-24) and $615.1 million (FY 2024-25) totaling $1.52 billion is attributable to this revenue source. This source of revenue does pose risks for adjustments as individuals adjust spending habits due to continued inflationary increases. You can find the summary here.
FHA Hosts Meeting with CMS on Medicaid Redeterminations from the Hospital Perspective
On August 22, FHA and the Primary Care Access Network hosted the second roundtable with Teresa Zayas, CMS Marketplace Representative for Region 4, and Sherard McKie, CMS Atlanta Regional Administrator and Local Engagement and Administration Staff Director with hospitals and health systems from the central Florida region. Representatives from AdventHealth, Nemours, Orlando Health, and HCA. There were representatives from Orange County Health, local FQHCs, Department of Children and Families (DCF) Community Health Partners, and Healthy Start of Orange County in attendance. Hospitals discussed their experiences with patients losing coverage, local partnerships, utilizing provider access to assist individuals with applying for coverage and using marketplace referrals for alternative coverage options.
FHA also hosted a Statewide Medicaid Redeterminations Webinar on August 11, with Tera Bivens, Deputy Assistant Secretary for Economic Sufficiency with DCF to get current updates on the redetermination process and allow our members to ask questions about the Department’s partner referral process. DCF estimates that 4.6 million Medicaid recipients will have their cases redetermined over the 12-month unwinding period. It is estimated that approximately 20% of these recipients will not meet eligibility criteria. More than 1.3 million have been redetermined so far. Visit FHA’s Medicaid Redeterminations page to get access to the latest information and resources on the state’s Medicaid redetermination process.
Behavioral Health Roundtable hosted by Representative Joel Rudman
Behavioral Health Roundtable hosted by Representative Joel Rudman
Representative Joel Rudman and a consortium of bipartisan, first-term House members have been hosting roundtable discussions around the state to discuss access to high-quality behavioral health services in Florida. At the request of Representative Rudman, FHA helped to coordinate a roundtable meeting at Memorial Behavioral Health Center in Davie, Florida. Attendees included Representatives Kim Berfield (R – Tampa), Darryl Campbell (D – Ft Lauderdale), Hillary Cassel (D – Hollywood), Gallop Franklin (D – Tallahassee), Joel Rudman (R – Navarre Beach), member hospital executives from Baptist Health South Florida, Cleveland Clinic Florida, Jackson Health System, Memorial Health Care System, and University of Miami Health System, as well as representatives from the Broward Behavioral Health Coalition, HCA, Henderson Behavioral Health, and a local practicing therapist.
The group of legislators was focused on listening to the experiences of community providers to inform legislative opportunities during the 2024 legislative session. FHA had the opportunity to share data on behavioral health discharge interactions from three counties in Southeast Florida to help spur the discussion. Representative Rudman discussed the need to address Medicaid coverage and reimbursement policies to increase access to behavioral health treatment in the community and cultivate wrap-around services. Although no formal legislation has been announced, the legislative guests indicated their support for previous bills that would provide loan forgiveness to individuals entering behavioral health professions, eliminate step therapy requirements for psychiatric drugs, and increase accountability over privatized Medicaid Managed Care Plans.
Lawsuit Filed Alleging Florida Violated Law in Medicaid Redetermination Process
On Tuesday, the National Health Law Program filed a lawsuit on behalf of three Floridians in a U.S. district court alleging that Florida violated federal law by failing to sufficiently notify enrollees that their Medicaid coverage was ending or to give them information on how to appeal. The defendants include the secretaries of AHCA and the Department of Children and Families, who have stated that the lawsuit is baseless. The plaintiffs, who are seeking class-action status, have asked the court to restore Medicaid to those who lost benefits and to issue an injunction forbidding Florida from continuing Medicaid redeterminations until it amends the state’s notification and appeals system.
FHA and DOH Discuss the $10 Million Rural Hospital Capital Improvement Grant Program
On Thursday, August 18th FHA hosted the Department of Health (DOH) leadership at a statewide meeting of rural hospitals to discuss implementation of the Rural Hospital Capital Improvement Grant Program. FHA successfully advocated for funding of this program during the 2023 session, and it was included in the 2023 - 2024 SFY budget. Michael Leffler, Health, Access, Resiliency and Telehealth (HART), Section Administrator for DOH provided deadlines for submitting a Letter of Intent (LOI) to apply for the funds, with an application deadline of October 16, 2023. Guidance was sent to rural hospitals by the DOH on August 18, 2023.
The Joint Commission Releases Sentinel Event Alert 67: Preserving Patient Safety after a Cyberattack
There are growing concerns about patient safety when healthcare organizations experience a cyberattack. The Department of Health and Human Services reports that at least 707 data breaches occurred in 2022, resulting in the exposure of more than 51.9 million patient records. On August 15th, The Joint Commission issued Sentinel Event Alert 67: Preserving patient safety after a cyberattack which focuses on the risks associated with cyberattacks and actions that hospitals and healthcare organizations can take to prepare to deliver safe patient care in the event of a cyberattack.
FHA Hosts “Workplace Safety in Healthcare”
On August 23, in partnership with the Florida Organization for Nurse Leaders, FHA hosted a virtual event on Workplace Safety in Healthcare with nearly 100 attendees. The objectives of the program included:
- Understanding the challenges facing today’s health care environment for safety and prevention of workplace violence.
- Discussion of leadership strategies critical for engaging front-line staff in addressing safety in the workplace.
- Learning how hospitals are taking steps to ensure the safety of the health care workforce.
The program included panel presentations from nursing and safety leaders from around the state of Florida and included leadership representation from AdventHealth, BayCare, Lee Health, and Madison County Memorial Hospital. These hospital leaders shared their perspectives on the challenges and strategies for maintaining a safe work environment and preventing workplace violence for their health care staff and patients.
FFY 2024 Medicare Inpatient Prospective Payment System (IPPS) Final Rule Analysis
The FHA has provided hospitals in Florida with the FFY 2024 Medicare IPPS Final Rule Analysis, shedding light on changes in Medicare payments between FFY 2023 and 2024. This report highlights FFY 2024 policies, encompassing payment shifts, rural wage impact, and CMS endeavors toward equitable wages. Moreover, it presents updated comparisons between the Proposed and Final Rule's Market Basket indies. FFY 2024 witnessed substantial alterations in payment estimates compared to FFY 2023. Notably, the total dollar impact on IPPS payments for FFY 2024 is projected to rise significantly by 4.1% ($318.8M), a marked increase from FFY 2023's projected 1.3% ($100.4M ) IPPS payment to the state. Despite the overall rise in estimated IPPS payments, the FFY 2024 market basket update reflects a minor decrease of 3.1% or a $162.1M change, potentially influenced by budget neutrality factors.
AHA Releases New Resource to Address Workplace Violence
Together, teams representing AHA’s Trustee Services and Hospitals Against Violence released a new brief that highlights the engagement and oversight responsibility of the board in contributing to a safe workplace and community. The brief includes a framework to help guide leaders in their efforts to address violence, recognizing that violence in the community can impact the health care setting.
The Joint Commission has also issued Workplace Violence Prevention Standards that require:
- Annual worksite analysis of the hospitals’ prevention program and a record of the actions taken to mitigate or resolve workplace safety and security risks.
- A process for continually monitoring, reporting, and investigating incidents involving patients and staff, occupational illnesses or injuries, and potential hazards such as fire, medical equipment, and utility systems.
- Training, education, and resources on the hospital’s workplace violence prevention program at the time of hire, annually, or for staff changes. This includes education on the roles and responsibilities of leadership, clinical staff, security personnel, and law enforcement as well as de-escalation training.
- A designated individual to lead the workplace violence prevention program developed by a multidisciplinary team that includes policies and processes to prevent and respond to workplace violence, support victims, and report to the governing body.
Violence is recognized as a public health crisis that affects us all in our communities and the work environment. Boards play an important role in ensuring a safe work environment where the healthcare workforce can deliver quality, compassionate care to those in need.
Maui Wildfire Disaster Support
Our hearts are broken for the lives lost and the lives upended by devastating wildfires in Maui, Hawaii. There are still hundreds of people missing and it is anticipated the death toll will continue to rise. It has been a time of deep sadness and vulnerability for the entire state of Hawaii. Several organizations are accepting donations to provide funds and resources to families, individuals, and communities that are in need during the aftermath of the destruction left behind by the wildfires. If you are interested in providing funds or resources to help the individuals in Maui, please visit the below links:
Our thoughts and prayers are with all who are suffering and for the lives lost.
Florida Hospital Association 2023 Annual Meeting
October 4–6, 2023 | Orlando, FL
Enjoy the excellent hospitality of our Title, Platinum, and Gold Sponsors at the FHA Annual Meeting!
FHA would like to offer special thanks to our Title Sponsor KPMG and the Platinum and Gold Sponsors for the 2023 Annual Meeting! As a highlight of their sponsorship, some of these extraordinary sponsors are participating in the Innovation Hub, a special dedicated space in the Plaza Ballroom, to meet with attendees and share their unique solutions for Florida’s hospitals. All attendees are invited to visit the Innovation Hub to connect with our sponsors to enjoy relaxing seating and sample special refreshments.
Please take a moment to visit their websites linked with their logos below
Groups of 10 or more are eligible for a discount of $50 per registrant. Please contact AK Consulting Group for information.
If your hospital or system is a current member of FHA, please select “member” as the registration type. All staff of member providers are eligible to register as a member. To verify your organization's membership status, please check the FHA Member Directory.
To reserve your hotel room for the meeting, please click here. The window to reserve in the FHA room block ends September 13, 2023.
We look forward to seeing you at the Annual Meeting 2023!
Save the Date!
FHA Annual Managed Care Conference, November 1 – 2, 2023!
Registration is coming soon! This year’s presentations will include:
State of the Industry, The Advisory Board
Examining Price Transparency
Reference-Based Pricing Moving Forward
American Hospital Association Update
Getting Beyond Survival: A Field Guide for Health Systems
FHA Florida Health Care State of Affairs and more!
The highly anticipated Managed Care Conference will be at the Westin Lake Mary. Please save the dates now and plan to attend!
OTHER EDUCATION EVENTS OF INTEREST
Florida HFMA Fall Conference
September 10-12 at Margaritaville Hollywood Beach Resort, Hollywood, FL | Register
HFMA Region 5 South Eastern Summit
The FL HFMA Chapter is seeking presentations for the Region 5 South Eastern Summit (SES) at Tampa Marriott Waterstreet in Tampa, FL. The event dates are February 25 – 28, 2024. They are soliciting presentations from their members and industry experts that will provide valuable and relative industry education. Please click on the link below to complete the speaker proposal form in its entirety to be considered. Speaker Proposal for Region 5 2024 South Eastern Summit
Violent Extremist Mobilization Workshop and Intelligence Brief
University of Miami Health System & Miller School of Medicine Division of Emergency Management has partnered with the National Counterterrorism Center to deliver the U.S. Violent Extremist Mobilization Indicators Workshop & Unclassified Intelligence Situation Briefing on October 12 from 10:00am-12:00pm, ET.
Registration is required and space is limited.
H-CAP Presents: A Healthcare Apprenticeship Resources Playbook: A GUIDE TO FEDERAL AND STATE FUNDING WEBINAR
Do you need help locating funding opportunities for your Healthcare Registered Apprenticeship Program?
Join H-CAP for an online webinar on Thursday, September 7, 2023, at 12:00 p.m. (CDT). The Healthcare Apprenticeship Resources Playbook is a comprehensive, easy-to-read guide providing helpful insights into federal and state resources available for healthcare apprenticeships.
This valuable opportunity will enhance your understanding of where to locate public funding for your Registered Apprenticeship.
Register Now To Secure Your Spot!
Florida hospitals rebound from severe nursing shortage during pandemic | Tampa Bay Times
Recently, the Tampa Bay Times reported that the nursing workforce crisis in Florida is beginning to rebound and stabilize in response to the great work being done by Florida’s hospitals to build the health care workforce pipeline through partnerships, recruitment, and retention strategies. The article focuses on the results from the FHA Vacancy and Turnover survey of all Florida hospitals with a response rate that reflects 56% of all hospital beds. FHA President Mayhew spoke with Tampa Bay Times and stated, “I saw just a level of concern among the hospital executives about the workforce that I had not seen before,” she said. “Hospitals have been working to both recruit new nurses and retain the staff that they have and they’re seeing incredible results from that.”
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