Key Story – Hospital Impact Bills Still in Play

Workplace violence (SB 568 / HB 825)

• People working in hospitals face a heightened risk of physical and verbal abuse every day, and FHA is leading ongoing legislative efforts to give them the tools they need to be safe in the workplace. FHA-sponsored legislation that would enhance criminal penalties for assault or battery of hospital personnel is nearing passage in both chambers. HB 825 is postured for a vote on the House floor as early as next week, and SB 568 has to clear the Senate Rules Committee for its final hearing. FHA encourages members to share support for this legislation with their local lawmakers and help us move this over the finish line.

Pharmacy Benefits Managers/White Bagging Prohibition (SB 1550 / HB 1509)

• On Thursday, SB 1550 Prescription Drugs by Senator Brodeur was reported favorably by the Senate Fiscal Policy Committee as it progresses to the Senate floor. The FHA-backed language that would prohibit harmful “white bagging” practices by insurers is still included in the Senate bill and we encourage members to lend their voices in support. The House version is expected to regain momentum next week and will be the focus of significant attention amongst health care stakeholders for the rest of session.

Health care expenses (SB 268 / HB 1413)

• FHA reported earlier this week on hospital transparency measures that have been moving in both chambers of the legislature. The bills are largely duplicative of existing federal requirements on posting of shoppable health care services. On Wednesday, SB 268 was temporarily postponed by the Appropriations Subcommittee on Health & Human Services following FHA sharing its concerns with key lawmakers. For now, the bill remains stalled in the Senate and FHA will inform members if anything changes.

Immigration (SB 1718 / HB 1617)

• Recent indications confirm that immigration reform remains a priority of the Governor and Legislative leadership. Of importance to FHA, the bills require hospitals to request and record the citizenship status of their patients. FHA has fielded comments from members and continues to communicate with both bill sponsors to ensure that these provisions 1) do not provide overly prescriptive requirements on hospitals, 2) provide clarity around which hospital visits require data collection, and 3) include an option for the patient to abstain from answering.

COVID Mandates (SB 252 / HB 1013)

• Although these bills sat idle for much of session, they remain a focal point of ongoing health care policy decisions being made in the legislature. FHA continues to monitor for their next committee hearing in the coming days.

FHA & House Democratic Caucus hold Wonderful Wednesday Event 

This week, FHA staff joined the House of Representatives Democratic Caucus for their “Wonderful Wednesday” event in Tallahassee. We thank Democratic Leader Fentrice Driskell and all the members who joined to engage with FHA and discuss health care policy issues. 

State Budget Update

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 continued their internal negotiations before budget conferencing begins next week.  

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.

Finally, these are some of the other provisions of interest to hospitals that will be negotiated between the two chambers before the end of session:

• Medicaid Funding Provisions 
  
  • No Cuts to Hospital Medicaid Reimbursements
  • $76 M for children’s hospital’s rate increase
  • $76.1M Rate Increase for Medicaid Pediatric Physician Services
  • $30 M for new Graduate Medical Education Slots for Doctors program – matched in both chambers
• Substantial investments in community mental health, including:
  • $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
  • 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 
  • More than $1.3 B (including $523 M General Revenue) to the Agency for Health Care Administration for community mental health services
  • $294 M general revenue for grants and aids for community mental health treatment

Salary Survey Reminder

As a reminder, FHA’s salary survey is due today, April 14, 2023. If you require an extension please reach out to Stephanie Scanlon at [email protected]. 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. Please send your submission to [email protected].

By June 30th, FHA will distribute the compiled 2023 Salary Survey results to those hospitals and health systems that participate. Hospital-specific data will remain strictly confidential and only aggregated data will be published.

Payer Accountability & Health Insurance Legislation

Florida Kidcare Eligibility (HB 121 / SB 246)

• FHA worked with House Speaker Paul Renner and Representatives Bartleman and Trabulsy throughout the off-season to educate on Florida’s profile of health care coverage and reimbursement. We have been pleased to support HB 121 increasing income eligibility thresholds for Florida KidCare through the legislative process as it was passed by the House of Representatives on Thursday. We thank Speaker Renner for his commitment to preserving access to health care for families across the state. Its companion bill, SB 246 by Senator Calatayud, is once again moving and is expected to pass in the coming weeks.

Step Therapy Exemption for Drugs for Serious Mental Illness (SB 112 / HB 183)

• FHA continues to monitor legislation that would require AHCA to approve drug products for the treatment of serious mental illness without step-therapy prior authorization. We advocate for and support a variety of legislative efforts to hold payers accountable and reduce barriers to treatment for vulnerable individuals across our state. SB 112 was approved by the Fiscal Policy Committee on Thursday and will next receive a vote from the full Senate.

Multiple Employer Welfare Agreements (SB 940 / HB 897)

• 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.

Workforce legislation

Foreign-Licensed Physicians (SB 956 / HB 1145)

• FHA continues to monitor this legislation which would exempt graduates of foreign medical schools from completing an approved residency in certain instances. The Senate version appears to be stalled in the Health Policy Committee.

Education Package (SB 240 / HB 1537)

• Senate Bill 240 passed through the Fiscal Policy Committee on April 13th, and it now heads to the floor. The bill provides resources to district school boards, Florida College System institutions, and other stakeholders in Florida’s workforce development system to provide students with high-quality career and technical education workforce education programs. The bill has an appropriation of $100 million to support career and technical education for students in secondary grades and an appropriation of $2 million to reimburse employers that provide work-based learning opportunities for students. FHA continues to support efforts to expand the health care workforce by supporting students as they work towards their educational goals.

Protection of Medical Conscience

HB 1403 was approved by the House Health & Human Services Committee on Monday and now heads to the House floor. The bill and its companion, SB 1580, allow health care providers and payers to opt out of participation or payment for services based on objections of conscience. This legislation will continue to be a central focus of health care-related legislative activity for the rest of session, and FHA will continue to report on its movements.

Regulations on Termination of Pregnancy Pass Florida Legislature

SB 300, which limits Florida’s existing ban on termination of pregnancies to 6 weeks gestational age of the fetus, passed the Florida Legislature after seven hours of debate and has been presented to Governor DeSantis. He is expected to sign the bill in the coming days.

Hemp Legislation

HB 1475 & SB 1676 regulate the origination, distribution, packaging, and dosages of hemp extract products sold in Florida. Specifically, the bill would prohibit the sale of hemp extract to persons under 21, alter requirements for storage to mitigate children obtaining the packaging and limit the dosage of THC to 5 milligrams per serving and 50 milligrams per container. Both the House and Senate bills have one more committee stop to clear, and FHA will continue to report on this legislation as it relates to public health in Florida.

Cybersecurity Risk Assessment Available

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. 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’s risk assessment consists of an online survey addressing a range of cybersecurity concerns 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!

FY 2024 Medicare Inpatient Psychiatric and Rehabilitation Facility Analysis

FHA has generated two financial analyses regarding the proposed rule for Inpatient Psychiatric and Rehabilitation Prospective Payment Systems. The reports are intended to show providers how Medicare fee-for-service (FFS) payments would change from FY 2023-2024 based on the proposed rulings.

Comments to CMS for the Inpatient Rehabilitation proposed rule are due on June 2, 2023, and for the Inpatient Psychiatric, June 5, 2023. Comments can be electronically submitted via http://www.regulations.gov.

Contact Stephanie Scanlon at [email protected] or Ana Rivas at [email protected] if you have any questions about this report.

2023 NSI National Health Care Retention & RN Staffing Report

NSI Nursing Solutions has released its 2023 National Health Care Retention and RN Staffing Report. Nurse recruitment and retention remain a top priority for every hospital and health system. Results from the 2023 NSI National Health Care Retention & RN Staffing Report revealed the following highlights:

• The average cost of turnover for one staff RN increased 13.5 percent from 2021 to 2022, to $52,350.
• In 2022, the turnover rate for staff RNs decreased by 4.6 percent, resulting in a national average of 22.5 percent.
• The average cost of turnover for a staff RN is $52,350, with the range averaging $40,200 to $64,500. This is up from the average cost of turnover for an RN in 2021, which was $46,100.
• Each percent change in RN turnover will cost or save the average hospital $380,600 per year.
• The RN Recruitment Difficulty Index ranges from 61 to 120 days, meaning it takes at least two or four months to recruit an experienced RN.
• For every 20 travel RNs eliminated, a hospital can save $3,140,000 on average. Every RN hired saves $157,000.

A copy of the full report can be found here.

CMS National Stakeholder Call on April 25, 2023, 1:00 p.m. ET

Please join the Administrator of the Centers for Medicare & Medicaid Services (CMS), Chiquita Brooks-LaSure, and her leadership team, who will provide an update on CMS’ recent accomplishments and how our cross-cutting initiatives are advancing CMS' Strategic Plan. Our second National Stakeholder Call with the CMS Administrator in 2023 will provide an opportunity to learn more about how you can partner with us to help implement our Strategic Plan and key initiatives.

When: April 25, 2023, from 1:00 PM (ET) – 2:00 PM (ET)

Speakers:

• CMS Administrator, Chiquita Brooks-LaSure
• CMS Principal Deputy Administrator and Chief Operating Officer, Jon Blum
• CMS Leadership Team

Who should attend: National and local CMS stakeholders and partners

RSVP: https://cms.zoomgov.com/webinar/register/WN_-_ucuPD0THOxWCWpdpQq5g

After registering, you will receive a confirmation email containing information about joining the call. Please note that when you click the link to join the call on April 25, you will see a message stating that the host will allow you to join the event momentarily. Please continue to wait at that screen until the CMS team begins the call.

CMS Issues Inpatient and LTC Hospital 2024 PPS Proposed Rules

On April 10 the Centers for Medicare and Medicaid Services (CMS) issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS proposed rule for fiscal year (FY) 2024. The rule proposes a net 2.8% rate increase for inpatient PPS payments in FY 2024. This would increase hospital payments by $3.3 billion, minus a proposed $115 million decrease in disproportionate share hospital payments (largely due to a decrease in the uninsured) and proposed $460 million decrease in new technology add-on payments.

Other provisions in the rule include:

• A continuation of the low wage index hospital policy for FY2024 – rural reclassified hospitals will be treated as geographically rural to calculate the wage index and “dual reclasses” will be excluded from the rural wage index.
• A structure for graduate medical education payments to be made to Rural Emergency Hospitals.
• Provisions regarding self-referral (Stark) law exceptions in the context of physician-owned hospitals. The proposed rule also reinstates program integrity restrictions for physician-owned hospitals approved as “high Medicaid facilities.”
• A requirement to require “up to date” staff vaccination status for quality reporting purposes.
• A request for information for safety net hospitals to describe barriers to achieving health equity.

The CMS Fact Sheet for the proposed rule can be found here.

FHA will be conduct further analysis of the proposed rule and work with our members to draft comments. If you have any questions or comments, please contact Michael Williams at [email protected].

FHA aims to bolster Florida’s nurse workforce through training, legislative initiatives | State of Reform

President Mayhew spoke with the State of Reform regarding Florida’s crucial workforce shortage and the effective strategies for a robust workforce pipeline. “CareerSource is a great partnership as we focus on career leaders and pathways, and getting creative around how we support that individual who today may be a (certified nursing assistant) but wants to become an RN,” FHA President and CEO Mary Mayhew said. “That pathway shouldn’t have to include quitting their job and going to school full-time."

FHA Quality Conference June 22-23, 2023 – Registration is Open!

FHA is pleased to announce the first annual FHA Quality Conference is confirmed for June 22-23, 2023! The registration portal is now open, and we encourage FHA hospital and health care system members as well as non-member health care providers to register for this important event.

Attendees will hear from esteemed subject matter experts and distinguished colleagues, including two special national speakers for the conference opening and closing keynote sessions.

• Informative presentations from hospitals and other providers will include: 
• Improving Care Transitions/Reducing Readmissions 
• Reducing Sepsis Mortality
• Measuring and Implementing Programs to Create a Safety Culture and High Reliability
• Reducing Maternal Mortality, C-sections, and Improving Care for Mothers and Babies
• Approaches to Improve Medication Safety
• Addressing harm across the board through a comprehensive approach to performance improvement

The conference will take place at The Westin Lake Mary, 2974 International Pkwy, Lake Mary, FL, 32746. Please click here to reserve your room in the FHA room block! The deadline to reserve a room is Tuesday, May 30, 2023. For questions about the conference, please contact FHA Education at 850-222-9800 or [email protected].

Florida Hospital Association 2023 Annual Meeting
October 4 - 6, 2023 | Orlando, FL
Registration to attend will be opening soon!

FHA Medicare 101 Course – Register now!

Updated for 2023, this FHA member training provides a high-level overview of the Medicare program, how it is organized, and how it impacts hospitals and health systems. It will focus on the sources of supplemental coverage, the funding of the program, a payment system overview, and discuss the basics of the Medicare Advantage plan. The goal of this training is to give attendees the fundamental framework to understand how Medicare reimburses for hospital-related services and will include a discussion of recent policy developments. Please join us for the two-hour training on. 

Tuesday, June 6, 2023, 1:00 – 3:00 p.m. ET.
REGISTER

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
REGISTER

Readmissions Webinar Series – Leveraging Your Area Agency on Aging to Prevent Readmissions

April 17, 2023, 2:00 p.m. – 3:00 p.m. ET
REGISTER

Community Benefit Forum

April 20, 2023, 1:00 p.m. – 2:00 p.m. ET
REGISTER

FHA Managed Care Monthly Call

April 20, 2023, 9:00 a.m. – 10:00 a.m. ET
REGISTER

Infection Prevention Hot Topics – Antibiotic Stewardship and What We Can Learn from Antibiograms

May 17, 2023, 2:00 p.m. – 3:00 p.m. ET
REGISTER

Infection Prevention Hot Topics – Ventilator-associated Events

June 20, 2023, 2:00 p.m. – 3:00 p.m. ET
REGISTER

HFMA | Healthcare 2023: Dancing to a Different Beat

Apprenticeship Accelerator

Please find information below on upcoming Accelerators in Tallahassee Apr 19, Gainesville Apr 27, Orlando on May 3, and Sarasota on Jun 15. Each will have a healthcare component and all events take a deeper dive into available funding opportunities.

Tallahassee - Free Employer Workshop on the Benefits of Apprenticeships
April 19, 2023, 1:00 p.m. – 3:30 p.m.
Register Here

UF Gainesville - Free Employer Workshop on the Benefits of Apprenticeships
April 27, 2023, 2:00 p.m. – 4:00 p.m.
Register Here

Heathrow - Free Employer Workshop on the Benefits of Apprenticeships
May 3, 2023, 8:00 a.m. – 12:00 p.m.
Register Here

Sarasota - Free Employer Workshop on the Benefits of Apprenticeships
June 15, 2023, 8:00 a.m. – 12:00 p.m.
Register Here