Legislative Update: After the 2018 Mid-Term Election Healthcare Financial Management Association (HFMA)-Florida Chapter Joni Higgins & Jason Rodriguez Government Relations & Community Outreach, BayCare Lecia Behenna Director of Finance, Florida Hospital Association November 9, 2018
First, a Quick Outline Who We Are & What We Do 2018 Mid-Term Election What Just Happened? What s Next Washington Tallahassee Why It Matters
Who We Are: Government Relations & Community Outreach Lisa Bell, Community Benefit Manager Keri Eisenbeis, Director, GR & CO Joni Higgins, Federal Gov t Relations Mgr Danielle Mauck, Grants Manager Alex Licwinko, Post Award Grant Coord. Leah Millette, Community Benefit Coord. Mary Ann Vavala, Administrative Assistant Rosely Marmolejos, CB Dept. Secretary Amber Smith, Gov t Relations Coordinator Jason Rodriguez, State Gov t Rel. Mgr Ann Marie Frierson, Pre-Award Grant Crd Colleen Mangan, Comm. Benefit Analyst
What We Do Dig deep into the issues Figure out which levers to pull or push Tell our story - advocacy Influence outcomes and/or mitigate damage
Taking Our Story to Decision Makers
2018 General Election Nov. 6, 2018 Historic Turnout First midterm ever to exceed 100 million votes - 49% turnout In Florida, more than 8 million ballots cast To compare, 2014 midterms had one of lowest turnouts in history 36.4% participated In Florida, 6 million voters President Obama s first midterm in 2010 had 41% participation
So, That s a Wrap, Florida?
Well, Not Exactly Visions of 2000
Florida s Race for U.S. Senate Difference of 0.22% triggers manual recount -Republican Rick Scott: 4,091,417 (50.11%) -Democrat Bill Nelson: 4,074,073 (49.89%)
Dead Heat for Ag Commissioner Difference is 0.00% -Republican Matt Caldwell: 4,018,452 (50%) -Democrat Nikki Fried: 4,019,027 (50%)
And, First Recount in History for Governor Difference of 0.47% Republican Ron DeSantis: 4,069,451 (49.62%) Democrat Andrew Gillum: 4,030,936 (49.15%)
Also, on a Local Level State Senator for West Hillsborough County Republican Dana Young: 103,384 (49.93%) Democrat Janet Cruz: 103,673 (50.07%) Difference of 0.14% - 289 votes
Other Notables U.S. Congress Democrat Darren Soto (Osceola, Orange, Polk) Republican Gus Bilirakis (Pasco, Pinellas) Republican Greg Steube (Charlotte, DeSoto, Glades, Hardee, Highlands, Okeechobee, Polk) Republican Ross Spano (Hillsborough, Polk, Lake) Republican Vern Buchanan (Hillsborough, Manatee, Sarasota) Democrat Charlie Crist (Pinellas) Republican Daniel Webster (Sumter, Citrus, Hernando, Pasco) Democrat Kathy Castor (Hillsborough)
And, Florida Legislature Democrat Fentrice Driskell (New Tampa) Democrat Jennifer Webb (SW Pinellas) Republican Ed Hooper (North Pinellas, West Pasco) Democrat Adam Hattersley (Greater Brandon) Republican Melony Bell (Desoto, Hardee, S. Polk) Republican Mike Beltran (SE Hillsborough)
View from Washington
In 2017, Repeal & Replace Dominated
Despite Effort, Failed to Pass
Focus Shifts for Health Care in 2018 Repeal & Replace failure, fatigue + Leadership change at HHS due to travel scandal = Revamped health care priorities for Trump Administration
New Federal Health Care Decision Makers Priorities emerging: Medicaid Work Requirements Drug Pricing Value-Based Care Opioids Alex Azar now at the helm of the U.S. Department of Health and Human Services Seema Verma as CMS Administrator Medicaid policy expert
Today s Health Care Agenda in DC Opioid Epidemic Drug Pricing 340B Reform Price Transparency Medicaid Reform (Work Requirements, Block Grants?) Value Based Pricing Administrative efforts to weaken ACA Non-compliant plans Impact of individual mandate repeal
Fall Agenda on Capitol Hill Kavanaugh Confirmation Spending Bills Opioid Legislation Recess for Election
And, Moving Forward to 2019 Health Care in the Lame Duck? Expect limited movement on health care legislation in 116 th Congress given divided control Continue to expect regulatory action from HHS, CMS Without question, to be continued as dust settles from mid-term election
View from Tallahassee
2018 Session Opens with Health Issues On-going Regulatory Challenges Hospital Budget Battles Opioid Promises
Then, Focus Dramatically Shifts
Crisis Impacts Health Care Issues Budget: Pressure to reallocate resources - Medicaid retroactive eligibility change supported by legislature - Loss of additional general revenue to offset hospital cuts - Senate folds on hospital budget battle Mental Health: $400m added for schools, facility security. Opioids: remain focus, but more on policy vs. funding.
Legislators Pass Bill on Guns, Mental Health Legislature passes Marjory Stoneman Douglas High School Public Safety Act Includes gun control regulations Adds $125 million for mental health - $69 million for school districts Mental Health Assistance Allocation - $9.8 million for additional CAT teams - $18.3 million for additional mobile crisis teams - Mental Heath First Aid Funding Governor signs bill into law on March 9
Lawmakers Pass Opioid Bill (HB 21) Three-day prescribing limit for acute pain, may extend to 7 days if deemed medicallynecessary PDMP requirements consult before prescribing or dispensing Prescribers must complete 2-hour CME course by January 31, 2019 Example of critical internal collaboration to ensure readiness for July 1, 2018 implementation (Pharmacy, Behavioral Health, Information Services, BMG, CMOs, Communications, Gov t Relations, Other )
Budget Directs Changes Around LIP, Medicaid Request to modify LIP to add: Regional Perinatal Intensive Care Centers (RPICCs) Community behavioral health providers Seeking to end Medicaid Retroactive Eligibility for non-pregnant adults and children over 21 years State request pending before CMS -- requires federal approval in order to move forward
New Policy Issues Major Wins Advanced birth centers stopped Trauma center compromise Central pharmacy regulation established
On Deck, 2019 Legislative Session New legislative leadership House Speaker Oliva (Miami), Senate President Galvano (Manatee, SE Hillsborough Counties) Preparing for renewed battles on familiar fronts Reject Obamacare/Medicaid Bribes Certificate of Need 24 Hour Stays at Ambulatory Surgery Centers Patient Safety Culture Surveys
And, Hurricane Michael Relief Immense needs on Panhandle sure to add to state budget pressures for 2019 session
Potential Bright Spot Interest in telehealth Context will be critical continue to advocate for coverage, reimbursement Right Now Working with Publix to extend invitations to legislators to visit Walk-In Care stores
Get Involved - Calls to Action - Advocacy Team - Legislative Outreach - Issue Awareness
Why It Matters
Florida by the Numbers Healthcare Financial Management Association (HFMA) Lecia Behenna Director of Finance Florida Hospital Association November 9, 2018
SFY 2018-19 State Budget by the Numbers FY 2018-19 Florida Budget by Category Category General Percent of Percent of Total Budget Revenue State GR Total Budget Education All Programs $ 16,808.1 51.90% $ 25,258.4 28.5% Human Services $ 9,879.6 30.51% $ 37,140.8 41.9% Criminal Justice and Corrections $ 3,819.8 11.80% $ 4,669.7 5.3% Natural Resources/ Environmental / Growth / Transportation $ 436.0 1.35% $ 14,838.1 16.7% General Government $ 993.5 3.07% $ 6,281.1 7.1% Judicial Branch $ 446.0 1.38% $ 539.3 0.6% Total $ 32,383.0 100% $ 88,727.4 100.0%
Agency for Health Care Administration (AHCA) Total Budget: $29.2 billion for SFY 2018-19 Medicaid Budget: $28.3 billion 32% of the State budget 97% of AHCA s budget Approximately $4.8 billion on inpatient and outpatient services (through fee for service and managed care) Includes $2.1b in supplemental payments
Medicaid SFY 2018-19 Funding by the Numbers
Low Income Pool Update for SFY 2018-19 Letters of Agreement were due October 1, 2018 per Florida Statute 409.908. IGTs came lower than expected. The RPICC and Behavioral Health Amendments submitted to CMS have not been approved. AHCA developed and is currently reviewing a model internally. AHCA will submit the LIP model as budget amendment, then it will be posted for 14 days. After approval invoicing and payments begin.
2019 Legislative Session Key Dates Social Services Estimating Conferences (SSEC) o November 13 TANF Caseload/Expenditures o November 19 Medicaid and KidCare Caseloads, FMAP o December 5 KidCare Expenditures o December 10 -Medicaid/ Long-Term Expenditures December 11 th Intermit Committee weeks begin o January 7 o January 22 o February 4 o February 11 o February 19 January 8 th - Governor s Inauguration Ceremony February 2 Governor s Budget is due March 5 th Regular Session Convenes May 3 rd last day of Regular
SFY 2019-20 State Budget General Revenue Estimating Conference will be scheduled in December 2018 or January 2019. Transition Team Personnel Shuffles Budget Pressures Red Tide Hurricane Michael and
November 7, 2018
Questions? Discussion? Federal: Joni Higgins Joni.Higgins@BayCare.org 727-519-1220 State: Jason Rodriguez Jason.Rodriguez@BayCare.org 727-519-1885 Lecia Behenna leciab@fha.org (850) 509-5413 (850) 222-9800