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IN THIS ISSUE Top Story: Governor DeSantis Announces Budget Recommendations On Thursday, Governor Ron DeSantis released his “Freedom First Budget” for fiscal year 2022-2023. The budget totals $99.7 billion, of which $37 billion is General Revenue. The Governor highlighted the improved economic conditions in Florida and revenue projections far surpassing pre-pandemic estimates by over $3 billion. Sales tax continues to be the largest revenue source, exceeding 70 percent of the state’s General Revenue. The Governor highlighted that Florida has $15.3 billion in total reserves. The Agency for Health Care Administration (AHCA) budget totals $36.8 billion, an increase of $1.4 billion from the current year. The Agency’s budget will make up 25.6 percent of the total General Revenue need in the state to fund the Medicaid program, compared to the Education budget that makes up 48 percent of the total General Revenue need. Historically hospitals have received $7 billion annually in Medicaid funding, of which approximately $1.5 billion is General Revenue. There are NO CUTS to Florida hospitals included in the Governor’s budget. Governor DeSantis’ Freedom First Budget can be found here. The Florida Legislature will now evaluate the Governor’s recommendations and begin the work of crafting Florida’s state budget for fiscal year 2022-2023. ? New Court Rulings on Federal Vaccine Mandates Both the 11th U.S. Circuit Court of Appeals and the U.S. District Court in the Northern District of Florida have issued rulings in Florida’s lawsuit seeking to prevent implementation of the Centers for Medicare and Medicaid Services’ (CMS) rule requiring COVID-19 vaccinations for all health care facility staff as a Condition of Participation in the Medicare program. The District Court Judge, M. Casey Rodgers updated her ruling based on additional considerations after Florida passed its vaccine mandate exemption law. After further consideration, Judge Rodgers confirmed her refusal to grant a preliminary injunction noting that the CMS rule is “not usurping the state’s police power to broadly regulate for the common good but instead has implemented a health precaution for the effective and efficient administration of the federal health care programs it is entrusted with administering.” A three-judge panel in the 11th Circuit Court of Appeals seemed to agree with Judge Rodgers, refusing to grant an injunction, with a written opinion to follow the denial of the motion. Neither of these rulings impacts the current nationwide stay of the CMS rule issued out of the Fifth Circuit last week. The state of Florida has a number of options for next steps, including requesting a full panel of the 11th Circuit Court of Appeals to hear the complaint. Eventually, these issues are likely to be decided by the U.S. Supreme Court. FHA has developed a Vaccine Mandate Chart that provides an in-depth review of the CMS, OSHA, and HB1b rules. You can read the document here; it reflects the current nationwide stay and includes compliance notes regarding the implementation of Florida’s vaccine mandate exemptions. Department of Legal Affairs Publishes Rule for Filing Complaint Related to Vaccine Mandate Exemptions Pursuant to Florida’s new COVID vaccine exemption law, the Department of Legal Affairs has published complaint forms for employees who have been terminated without being offered statutory exemptions. Information about complaint forms can be found on the Florida Attorney General’s website. Congress to Sidestep Medicare Cuts On Tuesday, the U.S. House of Representatives passed the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610) to delay 6% in Medicare cuts set to go into effect Jan. 1. S. 610 delays the 2% sequestration reduction, previously extended in April through the end of 2021 through the end of March, at which time a 1% sequester will become effective, then the full 2% sequestration will be implemented beginning July. The bill also delays the 4% PAYGO reductions until 2023. Delays in these cuts will benefit Florida hospitals an estimated total of $650 million over time period relevant to the delays. The Bill still must pass the Senate where it requires 60 votes for passage. This means that at least 10 Republican senators must vote to approve a bill. However, the Republican caucus, including Florida’s two senators, have voiced concern with the House bill, which contains language permitting a 50% vote to extend the debt ceiling. FHA has discussed this issue with Senators Rubio and Scott, and we encourage our members to do the same. If you need help contacting Senator Scott or Rubio, or draft language to encourage passage of S. 610, please contact Michael Williams at michaelw@fha.org. FHA Submits Comments on the No Surprises Act On Monday, December 6, FHA submitted comments on the “Requirements Related to Surprise Billing; Part II”, expressing concerns about using the qualified payment amount (QPA) as the presumptive rate for the independent dispute resolution (IDR) program; the amount of detailed information required on the Good Faith Estimates (GFE) for the self-pay patients; and the $400 threshold above the GFE as the definition for excessive charges to use the patient-provider dispute resolution program. Several provisions go into effect on January 1, 2022, including the prohibition on balance billing, use of the IDR to settle out-of-network payment disputes, providing GFEs to self-pay and uninsured patients, notice and consent process, and patient notification of rights. Additional policies go into effect after January 1 and will likely require additional rulemaking. The Centers for Medicare and Medicaid Services have created a Provider Requirements and Resources webpage with an overview, resources and links to key information. Watch for an FHA Alert with resources specific to Florida. AHA and AMA file lawsuit challenging the IDR component of the No Surprises Act After FHA, the American Hospital Association, the American Medical Association and other provider groups expressed major concerns with the Independent Dispute Resolution (IDR) program and the presumption that the QPA, which is based on the in-network contracted rates, would be the foundation for decisions made by the IDR organization. All noted that Congress outlined several factors that should be considered in deciding the amount to pay an out-of-network provider, which was ignored in the interim final rule. Hospital Funding Opportunity: Rural Critical Access Grant The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) announced an FY 2022 Rural Communities Opioid Response Program-Implementation (RCORP-Implementation) funding opportunity. The multi-year initiative is aimed at expanding access to prevention, treatment, and recovery services for substance abuse disorder, including opioid use disorder. Eligible critical access hospitals in high-risk communities should consider applying for the grant; the deadline is January 13, 2022. New Maternal Morbidity Measure will drive CMS “Birthing-Friendly” Designation Beginning October 1, 2022, the Centers for Medicare and Medicaid Services adopted a new measure for the Hospital Inpatient Quality Reporting Program to capture hospital participation in a statewide or national maternal safety quality collaborative and whether they have implemented the recommended safety practices or bundles to improve maternal outcomes. Through this measure and others, CMS will be proposing, hospitals could be considered “Birthing- Friendly” with a special designation on the CMS Care Compare website. Participation in the Florida Perinatal Quality Collaborative (Florida Perinatal Quality Collaborative | USF Health) counts for this measure. We encourage all FHA member hospitals to participate in FPQC activities and sign up for the Quality Indicators Project - Florida Perinatal Quality Collaborative | USF Health which will count for this measure. If your hospital is not participating in the PQI program, you must sign up by next Friday for it to count for 2021. A list of participating PQI hospitals is on the PQI webpage. For questions about the measure, please contact Kim Streit at kims@fha.org. Two Free Buprenorphine CME Training Webinars for OB Providers—1.25 hours of AMA PRA Category 1 Credit In partnership with Tennessee’s perinatal quality collaborative, the Florida Perinatal Quality Collaborative (FPQC) is offering free CME training on Buprenorphine used in obstetrical practice. The first session describes the basics of Buprenorphine treatment during pregnancy. The second session how to make prescribing Buprenorphine in your obstetrical practice work. Both of these sessions with assistance from Florida’s Behavioral Impact Project can help you include them in your OB practice. A training discussion webinar entitled "Adding Buprenorphine Treatment in Obstetrical Practice: Lessons Learned" will be held on Tuesday, January 18th at 4:30 PM ET, and can also help answer additional questions and concerns. ICYMI: Getting Ready for AHCA Culture of Safety Reporting FHA, in partnership with Beterra Health, hosted a call on December 8 to discuss strategies to prepare for the upcoming reporting and subsequent public release of hospital-specific Culture of Safety data. While the rule has not been finalized, once it is hospitals will have two years to conduct a Survey on Patient Safety Culture (HSOPS) with Florida-specific questions added and submit the data to the Agency for Health Care Administration. If you missed the webinar, you can listen to the recording here. Passcode: 7AU?$5ua. Registration Open for HOSPITAL DAYS! The Florida Hospital Association's Hospital Days are coming to the state capitol on January 24 & 25, 2022. Join us to show support for Florida's health care heroes and engage with state lawmakers. Please contact Sophia Stich at SophiaS@FHA.org or 850-222-9800 if you have any questions. REGISTER HERE! Addressing Workplace Violence Hospital and health system leaders must continually emphasize and demonstrate the importance of physical and psychological well-being by promoting an organizational culture of safety. The AHA has created a guide that shares how organizations have addressed workplace violence using both best practices and customizable solutions based on an organization’s size, resources and culture. Strategies in the guide include: Focusing on workforce well-being and safety. Developing synergistic relationships between security and police departments, clinical groups and operational leaders. Promoting data-driven approaches to decision-making. Engaging and supporting team members in the role of security as a part of everyone’s job Integrating safety and security in existing workflows and electronic medical records. FHA NEWS CLIPS Halt to Jab Mandate Gives Hospitals Breather—But Just a Bit | Bloomberg Law Southwest Florida hospitals in 'very fluid situation' as vaccine mandate rules change day by day | Fort Myers News-Press Vaccine mandate for health care workers on hold despite Florida judge’s ruling | WTSP Omicron surge? Hospital leaders optimistic it won’t be as bad as delta | WFTV Florida hospitals want clarity in preemption in CMS vaccine rules | Politico Pro ABOUT The FHA Pulse is the Association's regular update that contains articles, information, and our upcoming events. We hope you will enjoy and share among your staff. If you have any questions or content suggestions, please email us at Communications@FHA.org. UPCOMING EVENTS Alliant Health: AdventHealth’s remote patient monitoring during COVID-19 on December 14, 2021, at 2:00 PM (ET) Alliant Health: Signs of opioid addiction screening tools and referral to treatment on December 15, 2021, at 3:00 PM (ET) FHA Infection Prevention Hot Topics: Epidemiology on December 15, 2021, at 3:00 PM (ET) FHA Monthly Managed Care callon December 16, 2021, at 9:00 AM (ET) [[UNSUBSCRIBELINK]] from all FHA e-communications. 306 East College Avenue | Tallahassee, FL 32301 | Website
Halt to Jab Mandate Gives Hospitals Breather—But Just a Bit | Bloomberg Law
Southwest Florida hospitals in 'very fluid situation' as vaccine mandate rules change day by day | Fort Myers News-Press
Vaccine mandate for health care workers on hold despite Florida judge’s ruling | WTSP
Omicron surge? Hospital leaders optimistic it won’t be as bad as delta | WFTV
Florida hospitals want clarity in preemption in CMS vaccine rules | Politico Pro
[[UNSUBSCRIBELINK]] from all FHA e-communications. 306 East College Avenue | Tallahassee, FL 32301 | Website