Legislative Update: After the 2018 Mid-Term Election

Healthcare Financial Management Association (HFMA)- 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 : 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 : 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,

• Democrat Fentrice Driskell (New Tampa) • Democrat Jennifer Webb (SW Pinellas) • Republican (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 Seema Verma as CMS helm of the U.S. Administrator – Medicaid Department of Health policy expert and Human Services 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 116th 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 medically- necessary • 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

General Percent of Percent of Category 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 11th – Intermit Committee weeks begin o January 7 o January 22 o February 4 o February 11 o February 19  January 8th - Governor’s Inauguration Ceremony  February 2 –Governor’s Budget is due  March 5th – Regular Session Convenes

May 3rd – 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 [email protected] 727-519-1220

State: Jason Rodriguez [email protected] 727-519-1885

Lecia Behenna [email protected] • (850) 509-5413 • (850) 222-9800