Joint Legislative Budget Commission — Closed Captions

>> Chair: WELCOME, THE LEGISLATIVE BUDGET COMMISSION WILL COME TO ORDER. >> Chair Hooper: HERE. >> Senator Berman: HERE. >> Senator Boyd: HERE. >> Senator Brodeur: HERE. >> Senator Harrell: HERE. >> Senator Passidomo: HERE. >> Senator Rouson: HERE. >> Senator McClure: HERE. >> Rep. Andrade: Rep. Busatta: HERE. >> Rep. Shoaf: HERE. >> Rep. Snyder: HERE. >> Rep. Tant: HERE. >> Rep. Woodson: HERE. >> A QUORUM IS PRESENT. >> Chair: AS A REMINDER PLEASE SILENCE ELECTRONICS. THERE ARE TWO BUDGET AMENDMENTS ON TODAY'S AGENDA. THE FIRST ONE OF THOSE IS FOR THE AGENCY OF HEALTHCARE ADMINISTRATION. WE HAVE BRIAN MYERS DEPUTY SECRETARY FOR MEDICAID HERE TO PRESENT AMENDMENT B2026 0831. YOU ARE RECOGNIZED. >> GOOD MORNING. MEMBERS OF THE COMMISSION I AM BRIAN MEYER DEPUTY SECRETARY FOR MEDICAID AND I WANT TO THANK YOU FOR THE OPPORTUNITY TO PRESENT THE BUDGET AMENDMENT. FISCAL YEAR 2025 26 PROVISO IMPLEMENTING LANGUAGE AUTHORIZING THE AGENCY FOR THE LOW INCOME POOL. THE PROGRAM PROVIDING GOVERNMENT SUPPORT FOR SAFETY NET PROVIDERS FOR THE COST OF UNCOMPENSATED CARE. THIS REQUEST FOR 2.1 BILLION IN BUDGET AUTHORITY IN THE GRANTS AND DONATIONS TRUST FUND FOR MEDICAL CARE TRUST FUND WITHIN THE MEDICAID SERVICES TO INDIVIDUALS BUDGET ENTITY WOULD ALLOW THE AGENCY TO MAKE A LOW INCOME POOL PAYMENTS TO ELIGIBLE PROVIDERS. THAT IS THE AMENDMENT. >> Chair: QUESTIONS> SENATOR BERMAN. >> Senator Berman: IT IS MY UNDERSTANDING THAT WE JUST GOT APPROVAL FOR THIS YEAR'S MODEL ON APRIL 7th. PLEASE TELL US WHEN ACHA SUBMITTED THE MODEL TO CMS AND PROVIDE DETAILS AS TO WHY IT WAS SO LATE THIS YEAR. >> I DON'T HAVE A SPECIFIC DATE IT WAS SUBMITTED. WE CAN FOLLOW UP WITH THE DATE. I CAN SAY WE DID RECEIVE APPROVAL FOR THE REIMBURSEMENT FUNDING METHODOLOGY LATER THAN TYPICAL I THINK THAT HAS BEEN OUR EXPERIENCE SO FAR WITH THIS ADMINISTRATION, THE NEW ADMINISTRATION. A LOT OF THE SUPPLEMENTAL PAYMENTS HAVE COME UNDER ADDITIONAL REVIEW FROM MEDICAID SERVICES. WE ARE SEEING THIS ACROSS THE BOARD FROM ALL SUBMISSIONS BUT SO FAR TO DATE WE ARE GETTING APPROVALS ON WHAT WE ARE SUBMITTING. >> Senator Berman: THANK YOU. >> Chair: REPRESENTATIVE WOODSON. >> Rep. Woodson: GOOD MORNING. MY QUESTION HAS TO DO WITH WE KEEP HEARING FROM THE HOSPITAL THAT THE REIMBURSEMENT RATE IS LOW. HAS THERE BEEN ANY REQUESTS MADE IT TO THE CENTER FOR MEDICARE AND MEDICAID IN ORDER TO COVER THE SHORT FALL FOR THE CHILDREN'S HEALTH INSURANCE PROGRAM MAKING SURE THAT THE HOSPITALS ARE REIMBURSED FOR THAT AND HAS THERE BEEN A REQUEST FROM YOUR SIDE TO ADDRESS THAT TO COVER THE SHORTFALLS? >> Chair: YOU ARE RECOGNIZED. >> THANK YOU. I AM NOT AWARE SHORTFALLS ON THE PRESPECTIVE CHILDREN'S HEALTH INSURANCE PROGRAM BUT I DO KNOW THERE ARE A LOT OF SUPPLEMENTAL PAYMENTS ON THE MEDICAID SIDE FOR THE UNCOMPENSATED. THIS PROGRAM DOES COVER UNCOMPENSATED CARE AND I ALSO KNOW THE NEXT AMENDMENT IS ANOTHER PROGRAM THAT ADDRESSES MEDICAID SHORTFALL. I AM HAPPY TO FOLLOW UP WITH THE AFTER ON SPECIFICS OR IF YOU DO HAVE SPECIFICS OF HAPPY TO FOLLOW WITH YOU AFTERWARDS. >> Chair: FOLLOW UP. >> Rep. Woodson: I WOULD LOVE THAT BECAUSE BASED ON WHAT I AM READING THIS DOES NOT COVER THE COST FOR INSURED INDIVIDUALS BECAUSE MANY ARE INSURED HOWEVER THE INSURANCE STILL DOES NOT COVER EVERYTHING BAD DEBT ALSO MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAM AND I'M VERY CONCERNED ABOUT THE CHILDREN SO THAT IS THE REASON OF MY QUESTION. >> Chair: ADDITIONAL QUESTIONS? ANYONE ONLINE HAVE A QUESTION? THERE IS NO PUBLIC TESTIMONY. IS THERE DEBATE? IS THERE OBJECTION TO THE AMENDMENT? WITHOUT OBJECTION SHOW THIS AMENDMENT IS ADOPTED. WE WILL NOW TAKE UP MR. MYERS TODAY DOGE B 2026 0875 YOU ARE RECOGNIZED SIR. >> THANK YOU FISCAL YEAR 2025 25 PROVISO IMPLEMENTING LANGUAGE AUTHORIZING THE AGENCY TO REQUEST BUDGET AUTHORITY TO IMPLEMENT THE DIRECT PAYMENT PROGRAM. FLORIDA'S DIRECT PAYMENT PROGRAM FOR HOSPITALS PROVIDES PAYMENTS TO HOSPITALS FOR BOTH INPATIENT AND OUTPATIENT SERVICES TO MEDICAID MANAGED CARE ENROLLEES. THE REQUEST PLACES A 7.9 BILLION IN UNBUDGETED RESERVE IN THE GRANTS AND DONATIONS TRUST FUND AND MEDICAL CARE TRUST FUND WITHIN THE MEDICAID SERVICES TO INDIVIDUALS BUDGET ENTITY UNTIL THE AGENCY RECEIVES FINAL APPROVAL FROM CENTERS FOR MEDICARE AND MEDICAID SERVICES. THAT IS THE AMENDMENT. >> Chair: QUESTIONS? SENATOR BERMAN. >> Senator Berman: THANK YOU. I UNDERSTAND THAT FINAL CMS APPROVAL IS CONTINGENT UPON HOSPITAL ATTESTATIONS THAT THEY DO NOT PARTICIPATE AND HOLD HARMLESS AGREEMENTS. CAN YOU EXPLAIN IN MORE DETAIL WHAT ARE THE CONTEXT OF THESE HOLD HARMLESS AGREEMENTS UNDER THE HOSPITAL DPP PROGRAM? >> Chair: MR. MEYER. >> FIRST ABOUT THE REFERENCED ATTESTATIONS WE HAVE RECEIVED THEM FROM HOSPITALS AND THEY HAVE BEEN SUBMITTED TO CMS AND AT A HIGHER LEVEL HOLD HARMLESS ARE FEDERAL REGULATIONS AND FEDERAL REQUIREMENTS AROUND PROVIDER TAXES AND POTENTIAL IN THE PROVIDER TAXES AROUND UNIFORM AND BROAD BASED TAX AUTHORITY AND HOSPITALS HAVE TO ESSENTIALLY PARTICIPATE IN THESE PROGRAMS WHETHER THEY ARE HIGH MEDICAID UTILIZERS OR NOT SO A LOT OF THE HOLD HARMLESS REQUIREMENTS THAT SHOULD GOVERN MEANING AN INDIVIDUAL HOSPITAL MIGHT HAVE TO PARTICIPATE UNIFORM OR BROAD BASED TAX PROGRAM AND IN THE SENSE THAT YOU MIGHT BE TAXED AT A HIGHER RATE THAT WHAT YOU RECEIVE A PAYMENT BACK. >> Chair: FOLLOW UP. YOU ARE RECOGNIZED. >> Senator Berman: YOU MENTIONED THAT THEY ALL HAVE GIVEN JUST SOME OF THEM HAVE TO UNWIND THOSE HOLD HARMLESS AGREEMENTS? OR HAS THAT ALREADY BEEN DONE? >> WE RECEIVED ATTESTATIONS FROM EVERY HOSPITAL. I AM NOT AWARE OF ANYTHING THAT HAD TO BE UNWOUND BUT WE RECEIVED ATTESTATIONS FROM THE HOSPITALS. >> Chair: FOLLOW UP. >> Senator Berman: YOU DID MENTION FINAL APPROVAL STILL HAS NOT BEEN GRANTED. HOW LONG DO YOU ESTIMATE THAT IT WILL TAKE TO GET FINAL APPROVAL AND IF IT IS GRANT WILL WE NEED TO HAVE ANOTHER BUDGET AMENDMENT AT THAT TIME? >> Chair: MR. MEYER. >> WE ARE HOPEFUL FINAL APPROVAL WILL COME ANY DAY AT THIS POINT NOW ESPECIALLY WITH THE SUBMISSION OF THE ATTESTATION. I THINK THAT IT IS POSSIBLE I AM NOT A BUDGET EXPERT HERE BUT I THINK IT GOES INTO RESERVES AND I DON'T KNOW IF IT GOES INTO A 14 DAY AFTER THAT OR WHAT NOT BUT THE HOPE IS THAT WE CAN GET APPROVAL ANY DAY NOW THAT IS WHAT WE ARE HOPEFUL FOR AND THAT WE CAN MOVE FORWARD WITH ISSUING THE PAYMENTS. >> Senator Berman: THANK YOU. >> Chair: REPRESENTATIVE WOODSON. >> Rep. Woodson: I AM FOLLOWING UP ON SENATOR BERMAN'S QUESTION AND ALSO READING WHAT I'M READING HERE I UNDERSTAND THE UNIVERSITY OF MIAMI WHOSE HOSPITAL UNIVERSITY OF MIAMI AND THE MOFFITT CENTER WILL PROVIDE CARE TO CANCER PATIENTS AND ARE NOT PARTICIPATING IN THE PROGRAM. IF SO DOES THIS MEAN THAT SOME OF OUR RESIDENTS ARE NOT ACCESSING THE CARE THAT THEY NEED AND IF SO WHAT HAVE YOU DONE TO ENSURE THIS NEGLECTED LOW INCOME POPULATION WHO MAY NOT HAVE ACCESS TO CARE BECAUSE THE HOSPITAL IS NOT PARTICIPATING IN THE PROGRAM WHAT ARE YOU DOING TO ENSURE THAT THIS POPULATION IS NOT NEGLECTED AND IS HAVING ACCESS TO CARE THAT THEY NEED? THAT IS MY QUESTION. >> Chair: MR. MEYER TO ANSWER THOSE THREE QUESTIONS. >> CORRECT. CANCER HOSPITALS ARE NOT PARTICIPATING IN THIS. IT IS NOT IMPACTING CARE FOR MEMBERS IN THESE INSTITUTIONS. THE CANCER HOSPITALS ARE PARTICIPATING IN THE FLORIDA CANCER HOSPITAL PROGRAM. IT IS A SEPARATE SUPPLEMENTAL PROGRAM THAT THE CANCER HOSPITALS ARE PARTICIPATING IN. >> Chair: IS THAT GOOD REPRESENTATIVE WOODSON? >> Rep. Woodson: I DON'T THINK MY QUESTION HAS BEEN FULLY ANSWERED BECAUSE IF THE TWO HOSPITALS ARE NOT PARTICIPATING IN THE PROGRAM OF COURSE YOU WILL HAVE PATIENTS WHO ARE NOT ACCESSING CARE BECAUSE WE CAN SEE HOW HIGH THE CANCER RATE IS RISING IN THE STATE OF FLORIDA. SO ARE YOU DOING ANYTHING PROACTIVE TO ENSURE THAT EVERYONE IS SERVED? >> THERE IS A SEPARATE SUPPLEMENTAL FUNDING PROGRAM FOR THE FLORIDA CANCER HOSPITAL PROGRAM. IT IS NOT ON THE AGENDA TODAY BUT IT HAS BEEN APPROVED AND WE ARE ABLE TO MOVE FORWARD WITH ISSUING THE PAYMENT SO THAT IS THE REASON THE CANCER HOSPITALS ARE NOT PARTICIPATING IN THE PROGRAM IS BECAUSE IT IS A SEPARATE PROGRAM THAT THEY ARE PARTICIPATING INTO FUND THESE INSTITUTIONS. >> Chair: [INAUDIBLE]. >> THANK YOU. YOU KNOW OBVIOUSLY I WAS CONCERNED AND APPRECIATIVE OF ACHA AND OTHER STAKEHOLDERS WORK GETTING THE DPP STAKEHOLDERS UNSTUCK IN THE PAST SEVERAL MONTHS BUT WHAT I AM READING AND UNDERSTANDING FROM WHAT YOU SAID TODAY ALL HOSPITALS BROUGHT ATTESTATIONS THAT NO HOLD HARMLESS STATEMENTS ARE IN PLACE RIGHT NOW BUT IT SOUNDS LIKE THAT WAS A BIG CONCERN FOR CMS. IS IT YOUR UNDERSTANDING THAT THERE MAY HAVE BEEN SOME MISCOMMUNICATION OVER THE PAST YEAR ABOUT WHETHER OR NOT THE HOLD HARMLESS AGREEMENTS EXISTED IN FLORIDA? WAS IT SOMETHING THAT NEEDED TO BE OR COULD HAVE BEEN CLARIFIED EARLIER? YOU KNOW, JUST LOOKING FORWARD EXACTLY WHAT IS YOUR UNDERSTANDING OF WHAT MAY OF HAVE CREATED THIS HOLD UP AT THE CMS LEVEL AS FAR AS THE DPP APPROVAL? >> Chair: MR. MEYER. >> SIMILAR TO EVERY SUPPLEMENTAL PAYMENT PROGRAM STATE DIRECTED 8.6 EVERYTHING WE EXPERIENCED WITH THIS ADMINISTRATION HAS COME UNDER LONGER LEVELS OF REVIEW. IT IS TRUE WITH OUR INPATIENT STATE PLAN AMENDMENTS, ENERGY PROGRAMS OF FLORIDA, ALL THE STATE DIRECTED PAYMENTS WHEN WE TRY TO GET APPROVAL FOR CMS AT THE FLORIDA CANCER HOSPITAL PROGRAM HAD BEEN OUTSTANDING FOR UPWARDS OF 500 DAYS. AND IT HAS BEEN APPROVED. I WOULD SAY THIS FOLLOWS THE PATTERN THAT WE HAVE SEEN WITH CMS IN TERMS OF ENHANCED SCRUTINY UNDER STATE DIRECTED PAYMENTS PROVIDER TAXES WITH ONE BIG BEAUTIFUL BILL THAT WAS A FOCAL POINT STATE DIRECTED PAYMENTS PROVIDER TAXES AND REGULATIONS AROUND THAT. CMS IS PURSUING A REVIEW OF THESE WITH ADDITIONAL LEVELS OF REVIEW AND SCRUTINY. >> Chair: SENATOR HARRELL. >> Senator Harrell: THANK YOU. CERTAINLY LOOKING AT THE CANCER PROGRAM I AM VERY FAMILIAR WITH THE SUPPLEMENTAL PROGRAM THAT COMES WITH CANCER CENTERS BUT MOFFAT IS SOLELY A CANCER HOSPITAL BUT THE UNIVERSITY OF MIAMI IS BOTH A GENERAL HOSPITAL AS WELL AS CANCER AND IT IS ONE OF OUR NATIONALLY INSTITUTED CANCER HOSPITALS SO ARE THEY GETTING THE SUPPLEMENTAL PAYMENTS FOR THE OTHER PATIENTS THROUGH A DIFFERENT PROGRAM THAT THEY PARTICIPATE IN? DO THEY GET SUPPLEMENTAL PAYMENTS OTHER THAN JUST THE CANCER PROGRAM OR OTHER PATIENTS OTHER THAN CANCER PATIENTS? >> I HAVE TO FOLLOW WITH SPECIFICS AS TO WHETHER THEY ARE PARTICIPATING OTHER SUPPLEMENTAL PAYMENT MODELS. >> Chair: ARE THERE OTHER QUESTIONS? SEEING NONE IS THERE OBJECTION TO THE ADOPTION OF THIS AMENDMENT. WITHOUT OBJECTIONS SHOW THE AMENDMENT IS ADOPTED. THANK YOU MR. MEYER. IS THERE ANY OTHER BUSINESS BEFORE US? REPRESENTATIVE ANDRADE MOVES THAT WE ADJOURN. THANK EVERYONE.