An impasse over hospital spending

Lawmakers still at odds on Medicaid payments to hospitals

in the final negotiations over a new state budget sends the legislative session into overtime.

TALLAHASSEE — Florida lawmakers will need to go into overtime because of an impasse about hospital spending in final negotiations over a new state budget.

House Speaker Richard Corcoran, R-Land O’Lakes, told House members Tuesday night that lawmakers will have to extend the session, scheduled to end Friday, or hold a special session.

“Make preparations because that’s kind of where we are headed,” he said after a day of behind-the-scenes negotiations with the Senate.

Corcoran said a “best-case scenario” would be finishing the session Saturday. But he also said it was possible the session would be extended to Monday or that Gov. Rick Scott could call a special session that might start as soon as Monday.

It will mark the second year in a row that the Legislature was unable to complete its annual session in the allotted 60 days.

Last year, lawmakers extended the session for three days to vote on the budget and then had to return for a special session after Scott vetoed the public-school portion of the budget, which he deemed inadequate.

Corcoran did not detail the reasons for being unable to reach an agreement.

But earlier, Senate Appropriations Chairman Rob Bradley, R-Fleming Island, said the House and Senate still were negotiating payments to Florida’s hospitals. At least part of the issue involves whether to scrap a long-standing payment system for a new one that would increase base Medicaid rates paid to every hospital, regardless of Medicaid patient load.

Late Tuesday morning, he said it was “too early to tell” if lawmakers would be able to agree on an $87 billion-plus spending plan by midnight. Meeting the deadline would have given lawmakers enough time to adhere to a mandated 72-hour cooling-off period before a final budget vote Friday, the last scheduled day of the 2018 session.

But when Corcoran spoke to House members about 8:15 p.m., he made it clear the budget wouldn’t be done in time.

The House’s proposed spending plan for hospitals in the upcoming year is essentially a continuation of the current year’s budget. But the Senate has proposed redistributing $318 million in Medicaid “automatic rate enhancements” now paid to 28 hospitals with large Medicaid caseloads and use it to increase the rates paid for all hospitals.

The Senate budget also includes $50 million to offset the recurring effect of the current year’s budget cuts on hospitals. The Senate plan has been endorsed by some rural hospitals that say the additional $50 million in it is what they need.

But the Senate proposal would cut Medicaid payments to Jackson Memorial Hospital in Miami by as much as $58 million and Orlando Health by nearly $9 million. House Appropriations Chairman Carlos Trujillo, R-Miami, said the House would not let safety-net facilities such as those face steep reductions.

HCA Healthcare, a for-profit chain that owns 43 facilities in the state, could see nearly $40.5 million in Medicaid increases under the Senate plan. Tenet, which owns nine hospitals in Florida, would see a nearly $4 million increase in Medicaid payments under the Senate plan, and Community Health Systems, which owns 23 hospitals in Florida, would see as much as a $7.7 million bump in Medicaid payments.

The Senate budget also includes an additional $130 million increase in Medicaid payments for nursing homes that aren’t included in the House budget.

Bradley said Tuesday that once the chambers agree on the hospital spending, they will discuss nursing homes.

Negotiations have been completed on a $21 billion public school budget and a $7.9 billion budget for state universities and colleges, including financial aid, he said. But as of Tuesday evening, lawmakers had not released the details of the agreement.