Model Gaps, Regions and Shared Slides

Which input carries the most general revenue (GR) risk yet has no Health Professional Shortage Area (HPSA) evidence behind it, and what mix does it imply?

The hub payer mix — its revenue weights imply ≈36.5% commercial and 15% uninsured visits, vs 28.3% and 26.2% at the local Federally Qualified Health Centers (FQHCs) serving the same residents

What evidence is missing for the hub payer mix?

No source gives the payer mix of virtual primary-care visits for Health Professional Shortage Area (HPSA) residents, and HPSA visit payer mix is still an open P0 research gap

At what hub commercial share does the plan fail, and what is peak general revenue (GR) at the Federally Qualified Health Center (FQHC) mix?

It fails below ≈34.9% commercial, and at the FQHC mix peak GR is $213.49M with $856.2M of seed, both failures

Which three access filters has none of the 20 scenarios stressed?

Local Health Professional Shortage Area (HPSA) share (85% of local visits), virtual HPSA capture (80%) and virtual net of displacement (80%)

What do all 20 scenarios stress instead of the access filters, and is stress data already available?

All 20 stress money (collections, throughput, prices), although the Inputs sheet already holds stress values for the access filters

At what local Health Professional Shortage Area (HPSA) share does 2031 go above the 23.25-day target?

70.0%, vs 85% in the model

At what virtual capture does 2031 go above the 23.25-day target, and what does 70% capture give?

72.7%, vs 80% in the model, and 70% capture gives 23.42 days, a FAIL

At what virtual net capacity (net of displacement) does 2031 go above the 23.25-day target?

73.2%, vs 80% in the model

Why are the untested access filters dangerous?

Each breaks the 23.25-day target only 7–15 points below its model value

How is 22.81 days calculated, and why is it a forecast rather than a result?

It is calculated, not observed — the case packet's rule (Appendix A2), Days to care = 31 × (10.3M ÷ completed visits per year), applied to our 13.996M qualifying visits in 2031

What does the packet call its days-to-care rule, and why can't the rule show what happens to the waiting list?

Hypothetical case data — it equals Little's Law with the 2026 waiting list (≈875K open requests) held fixed

What Florida data could check 22.81 days, and why doesn't the only proxy work?

No Florida request-to-completion data exists — the only proxy is a 4-day first-offer figure from 13 Miami offices, which measures time to a first offered appointment, not to a completed visit

What would prove the 22.81-day forecast?

A measured 2027 baseline (mean, median, 90th percentile, open-request age) plus pilot counts of open requests ÷ daily completions

How much can the waiting list grow before 22.81 days rises past 23.25, and what could make it grow?

1.91% (≈16.7K requests) — if shorter waits bring back people who had given up, the target fails

How much must completed visits per Health Professional Shortage Area (HPSA) resident rise from 2026 to 2031?

From 1.48 a year in 2026 (10.3M ÷ 6.97M residents) to 2.01 in 2031 (+36%)

How many bookings does the 2031 visit target need at the packet's completion rate?

≈17.5M bookings vs 12.9M today, at the packet's 79.8% completion rate

Why is a rise to ~2.0 visits per Health Professional Shortage Area (HPSA) resident a demand risk?

No benchmark yet shows that ~2.0 visits a year is normal demand for non-shortage populations

Which slide 16 numbers have no source file in the vault?

Its fiscal years 2036–39 (FY2036–39) general revenue (GR) path ($143.44M → $170.40M) and the FY2040–43 award tails (≈$3.60M → $0.61M)

Why can't anyone trace slide 16's post-2035 numbers?

They come from an evidence report that was never filed in FINAL_REC

Which open ruling drives the post-2035 breach, and what does it decide?

Hub ruling 6 — whether the 1.5% yearly erosion of no-action capacity continues after 2031

What does the model assume on Hub ruling 6, and what if erosion stops?

It assumes erosion continues, so the hub adds 50 full-time equivalent (FTE) a year and general revenue (GR) breaches $150M in fiscal year 2037 (FY2037) — if erosion stops, most of the post-2035 gap goes away

What is missing behind the $150M contingency?

A sizing basis — the $150M is 21% of the $709.75M seed and tied to no named list of risks

How could the $150M contingency be sized properly?

From a risk register, or tied to the 20-case seed deltas (combined adverse +$110.30M, 95% collections +$88.28M)

How much cash is always in transit at a 60-day payment lag?

≈$108M ($656.77M of fiscal year 2032 (FY2032) receipts × 60 ÷ 365)

Why is the ≈$108M of receipts in transit a gap, and why can't the contingency cover it?

Nobody has priced who finances that working capital, and the $150M contingency can't back it as well as the risks it is meant for

What is unknown about the timing of the Medicaid match?

Under Statewide Medicaid Managed Care (SMMC) capitation, new visits may raise state cost only at a later rate rebasing

What is unknown about the source of the Medicaid match?

The 43.33% nonfederal share isn't automatically state general revenue (GR), but the model conservatively counts all of it

Who hasn't signed the Medicaid cash bridge, and what does the base carry as a result?

The Agency for Health Care Administration (AHCA) actuary, so the base carries 100% exposure ($86.26M in fiscal year 2032 (FY2032))

What legal check is still missing for crediting hub receipts, and why does it matter?

A legal basis for crediting a private hub operator's receipts against network cost, needed because at least 57.5% of the hub margin must be credited for the plan to pass

What analogy supports crediting hub receipts, and is it verified?

Title 2 of the Code of Federal Regulations (2 CFR) 200.307 (program income deducted from allowable cost), which is unverified

Why doesn't the Health Resources and Services Administration (HRSA) program-income rule cover the hub?

HRSA's rules cover health centers, not a private hub

What capacity has any host certified so far?

None — no rooms, sessions, staff, supervision or payer readiness

How many health-center clinical full-time equivalent (FTE) does the plan need, against Florida's stock?

≈496, ≈39.5% of Florida's 1,256 health-center FTE

What retention evidence is missing behind the 550 net, and why doesn't the 71% figure cover it?

An observed nurse practitioner / physician assistant (NP/PA) four-year retention rate, since the verified 71% four-year figure (Pathman) covers physicians only

What recruitment evidence is missing for the 2031 downside cohort?

A recruitment pool for the 326 offers it needs (vs 51 in the base)

What evidence is missing behind the 80% additionality?

Proof that hires are new capacity rather than transfers

Why is the rural share of Florida's Health Professional Shortage Area (HPSA) residents unknown?

HPSA population by county is still blocked (the Health Resources and Services Administration (HRSA) dataset query failed), so the rural share of the ≈6.97M HPSA residents is unknown

Which rural design shares can't be checked against need until county Health Professional Shortage Area (HPSA) population is known?

40% of net local clinicians and 20% of hub full-time equivalent (FTE)

What does no source yet measure about Florida shortage-area delays?

Whether delays come mainly from too few clinicians, scheduling, no-shows or distance, separately for rural and urban areas

Why can't the evidence we have rank the causes of delay?

It (e.g. Hendry/Glades surveys, Miami offer data, urban community health needs assessments) uses different methods and years

Which access route has no payer for uninsured residents' clinical visits?

The no-broadband route — supported video at assisted sites

On the no-car route, what do residents without a Medicaid transport benefit depend on?

Conditional Transportation Disadvantaged rides and the plan's gap budget (~100,000 one-way trips a year)

What data is missing before the county scorecard can show a baseline?

Observed county baselines of request-to-completion time (mean, median, 90th percentile, open-request age)

What sources could give county wait baselines, and what is the only proxy so far?

No Agency for Health Care Administration (AHCA) submission or local sample gives them yet, and the only proxy is Miami's 4-day first-offer figure

What does planned model run M1 test?

A hub payer-mix sweep from 28.3% to 36.5% commercial

What does planned model run M3 test?

Access filter stress cases at 70% capture and displacement

What does planned model run M4 add to the scenario grids?

Live two-input frontiers with the $150M contour

What does planned model run M5 test, and what result is expected?

The at-risk fee case (10% + 5 points), ≈$146M peak general revenue (GR) at 4,200 visits per productive full-time equivalent (FTE)

What does planned model run M6 compare for 2036–39?

The hub held at 1,100 full-time equivalent (FTE) vs +50 a year

What does planned model run M7 test?

3.8% cost growth with Federally Qualified Health Center (FQHC) receipts linked to the Medicare Economic Index (MEI)

What are the two-input scenario grids actually made of?

Frozen pasted values from a Google Sheets export, not live data tables

Why must the scenario grids be regenerated even though they were verified?

They were verified correct on 2026-10-17 but won't update if an input changes, and report §24 wrongly calls them native tables

What payer-rate discrepancy can a judge find in one step?

The same commercial payers are modeled paying the hub $129.94 per virtual visit but a Federally Qualified Health Center (FQHC) $100.05 per in-person private visit, so the lighter virtual visit is paid ≈30% more

How were the hub's $129.94 and the Federally Qualified Health Center (FQHC)'s $100.05 commercial rates derived?

The hub rate is the packet's $90 split by the 1.43 commercial-to-Medicare ratio, while the FQHC rate is a collections proxy

What internal inconsistency affects hub replacement hires?

New hub full-time equivalent (FTE) produce 75% in their first year, but replacement hires (10% of hub FTE a year) count as fully productive on day one

What happens if hub replacement hires ramp like new hires?

22.92 days, a 195K buffer (down from 262K) and $145.59M peak general revenue (GR), still a PASS

What did the 0.9 full-time equivalent (FTE) question turn on?

Whether 0.9 FTE means part-time pay (paid 0.9 of a salary) or full-time pay with 10% non-clinical time

How was the 0.9 full-time equivalent (FTE) question settled, and what would the other reading do?

Ruled pay basis on 2026-10-18, matching the model, while full pay would fail at $155.68M peak general revenue (GR)

What display error did the seed-by-region rows have?

They kept calculating after 2031, so the urban seed row showed −$62.6M to −$69.4M in fiscal years 2032–36 (FY2032–36)

Did the seed-by-region display error affect totals, and how was it fixed?

The totals were right, and the AUDITED copy stops the rows after fiscal year 2031 (FY2031)

What did the case selector and award-reserve text wrongly say before the AUDITED copy?

The case selector said "Enter 1–11" though there are 20 cases, and stale text described an award reserve that doesn't exist (the reserve is $0)

Which unlabeled rows did the AUDITED copy label?

Unused memo rows, including one that uses a flat 56.67% federal share

How are the scenario grids labeled in the AUDITED copy, and does case 1 still match?

As frozen snapshots, and case 1 recalculates identically

What does report §24 call the scenario grids?

"Native two-input sensitivity tables… not manually typed snapshots"

Since the workbook's grids are pasted snapshots, what should you say instead of "native"?

"20 recalculated scenarios", and never call the grids native

Why doesn't case 20 use the nurse practitioner / physician assistant (NP/PA) blend?

Case 20 (observed local productivity) uses 2,895 visits per full-time equivalent (FTE) for nurse practitioners only instead of the NP/PA blend of 2,927, kept so it still ties to the report's $171.21M

How many mobile operating days a year does the Deployment sheet give?

4 days × 48 weeks = 192 operating days

How many mobile operating days does report §25 use, and what does the difference do to visits a day?

200 days, giving 14 visits a day (2,800 ÷ 200), while 192 days would mean ≈14.6 a day

Which filter do mobile visits skip, and how much does it matter?

The 80% displacement filter that local and virtual visits get — ≈13,300 qualifying visits in 2031, under 0.1 day

What payer-mix simplification sits in the Federally Qualified Health Center (FQHC) receipts?

The FQHC payer mix sums to 99.54% because the 0.46% "other public" share was dropped (−$0.51 a visit)

How does the model grow Rural Health Clinic (RHC) Medicare rates, and what does the statute say?

2.5% a year, instead of the statutory steps ($165 → $178 → $190, 2026–28)

How do physician and nurse practitioner / physician assistant (NP/PA) first-year ramps differ in the model?

Physicians get no first-year productivity ramp, while NP/PAs produce 80% in year one

Which rate and hiring constants are hardcoded inside formulas?

The 0.56 Medicaid-to-Medicare ratio (Annual Forecast row 45) and the 12% physician share of hires (Workforce C11–C15)

Which assisted-site staffing constants are hardcoded inside formulas?

0.5 full-time equivalent (FTE) per assisted site with 1-to-10 supervision (Annual Forecast row 54)

Which fiscal year 2027 (FY2027) regional seed quantities are hardcoded?

5 vehicles plus 15 sites (Annual Forecast D91)

Why do the hardcoded constants matter when changing inputs?

Changing the Inputs sheet won't move them, so they must be edited in the formulas

How were the payer revenue weights derived?

Medicaid 24.94%, Medicare 13.11% and commercial 61.95% were derived together from the 0.56 and 1.43 rate ratios and a 23.2% Medicare share

What happens if one payer revenue weight is changed alone?

It breaks that calibration and the implied visit mix, so the three must be changed together

Why does fiscal year 2036 (FY2036) general revenue (GR) look too low in the workbook?

The workbook's FY2036 has no 2036 hiring cohort, so net local clinicians drop to 504 and FY2036 GR ($137.5M) looks too low

Why did the audit say the cap breaks in fiscal year 2038 (FY2038) while slide 16 says FY2037?

The audit straight-lined +$5.5M a year from the low FY2036 (FY2038 ≈$152M), while the extension adds the 2036+ replacements and breaches in FY2037 at $151.74M

Why is network administration probably understated?

It is 5% of the residual, only ~$1.4–1.6M a year on a $690–790M operation, and it shrinks as the hub surplus nets costs down

What if network administration were 1% of operating cost instead?

Peak general revenue (GR) rises $6.19M to $141.31M, still a pass

What does the model assume about displaced Medicaid visits?

They add no cost, even when a visit moves from the $62 other-setting rate to the $173.52 Federally Qualified Health Center (FQHC) rate

What is the upper bound on displaced Medicaid visit cost?

+$8.75M, giving $143.86M peak general revenue (GR), still a pass

What physician pay does the model use, and where does it come from?

The Bureau of Labor Statistics (BLS) Florida median of $227.7K, which the case packet cites

What does survey-level physician pay of ~$300K do to the plan?

Adds $11.42M ($146.53M peak general revenue (GR)), passing alone but leaving only ≈$3.5M of headroom

What error is in the judge question 10 (Q10) answer script?

It says a 5% receipt shortfall breaks the plan, but the breakpoint is 98.1%, so a ~2% shortfall is enough

What does a 5% receipt shortfall actually give, and what should the script say?

$174.71M peak general revenue (GR), so say "about 2 percent" breaks it

Which year wording errors are in the slide script?

"In 2032" should be "in fiscal year 2032 (FY2032)", and "by 2035", "2037" and "2039" should be FY2035, FY2037 and FY2039

How should the slide script describe the end of the seed Fund?

"Close on June 30, 2031", not "stop in 2031"

Why should the script say "per productive full-time equivalent (FTE)" rather than "per FTE"?

1,100 hub FTE are paid but only 1,075 are productive

Where does the 5.3% follow-up rate come from?

A 2024 telemedicine study of patients following up with their own primary-care doctor within 7 days

Why is the 5.3% follow-up rate questionable, and what happens at the alternative rate?

The same study found 7.3% when patients saw a different doctor, closer to a hub visit, but at 7.3% days are ≈22.94, still a pass (access fails only above 12.1%)

What 31 vs 32 day discrepancy exists between the packet and the model?

The packet's own examples use 32 days (34.5 days with no action, ~29.1, a 24-day target), while the model uses 31 and the strict 23.25

Does the plan pass under both the 31-day and 32-day baselines?

Yes — the % cut (1 − 10.3M ÷ visits) is the same either way, so 22.81 ≤ 23.25 and 23.55 ≤ 24

What two slide numberings coexist for Jerry's slides?

Jerry's script uses slides 11–16, while the recommendation (rec) §21 deck plan put Jerry on slides 13–17 and teammates on different numbers

How are rec-numbered slides labeled in notes, and what must the team do?

As "recommendation (rec) #N", and the team must agree on one numbering before recording

How much capacity do the 33 rural counties (8 clusters) get in 2031?

220 net local clinicians (40%), 220 hub full-time equivalent (FTE) (20%), 20 mobile units (80%) and 45 assisted sites

How much capacity do the 8 metro Health Professional Shortage Area (HPSA) markets get in 2031?

330 net local clinicians, 880 hub full-time equivalent (FTE), 5 mobile units and 25 assisted sites

How is the $709.75M seed split by region?

Rural ≈$228M, urban ≈$304M and statewide shared ≈$178M (including the whole $150M contingency)