Friday, April 17, 2009

Nursing Home Budget Update

On Thursday, the House and Senate passed their respective budgets, setting up conference negotiations to begin on Monday. The nursing home budget language remains unchanged, with a 3 percent rate reduction in the Senate ($81 million) and a 2.5 percent rate reduction in the House ($69 million).

The House version contains language that continues to prohibit the Agency for Health Care Administration (AHCA) from citing facilities for failure to comply with the 2.9 CNA staffing level as long as the facility remains above the 2.6 CNA staffing level through June 2010.

The staffing issue generated some debate on the House floor, as Reps. Ocscar Braynon (D-109) and Yolly Roberson (D-104) discussed how the 2.9 staffing has greatly improved care in Florida nursing homes. Chairman Kevin Ambler (R-47) responded that nursing homes funding is being cut because providers were able to buy back previous rate cuts from January 1, 2008 and January 1, 2009 with the Quality Assessment Program that passed during the special session earlier this year. To help ameliorate the current funding cut proposed, he stated, the House extended the 2.6 staffing for another year. He argued that between a recent AHCA staffing report showing quality of care was very good under the 2.6 staffing and the flexibility this gives nursing homes, the extended staffing moratorium should not have any impact on quality of care. Reps. Braynon and Roberson pressed Chairman Ambler that, if the money could be found for nursing homes, the 2.9 staffing should be restored. Ambler responded that if any additional money is put into the health care line item during the budget conference, the restoration of nursing home funding and the staffing level will be his first priority.

Rep. Braynon offered an amendment that, if the tobacco tax passed through the legislature, then the 2.9 CNA staffing level for nursing homes is restored. Unfortunately, the amendment did not directly link any revenues from tobacco money to a nursing home rate restoration, so after a positive discussion with Chairman Ambler on the House floor, he withdrew his amendment.

FHCA's position continues to be one of supporting the higher staffing ratio of 2.9 CNA hours if the legislature provides the appropriate funding. We believe that funding and staffing must be aligned. In the meantime, we will continue monitoring the budget process once the conference begins on Monday and keep urging legislators to reconsider these funding cuts to nursing home care for our most frail elders.

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