Monday, March 29, 2010

FHCA members speaks out on Medicaid funding cuts

Freddie Franklin : Nursing home residents deserve dignity, funding -

Friday, March 26, 2010

Budget update

On Tuesday, the Full Appropriations Council on Education & Economic Development took up the budget. As we told you last week, the House has a proposed $132.4 million (4.6%) reduction to nursing home funding. The Senate Ways and Means Committee took up the budget Thursday, and FHCA staff and lobby team members continued to monitor these discussions. As we've reported, the Senate has proposed a $199.5 million (7%) funding cut to nursing home care. This cut is nearly equivalent the Medicaid funding that is provided annually for the increase in CNA staffing from 2.0 to 2.9, which amounts to $211.8 million. FHCA continues to advocate that these funding cuts would threaten resident quality care and could negatively impact caregiver jobs, since 70 percent of your operating costs go to people - salaries and benefits.

The Senate has developed a contingency budget which considers the $1 billion that would come from the six-month extension of the enhanced FMAP, which we hope will be taken up by the U.S. Congress just after they return from the Easter/Passover break. However, even with the $1 billion in relief from the enhanced FMAP extension factored into their contingency budget, the Senate makes no attempt to restore any of the nursing home funding cuts.

We need your help with urging legislators to do the right thing and use the FMAP money as it was intended - to fund the Medicaid program and alleviate cuts to funding for nursing home resident care. Please join us in taking action and e-mail your legislators today. Ask them to oppose the nursing home funding cuts and use the FMAP money as it was intended. Click here and use our pre-printed message (or customize your own); you'll simply need to enter your zip code to identify legislators in your district. We appreciate your help with this important call to action to protect our state's seniors.

Weekly wrap up

This was a busy week in Tallahassee, with a number of bills FHCA's been watching taken up by committees. On Monday, the Health Care Regulation Committee passed HB 7183 by Rep. Hudson, which reorganizes the Department of Health and removes all inspection duties for facilities such as nursing homes. Today, the bill also passed the House Health Care Appropriations Committee, along with Rep. Hudson's HB 1143, which is the regulatory reduction bill that helps providers reduce or eliminate duplicative inspections in nursing homes by agencies other than AHCA.

Background screening legislation was taken up by the Senate Criminal Justice Committee today. Multiple amendments were added to SB 1520 by Sen. Ronda Storms (R-10) to conform it to the House bill (HB 7069); however, two additional amendments regarding child care centers that were added now result in differences between the House and Senate versions.

Another important bill we're watching which was taken up today by the Senate Judiciary Committee is SB 2034 by Sen. Steve Wise (R-5), which would effectively prohibit the use and enforcement of pre-dispute arbitration agreements in long term care settings by allowing the agreement to be rescinded at any time. FHCA associate member Andrew McCumber testified that arbitration is more efficient, less adversarial and has a reduced time to settlement. The bill passed through committee; however, FHCA will continue to work with lawmakers to educate them about the importance of arbitration clauses in ensuring that scarce Medicaid resources go toward improving resident care rather than paying the escalating costs associated with protracted lawsuits.

The Senate Children, Families and Elder Affairs Committee amended SB 2008 by Sen. Mike Fasano (R-11) to delay the requirement of Automatic External Defibrillators in ALFs until July 1, 2011, giving providers more time to prepare.

FHCA will continue to monitor these bills as they make their way through the process. In the meantime, legislators will take a short respite for the Easter/Passover break, but will resume mid-week to get back to business. Check back next week for an update on what transpires.

Thursday, March 25, 2010

Nursing Home Resident Care Faces Hit from Funding Cut ‘Perfect Storm’

Combination of Medicaid Cuts and Medicare Cuts Will Threaten Seniors’ Quality of Care, Caregiver Jobs

The Executive Director of the Florida Health Care Association (FHCA) warned that new federal Medicare cuts to Florida nursing homes amounting to $1.2 billion over 10 years contained in health care reform will threaten quality of care and quality of life for the nearly 71,000 frail elders who rely on their care. Combined with cuts to Medicare-funded nursing home care that went into effect October 1, 2009 - $895.8 million for Florida over the next 10 years - and the Florida Legislature’s proposed annual Medicaid funding cuts - $200 million in the Senate and $133 million in the House – these deep cuts will significantly endanger Florida nursing home residents’ care and jeopardize the state’s already fragile economy and caregiver jobs base.

“Nursing homes and the seniors under their care face an unprecedented ‘perfect storm’ funding threat from combined federal Medicare and state Medicaid cuts to nursing home care,’” said J. Emmett Reed, Executive Director of the Florida Health Care Association, the state’s first and largest advocacy organization for Florida long term care providers. “Legislators must understand that Medicare and Medicaid funding are inextricably linked, and the combination of cuts squeezes local facilities in a way that could harm seniors’ care, impact caregiver jobs and be detrimental to local economies.”

In the year 2010 alone, Florida’s Medicare cuts amount to $78.4 million – the 2nd highest level of cuts in the nation – as a result of federal regulatory cuts that went into effect October 1, 2009. The estimated economic impact on Florida in the year ahead, according to an analysis from the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care, will be a reduction of $132.2 million in business activity, a reduction of $65.9 million in labor income, and a loss of 1,960 jobs. These cuts don’t take into account the $1.2 billion in cuts to Medicare-funded nursing home care that is included in health care reform signed into law today by President Obama.

Approximately 20 percent of nursing home residents rely on Medicare to pay for their nursing home care, while nearly 60 percent of residents rely on Medicaid. Medicare funding is critical to nursing homes because it supplements inadequate Medicaid payments. On average nursing homes lose $9.91 a day, or just over $225,000 a year in caring for Medicaid residents.

Continued Reed: “Having suffered a massive Medicare funding cut this past October of up almost $900 million over the next 10 years – distinct and separate from the reductions our sector has willingly and cooperatively agreed to shoulder as part of achieving broader health care reform – we are alarmed that the sheer size of the cumulative Medicare and Medicaid funding cuts we ultimately suffer will be especially damaging to seniors in Florida, where our Medicaid program is already underfunded.

Reed noted that Florida nursing homes are seeing an increasingly diverse patient base, and providing a greater variety of acute care, rehabilitative and convalescent services that cannot be delivered elsewhere – care services which are now in jeopardy due to the combined Medicaid/Medicare funding cuts. These massive funding cuts, Reed said, will undermine facilities’ ability to effectively treat this more medically complex patient population, and also put the jobs of the direct care workforce they depend upon in substantial danger, since nearly 70 percent of nursing home costs go toward people – salaries and benefits of the caregivers and other key staff vital to the quality of care and quality of life for residents.

“Maintaining Medicaid funding for nursing homes has become even more urgent as a result of the Medicare cuts that went into effect in October and those we will experience as a result of health care reform. The combination of cuts will significantly reduce the resources available for nursing home care at a time when residents have more medically-complex needs than ever before and the demand for access to that care continues to grow with our state’s aging baby boomer population,” said Reed.

Wednesday, March 24, 2010

Staffing language passes House

Yesterday, the House Health Care Appropriations Committee passed language to provide for a combined (nurses and CNAs) weekly average staffing standard of 3.9 hours per resident per day, while retaining daily minimum staffing of 1.0 hours per patient day for licensed nursing and 2.7 hours per patient day for CNAs, which was included in the House Medicaid conforming bill (HB 5301). FHCA's Senior Director of Policy, LuMarie Polivka-West, testified before the committee about nursing homes are caring for residents with a much higher acuity level as a result of Florida doing a good jog of identifying the appropriate placement for those individuals requiring nursing home care (Florida has the second lowest percentage in the country of with its over-65 nursing home population at just 2.1% - compared to the national average of just under 5%). She also noted how the federal government is anticipating an increase in direct care nursing with RUGS IV and the composite 3.9 staffing will allow nursing homes to better accommodate the Medicare changes.

Last week, the Senate Medicaid conforming bill (SB 1464) passed with identical language. If the final legislation passes, the combined 3.9 CNA/direct nursing per patient day will allow additional flexibility in meeting the needs of higher acuity residents with additional licensed nursing staff.

Health care reform

Summary of issues affecting post acute and long term care in the health care legislation:

Monday, March 22, 2010

Changes to Department of Health Clear Committee

Calling it an "outside the box" approach, during today's House Health Care Regulation Committeee Rep. Matt Hudson explained PCB HCR 10-03, which breaks down the Department of Health and removes all inspection duties for facilities such as nursing homes. After technical amendments were adopted, the partisan debate began. Repeatedly grilled over and over by Democratic members, Rep. Hudson kept his composure and answered directly and clearly. The State's Surgeon General testified first about the reorganization, which is devastating in her mind, and did not acknowlege that the Department could still investigate disease due to wording changes. Other public interests were concerned about other areas, but the bill passed out along party lines.

Committee discussing health care reform and its impact on Florida

As I sit in the House Health Care Regulation Committee meeting this afternoon, it is clear that the federal health care bill which passed yesterday has fueled a volatile debate. Currently, the Committee is discussing HJR 37 by Rep. Plakon to create a constitutional amendment to protect Florida from the federal bill. As citizens, advocates and others stand in line to express their opinions while others shout out from the audience, it is clear that this issue is partisan and not finished yet. What does it mean for us? Follow this bill with us as it may be on your 2010 ballot.

Nursing Home Care Threatened by Medicaid Funding Cuts

New Report Shows Impact of Funding Cuts by County -

Sunday, March 21, 2010

House Health Care Regulation Committee takes up bill to revamp Department of Health

Three weeks down in the 2010 legislative session and usually by now, we are in a routine of what committees are meeting when, allowing us to actually plan some sort of schedule. But in looking at the calendar for the upcoming week, something important for Sunday afternoons, that routine is all shook up.

On Monday, the House Health Care Regulation Committee will discuss a proposed bill to totally revamp the Department of Health. There's lots of reasons, and probably politics behind it, but the important part for nursing homes is that it removes all DOH regulatory and inspection duties from any facility licensed by the Agency for Health Care Administration.

Could this really be happening? Might this legislation pass in 2010? There is lots of duplication between DOH and AHCA in regards to nursing homes, so FHCA will be watching and supporting this bill. Look for more later.

Friday, March 19, 2010

Senators support nursing home staffing

During today's Senate HHS Appropriations Committee meeting, Sen. Joe Negron offered an amendment to include language to provide for a combined (nurses and CNAs) weekly average staffing standard of 3.9 hours per resident per day, while retaining daily minimum staffing of 1.0 hours per patient day for licensed nursing and 2.7 hours per patient day for CNAs in the Senate Medicaid conforming bill (SB 1464). FHCA's Senior Director of Policy, LuMarie Polivka-West, testified before the committee about how the federal government is anticipating an increase in direct care nursing with RUGS IV and the composite 3.9 staffing will allow nursing homes to better accommodate the Medicare changes.

Sens. Don Gaetz and Durrell Peaden spoke in support of the amendment, and voted in its favor along with Sen. Negron and Sen. Mike Haridopolos. As a result, the amendment was adopted. Currently, the House Medicaid conforming bill (HB 5301) includes identical language. If the final legislation passes, the combined 3.9 CNA/direct nursing per patient day will allow additional flexibility in meeting the needs of higher acuity residents with additional licensed nursing staff.

Tuesday, March 16, 2010

Update on background screenings

During the House session, background screening legislation - HB 7069 by Rep. William Snyder (R-82) - rolled over to a third reading; all eight amendments were adopted with no questions. This includes FHCA's suggested amendment that current employees rescreened under the new law may apply for an exemption - and continue to work - if they have a disqualifying offense that was not a disqualifying offense at the time of the last screening (such offense may now be considered disqualifying as new crimes have been added under SB 1986, for example) and was committed prior to the last screening. Stay tuned for more updates on this important legislation.

House releases health care budget

Reports from the Capitol are out of the initial House Health Care Appropriations budget, which includes a $132.8 million cut to nursing home Medicaid funding (that amounts to approximately 4.6% or $8.50 per patient day). The budget also expands the Nursing Home Quality Assessment Program to the maximum 5.5 percent, and Hospice rates are reduced $11.6 million to reflect nursing home funding cut. There is a funding transfer of $8.5 million from nursing home case growth for the Nursing Home Transition Program (which represents 540 individuals) ; however, there is no expansion of additional slots for the Nursing Home Diversion Program.

The budget release is timely, as over 100 FHCA members representing Cypress Health Care Management, Gulf Coast Health Care, Summit Care, Avante Group and Ponce de Leon are in town this week to urge legislators not to make these devastating cuts which will threaten quality of care and quality of life for our state's most vulnerable citizens.

Please join FHCA in advocating for adequate nursing home funding and contact your legislator to urge them to oppose these funding cuts for our state's frail elders, 60 percent of who rely on Medicaid to cover the costs of their nursing home care. Our 'Greatest Generation' deserves better.

House takes up background screening

The House is in session today and background screening legislation (HB 7069 by Rep. Snyder) is on the agenda. Interesting to note that despite an appropriation attached to this bill, it leaped over that process, heading straight to the House floor. It's obvious this legislation is a priority this year. Stay tuned for an update on today's events.

Friday, March 12, 2010

Senate releases proposed budget

On Thursday, the Senate HHS Appropriations Committee released the initial Chairman's budget, which includes a 7 percent ($199.4 million) cut to nursing home Medicaid funding. The budget does not account for the $1 billion in Medicaid money that will result from the extended Federal Medical Assistance Percentage funding, which was included in legislation that cleared the U.S. Senate earlier this week.

Coverage for adult vision and hearing services were eliminated, managed care was expanded (but does not include long term care), hospice rates were reduced to reflect the cut in nursing home rates ($17.5 million) and the Nursing Home Quality Assessment was expanded to the maximum 5.5 percent. Funding was also shifted for nursing home case loads to more cost-effective home and community-based waiver programs, which is in line with FHCA's position statement to ensure cost-effective delivery of long term care services while preserving Florida’s economy and safeguarding the taxpayers’ interests.

This week the members of Our Florida Promise continued to urge legislators to keep the promise to fund quality nursing home care. On Tuesday, they delivered our blog post about how nursing homes are a critical component to the long term care continuum and must be adequately funded and not undercut by an expansion of less cost-effective programs. This grassroots campaign is making an impact, as the Senate's proposed budget contained funding for those more cost-effective home and community-based waiver programs but no expansion of slots for the Nursing Home Diversion Program.

The House is expected to release its version of the budget next week, and FHCA will keep you informed as soon as this information becomes available. In the meantime, there is talk at the Capitol of possibly using the FMAP dollars to fund other programs rather than alleviate funding cuts to the health and human service budget. Next week, we'll ramp up the message that legislators have no reason to impose these funding cuts when federal money is available. We'll be asking your help to take part in our grassroots campaign to e-mail this message to your local legislators, so stay tuned.

Thursday, March 11, 2010

FMAP extension legislation clears U.S. Senate

U.S. Senate's Medicaid funding vote will help Florida balance budget -

Another successful Lobby Wednesday

The best part of our Lobby Wednesday is listening to our members’ comments as they return to the office to “debrief” before heading back home. The group yesterday was very excited, as they got to see lots of special demonstrations and displays as part of the Ambassadors for Aging Day. What’s important for our members back home to know is that every time you visit Tallahassee and spend time with your legislator, you are reinforcing our FHCA positions on reimbursement, managed care, duplicative regulation and background screening. If you have not come to Tallahassee yet this year, please consider doing so before the end of the 2010 session. Your residents need you to get involved.

Wednesday, March 10, 2010

Wow, what a long I sit at my computer and ponder the events of the day, let me share what goes on in Tallahassee on a busy committee day.

Starting at 7:30 a.m., I joined other health care lobbyists to talk about the issues of the day. While there we met Dr. Alice Sterling, a candidate for the Florida House (Rep. Adams seat) and learned how she plans to win her competitive race-she states she has an opponent with support in Tallahassee, but she has local support and is very positive regarding her success. Following a serious discussion regarding SB 752, Medicaid fraud, it was agreed that most health care lobbyists still have concerns about some of the legislation passed last session that no one seems interested in fixing this year. That, unfortunately, has led to some health care professionals losing their professional licenses and their livelihood.

FHCA's de-regulation bill was on the agenda for Health Care Regulation at 9 a.m., so with minutes to spare I arrived at the Capitol and got my committee packet. Of course, the bill was last on the agenda, so at 11:30 a.m., I finally had a chance to check for amendments for the bills I had on the calendar in the afternoon. After a quick lunch that included reviewing my bill for a 2:00 committee meeting, I made it to the Clearinghouse meeting at Noon-an advocacy group for children, people with disabilities and seniors-a great chance to network with others with similar interests.

Just in time, I made it to the Senate documents room to see if there were amendments for my 3:30 bill. What - I exclaimed as the staff told me there were 13 amendments!! All filed within the last two hours. I grabbed the pile of papers and headed to my 2:00 over in the House. The Policy council passed HB 7069 on background screenings and Rep. Snyder agreed to work with us on how to handle current employees who might be affected by the new law.

I headed back to the Senate just in time to review SB 1520 by Senator Storms, the companion to HB 7069, and the 13 amendments. I felt better as I saw that the Senate bill was being conformed to the House bill, but there were three new amendments that now make the two bills different which must be resolved somewhere down the road.

At 6:00 p.m. I headed to the University Club for our Lobby Wednesday briefing with a large group from FHCA's Districts 4 and 5. They were so much fun - eger for information and excited to go to the Capitol...I'm going to be looking for them amidst all the hustle and bustle up there, as it is Ambassadors for Aging Day. I LOVE MY JOB!!

- Peggy Rigsby, FHCA Director of Government Relations

Monday, March 8, 2010

Nursing homes a critical part of the long term care continuum and funding must be protected

With Florida facing an increased demand for Medicaid-funded eldercare services, it is more important than ever for our state’s leaders to recognize the invaluable role nursing homes play in our local communities. This session, with Florida’s economy still facing declining revenues, legislators in Tallahassee will be forced to make tough decisions about how to allocate state funding, including how to secure the future of our state’s Medicaid program.

It is important to recognize that nursing homes are an essential part of our health care system. Caregivers in these settings provide life sustaining care and services for nearly 71,000 of Florida’s most frail and elderly individuals who can no longer care for themselves.

Today, nearly 60 percent of nursing home residents in Florida rely on Medicaid as an important safety net. Without it, these seniors would not have access to appropriate medical care; yet, they face a serious and worsening problem as the future of this vital program appears uncertain.

As discussions ensue over the next 60 days about how to balance the state’s $3 billion budget deficit and how to reform a broken Medicaid system, it is essential that all the facts are considered when evaluating long term care as part of the overall Medicaid program.

Currently, nursing home expenditures account for less than 15 percent of the state’s overall Medicaid budget, which is down from 19 percent in 2004. Additionally, the number of individuals relying on Medicaid to pay for the cost of their nursing home care is declining, with the number of days Medicaid patients spend in facilities dropping from 17.2 million in 2004 to 15.5 million in 2009.

Today’s nursing homes are providing care to more medically-complex populations than we have in the past, including increased levels of short-term patients seeking post-acute care following a hip replacement or stroke. Once rehabilitated, many of these patients return home as active members of their communities.

Much has been written about ways to save the state money by keeping individuals out of nursing homes for as long as possible. It’s important to remember that nursing homes have always supported the full continuum of long term care, which factors in appropriate placement to ensure seniors receive the proper care in the proper settings based upon their medical needs. Florida has always done a good job appropriately placing those who require nursing home care. Florida is the oldest state in the nation; yet, we have the second lowest percentage nationally of over-65 seniors living in nursing homes, at just 2.1 percent. That compares to a national average of just under 5 percent.

Long term care in Florida continues to make measurable improvements in quality care, which we are committed to maintaining and advancing. Regulations established in 2001, including mandated staffing levels, make certain that individuals residing in our state’s nursing homes are properly cared for. Along with that minimum number of hands-on caregivers attending to their needs, risk management programs, charting requirements, physician support and other aspects ensure that quality care. Proposals that suggest moving frail elders to less regulated and less medically-equipped settings is a dangerous proposition for those frail, vulnerable seniors who require 24-hour nursing care.

As millions of baby boomers approach retirement age and begin entering the long term care system, lawmakers must protect much-needed Medicaid funding for our state’s frail elders and the frontline caregivers who care for their needs. We cannot build reforms on the backs of our seniors who rely on us for the quality of care they expect and deserve.

J. Emmett Reed, CAE
FHCA Executive Director

Thursday, March 4, 2010

The time to get involved is now

As I sit in the House select committee listening to presentations on long term care, I am surprised at the number of legislators who believe there are people in nursing homes who don't need to be there. So I issue a challenge to FHCA members - get out and educate your legislator about who you care for every day. Do it at home or come to Tallahassee...we need each and every one of you this year.

Tuesday, March 2, 2010

Unemployment Tax Relief Passes Both Chambers

Today, Florida Legislators unanimously passed HB 7033 which provides Florida employers with immediate relief from unprecedented unemployment compensation tax increases that they were facing this year.

Without this important legislation, most Florida employers would be forced to pay unemployment taxes at levels higher than 1200% over last year’s amounts. Plus, the full payments would have been due April 1, 2010.

Specifically, HB 7033 makes the following key changes to the 2010 tax requirements:

  • Reduces the amount of each employee’s wages upon which the employer pays the UC tax – from $8,500 back down to $7,000 for 2010 and 2011.
  • Establishes a quarterly payment plan for 2010 and 2011 that lets employers spread out their unemployment compensation payments over the whole year without normal application of penalties or interest.
  • Eliminates all elements of the rate calculations in the current law that would otherwise increase the tax for purposes of replenishing the Unemployment Compensation Trust Fund balance for 2010 and 2011.
  • Allows unemployed Floridians to receive additional extended unemployment benefits funded by the federal government.

FHCA worked with Associated Industries of Florida, the Florida Chamber and other business groups who made a top priority to have the measure pass on the first day of session.

House passes two-year delay in business tax hike

This morning, Florida lawmakers passed a two-year delay in a massive unemployment compensation tax hike on thousands of businesses brought on by the deepening ranks of unemployed workers. Click here to read more.

Campaign to protect nursing home residents' quality care begins

The 2010 legislative session gets underway today with the House and Senate meeting on the floor this morning for opening day speeches by House Speaker Larry Cretul and Senate President Jeff Atwater. Lawmakers will work toward filling a $3 billion hole in the budget this year, with the health care budget experiencing a $1.8 billion deficit. Hope still remains for a boost in the federal portion of Medicaid through an extension of the enhanced Federal Medical Assistance Percentage (FMAP), and FHCA will be monitoring this issue at the federal level to keep members up-to-date.

Meanwhile, Our Florida Promise, a 501(c)(4) advocacy organization, wants to ensure the funding needed to preserve nursing home residents' quality care is protected. Click here to view the :30 second TV spot that will air in Tallahassee for the next two weeks on behalf of Florida's 71,000 nursing home residents. To sign up to show your support of maintaining adequate funding for nursing home quality care, click here. We'll keep you updated throughout the session on what's at stake.