Thursday, April 29, 2010

Crist budget veto?

As reported by Gary Fineout, The Current

Speculation mounts that Crist could veto budget

Gov. Charlie Crist’s emerging independence streak has some legislators wondering whether or not the governor plans to veto the nearly $70.4 billion state budget that lawmakers will approve on Friday.

Crist would not render a verdict, saying he had not yet been briefed on what had been included in the budget.

“I honestly don’t know at this point,’’ said Crist.

Saunders added that Crist would have valid reasons for the veto, ranging from the decision to raid the state’s road-building fund to cuts in funding for nursing homes.

Read more

The Drama Continues

As Reported by Gary Fineout for The Current

The unfolding controversy over abortion has caused the Florida House to shut down on Thursday morning. House Democrats told Republican leaders that they would not go along with normal procedural moves to speed along consideration of bills unless House leaders agreed to not take up HB 1143. Under rules it takes a two-thirds vote to take up a bill and message and roll it to final passage. There are 44 Democrats in the 120-member House.

The procedural move prompted the House to recess shortly after it began work.
The Florida Senate on Wednesday tagged on several controversial amendments to the bill including a limit on tax deductions for employer health insurance plans that include coverage for abortions and requiring women seeking abortions to have ultrasounds. The Senate has not yet passed the bill and sent it back to the House, but the decision to add the provisions to HB 1143 caused a highly charged debate on the Senate floor that lasted more than two hours.

Wednesday, April 28, 2010

Deregulation Bill Dilemma

HB 1143 by Representative Matt Hudson, the deregulation bill FHCA has been working on for months, had passed the House as we've previously reported. Today, its companion (SB 2434) was on the calendar in the Senate. When it came up, Senator Andy Gardiner accepted the House bill, and President Jeff Atwater moved into the amendatory process. That's when things got interesting.

A controversial amendment on blood banking by Senator Don Gaetz was added to the bill against the request of the sponsor (the House has previously said this language is not acceptable). Senator Gardiner then proceeded to add a controversial abortion amendment to the bill, and after nearly two hours of debate, the amendment passed. Immediately following, two other abortion-related items were amended on the bill. Suddenly, this deregulatory bill became the hottest topic of discussion on the fourth floor of the Capitol.

Will the Senate take off the blood banking language Thursday on third reading? Will the House kill the bill if it comes over with that language included? Does the House support the abortion language? What will Governor Crist do if the bill makes it to his desk? Suddenly nursing homes' deregulation issues are caught up in the middle of the pro choice/pro life debate. Who would have thought we'd see such a dilemma?

Stay tuned for more on Thursday, or watch it for yourself by visiting Online Sunshine at

Monday, April 26, 2010

Sponsors say Fla. Medicaid overhaul dead for 2010

The Associated Press

Published: Sunday, April 25, 2010 at 11:04 p.m.
Last Modified: Sunday, April 25, 2010 at 11:04 p.m.
( page of 3 )

TALLAHASSEE, Fla. — Sponsors of a massive House plan to overhaul Florida's Medicaid system on Sunday declared it dead for this year but said they'll try again in 2011. Click here to read more.

Tuesday, April 20, 2010

Regulatory bills update

I know some of you might not believe this, but regulation can be exciting! And, deregulation even more so. FHCA was anticipating that HB 1143 by Rep. Matt Hudson would be heard on the House floor today. You may recall this is the AHCA deregulation bill, which has important provisions that eliminate duplicative inspections and paperwork for providers.

The bill was on the special order calendar, but rumors started early and when the Speaker came to the bill, it was temporarily postponed. It took some time to figure out what was going on, but late this afternoon we were assured by Rep. Hudson that although there are lots of health care amendments being filed on the bill, it is still in play. We hope it will come up for House passage soon and will continue to watch this and keep members up-to-date.

On the Senate side, the companion SB 2434 was on the agenda in Senate Ways and Means Committee and had EIGHT amendments filed on it. One amendment was added at FHCA’s request to place pediatric staffing standards in statute rather than rule, and it was the first one taken up by the committee. After it passed, all other amendments were objected to by Senator Gardiner and were withdrawn. This is good news as it makes the Senate bill much closer to the House version.
We are finally getting closer, so stay tuned for more to follow.

By Peggy Rigsby, FHCA Director of Government Services

Urge Legislators to Prevent Funding Cuts to Nursing Home Care

Today we learned that the House has accepted the Florida Senate's proposed 7% ($200 million) funding cut to nursing home care. We need your help today with contacting your legislators and urging them to prevent these deep nursing home funding cuts as they prepare to finalize the 2010-11 budget. We still expect Congress to pass the six-month extension of the Federal Medical Assistance Percentage, and legislators should use that anticipated FMAP money to alleviate these deep cuts to nursing home care.

Help e-mail these important messages to your legislators:

  • Funding cuts could negatively impact caregiver jobs, since nursing homes devote 70% of operating costs to people - salaries, wages and benefits.
  • Florida's nursing home staffing standards are among the highest in the nation, and good care costs money. Staffing should fully funded.
  • The anticipated FMAP money should be used to fund the Medicaid program and help serve our most vulnerable citizens - frail elders who reside in our nursing homes, two-thirds of who rely on Medicaid to cover the cost of their care.

Click here and help send an e-mail to your lawmakers today and urge them to oppose these deep funding cuts. Lawmakers are conferencing on the budget this week, so time is of the essence.

Wednesday, April 14, 2010

Arbitration bill withdrawn

On Tuesday, the Senate Health Regulation Committee was expected to hear SB 2034, which would effectively end the use and enforcement of pre-dispute arbitration agreements in health care settings by allowing the agreement to be rescinded at any time. Members of FHCA's Management Committee, staff and lobby team met with the bill sponsor, Senator Steve Wise, to discuss the importance of arbitration clauses in long term care settings, which ensure that scarce health care resources go toward improving resident care rather than become diverted to pay the escalating costs associated with lawsuits. At the same time, FHCA members across Florida were contacting their legislators to share this same message.

FHCA is grateful to Senator Wise, who during yesterday's committee meeting withdrew the bill. He has agreed to work with FHCA and other health care groups in the coming months to develop model arbitration agreements providers can use.

This is another example of how the Association's collective efforts to educate lawmakers about the important work you do in caring for your residents is so valuable to the legislative process.

Thursday, April 8, 2010

FHCA analysis of House Medicaid reform proposal

On Monday, the Select Policy Council on Strategic & Economic Planning released two proposed committee bills (attached) mandating Medicaid managed care coverage for all beneficiaries including seniors needing long term care services. The proposal would be fully implemented over a five year period, beginning with an expansion of the current “Medicaid Reform” pilot program to Miami-Dade counties in 2011. The long term care component of the plan would require implementation to begin by July 1, 2011 with full implementation by October 1, 2012. The Council workshopped the bills in their meeting Tuesday night and is expected to amend and vote on the bills during their meeting next Monday, April 12th.

PCB 10-03 creates a new section of law entitled “Medicaid Managed Care” which creates provisions for the Medicaid managed medical assistance program, the managed long term care program, and the managed long term care for persons with developmental disabilities program. The agency is required to adopt any rules necessary to comply with or administer the program and to apply for and implement state plan amendments or waivers of federal laws and regulations necessary to implement the program.

Specifically, sections 409.978-409.985 is created to describe the long term care managed care program. As noted, the agency shall begin implementation of the statewide program by July 1, 2011, with full implementation by October 1, 2012. Medicaid recipients requiring nursing facility care as determined by the CARES Program and who are either 65 years of age or older or eligible for Medicaid by reason of disability are eligible for the program. All Medicaid recipients who are either residing in a nursing facility or enrolled in a Medicaid waiver program on October 1, 2012 are automatically eligible. The bill further defines the benefits available under the program.

The state will be divided into six regions and a specified number of qualified plans will be procured for each of the six regions. Qualified plans may be managed care entities or long term care provider service networks (owned by health care providers) or entities qualified as Medicare Advantage Preferred Provider Organizations, or Medicare Advantage Special Needs Plans. Plans must offer a network contract to all nursing homes, hospices, and aging service providers in their region during the first contract period after a qualified plan is selected, but may exclude the provider from the network after 12 months for failure to meet quality or performance criteria. Nursing homes and hospices are required to participate in all qualified plans in the region in which the provider is located.

Plans are required to pay nursing homes an amount equal to the nursing facility-specific payment rates set by the agency. Incentives are provided to Plans to reduce institutional placement and increase the utilization of home and community based services. The bill also establishes medical loss ratios that require Plans to spend at least 80 percent of Medicaid premiums on medical services and direct care management or pay a fine.

PCB 10-04 is contingent on the passage of PCB 10-03 and makes the statutory changes necessary to implement the managed care program. This bill eliminates the language that created Florida Senior Care, but more importantly provides language that will allow nursing homes to be more competitive in a managed care environment. Specifically, the bill creates a nursing home licensure workgroup that will develop a plan for license flexibility to assist nursing homes with developing comprehensive long term service capabilities, extends the CON moratorium for additional community nursing home beds until October 1, 2015, and suspends any CON condition requiring maintenance of specific minimum Medicaid utilization effective July 1, 2011.

There are still several issues, such as prompt payment, electronic claims processing and EFT payments, patient responsibility, conflict resolution, etc. that FHCA will continue to address with legislators and staff as this process moves forward.

Budget cuts threaten nursing homes and elder care

TALLAHASSEE (Bay News 9) -- State lawmakers are preparing to make deep budget cuts that could affect many of Florida's elderly.

If approved, the state House's budget plan will cut millions of dollars of funding from nursing homes.

Read more: Budget cuts threaten nursing homes and elder care

Tuesday, April 6, 2010

Lawmakers’ Bipartisan Letter Seeks Preservation of Robust Medicare, Medicaid Funding

Florida Health Care Association joined its national affiliate - the American Health Care Association (AHCA) - in praising today a new bipartisan letter from U.S. Representatives Shelley Berkley (D-NV) and Shelley Moore Capito (R-WV) to House Budget Committee Chairman John Spratt (D-SC) and Ranking Member Paul Ryan (R-WI) asking them to help preserve Medicare and Medicaid funding for the long term care community as their Committee examines issues related to these important entitlement programs.

“By leading this new letter to Chairman Spratt and Ranking Member Ryan, Congresswomen Berkley and Capito are once again acting in an effective, bipartisan manner to ensure America’s oldest seniors in need of the most intensive skilled nursing care receive the vital Medicare and Medicaid funding they require – and we thank them for their long-standing efforts on their behalf,” stated Bruce Yarwood, President and CEO of AHCA. “The letter draws needed attention to the chronic Medicaid under funding crisis, which is increasingly problematic for patients and facilities at a time when, in just the past six months, Medicare-funded nursing home care has been cut by nearly $27 billion over ten years.”

States the letter from Representatives Berkley and Capito to Chairman Spratt and Ranking Member Ryan:

Skilled nursing facilities (SNFs) face increasing pressures due to struggling state Medicaid programs coupled with Medicare funding reductions of more than $12 billion over ten years as of October 1, 2009. In fact, Medicaid fails to cover the cost of care for patients in nursing homes. In 2009, the shortfall was projected to be $4.6 billion nationwide or $14.17 per patient, per day. These combined Medicare-Medicaid funding cuts have had the effect of significantly reducing the resources available for providing skilled nursing care at a time when patients have more medically complex needs than ever before.

“Any further reductions will hurt a growing economic sector, since long term care added 50,200 jobs in 2009 alone while the country’s approximately 16,000 nursing facilities and 39,000 assisted living communities comprise 1.1 percent of our national Gross Domestic Product (GDP), or $153.8 billion. Because workforce expenses represent 70 percent of a facility’s total costs, any reductions in funding will result in workforce cutbacks which will not only severely compromise the ability of long term care to provide life-sustaining care services to frail, elderly and disabled patients and residents, but also will decrease the economic contributions of the sector.

“Please join us in requesting that the Budget Committee continue to support the long term care community through reasonable annual inflation adjustments and fair reimbursement for unpaid Medicare co-payments as they consider issues related to entitlement programs in preparing the Fiscal Year (FY) 2011 Budget Resolution.”

House to unveil Medicaid plan Tuesday; expects it to be part of end-game

By John Kennedy
The News Service of Florida

The House will unveil a wide-ranging, multi-year effort Tuesday to revamp Florida's costly Medicaid program — a plan that surpasses the Senate's already ambitious approach to expand managed-care coverage for low-income Floridians, according to those familiar with the proposal.
The House plan is emerging publicly for the first time past the session's midpoint, in keeping with a strategy that last year had Speaker-designate Dean Cannon, R-Winter Park, float an offshore oil-drilling proposal as a multi-billion dollar budget balm in the session's waning days.

Read the full Palm Beach Post article:

Thursday, April 1, 2010

Blended staffing ratio passes Senate, House to vote on budget today

This was a short week for legislators, who took a brief respite from legislative activities for the Passover/Easter break. They returned to Tallahassee and promptly covered the budget, with both the Senate and House heading into session and addressing as part of the agenda their Medicaid conforming bills (SB 1464 and HB 5301), which directly impact our members.

Both bills contain language which would combine a total direct care staffing requirement of 3.9 hours per resident per day by maintaining the daily staffing minimums of 1.0 hours of direct licensed nursing staff and 2.7 hours of direct CNA staff. Over the past two weeks, FHCA has been testifying during committee meetings as to how this combined standard would give providers additional flexibility in meeting the needs of residents who require more skilled care with additional licensed nursing staff. All the while, members, staff and our lobby team have been actively working with lawmakers to ensure they understand the importance of this issue.

Wednesday on the Senate floor, amendments were filed which attempted to limit this language rather than make it permanent. Sen. Mike Bennett, R-Bradenton, said nursing homes have had to comply with increasingly higher staff ratios while seeing their Medicaid reimbursement rates lowered by the state. “Let's give them some flexibility,” said Bennett. “They want to have the ability to manage their staff with limited resources.” A debate ensued and in the end the amendments failed and SB 1464 passed 25-9.

In the House, HB 5301 rolled over to a third reading and is expected to be taken up today with the House in session again to vote on the budget. Stay tuned for a final outcome this afternoon.