Friday marked the end of the 2010 legislative session, when lawmakers approved the 2010-11 budget and voted on a number of bills we've been monitoring on your behalf. Below is a wrap-up of how long term care providers fared this session:
Protecting Nursing Home Funding
Prior to the start of the 2010 session, the state agencies' original budget exercises included a 10 percent cut to nursing homes' Medicaid reimbursement rates. When the session began and initial budgets were developed, the Senate proposed a 7 percent cut, while the House proposed a 4.5 percent cut to nursing home funding. The final 2010-11 budget approved by legislators contains a reduction from the original 7 percent funding cut to a lower, 5 percent cut, contingent upon Congress passing the extension of the enhanced FMAP. The budget does include language that will allow providers to buy the entire rate cut back using an expanded Nursing Home Quality Assessment, as long as Congress releases the FMAP funding.
It also includes a number of other items that were successfully advocated by FHCA, including a permanent fix to the lease bond which suspends annual payments as long as $25 million remains in the trust fund. It also establishes a total combined weekly average direct care staffing requirement of 3.9 hours per resident per day while maintaining the daily staffing minimums of 1.0 hours of direct licensed nursing staff and 2.7 hours of direct CNA staff, giving providers flexibility with their staffing needs.
We have heard media reports, however, that Governor Crist may veto the budget, in particular due to the nursing home funding cuts that are included. All of us will be watching to see what happens once the budget hits the Governor's desk, and FHCA will update members as we learn more.
Additionally, FHCA will begin turning its attention to Washington, DC, to advocate for Congress' passage of the FMAP extension. Next week, FHCA will be working with the American Health Care Association to coordinate a legislative fly-in to Washington, DC, for our Florida members, so stay tuned for more details on this. Additionally, if you haven't signed up for American Health Care Association's Congressional Briefing (June 8-9th), you may want to consider joining us to help relay this important message to Florida's Congressional delegation face-to-face. We'll also be asking your help with sending an e-mail to your Congressman, so be on the lookout for that alert soon.
Streamlining the Regulatory Process
HB 1143, the deregulation bill for which FHCA has been vigorously advocating on your behalf, passed on Friday despite a controversial "Ultrasound Amendment" that was added in the last 48 hours. We don't know whether or not the Governor will sign the bill as a result of the added amendment; however, we do know the bill still contains those important provisions we've been working on which help reduce duplicative inspections and requirements for long term care providers. These include giving AHCA more flexibility in conducting follow-up surveys by desk review, reducing duplicative inspections by Fire Marshals and the Department of Health and eliminating monthly reporting of liability claims. FHCA will keep you updated once we learn of the Governor's action on this bill.
Both the House and Senate's proposals to expand managed care failed this year. As we had reported, the House had developed a more comprehensive proposal to overhaul the Medicaid system, which included moving all Medicaid recipients into managed care over the next five years (with seniors requiring long term care services enrolled by 2015). Although these bills failed, the House had incorporated several provisions supported by FHCA which included multiple safeguards for nursing home residents who depend on Medicaid to cover the cost of their care. We can expect this will be a priority for 2011, so the onus will be on all of us to continue educating lawmakers about the complexities of the long term care system so they have a better understanding when this issue surfaces next year.
Strengthening Resident Protections
Background screening legislation (HB 7069) passed and is on its way to the Governor's desk for signature. Originally developed as extremely onerous to long term care providers, the final legislation contained multiple amendments with language suggested by FHCA that makes these requirements more acceptable. The bill establishes that all employees or contractors who provide personal care and employees with access to resident living areas or residents' property must have the Level 2 FBI check completed before they can begin work. The requirement applies to new employees as of August 1, 2010, and current employees must be screened by June 30, 2015. We expect the Governor will sign this bill, and FHCA will provide more information once it becomes available.
Preventing Harmful Legislation
Even before the legislative session began, FHCA was advocating to prevent harmful legislation from seeing the light of day. A proposal by SEIU would have added new reporting requirements for nursing homes, which would have been beneficial for trial lawyers attempting to sue other parties in nursing home claims. After discussions with FHCA representatives, potential sponsors decided not to introduce the bill.
We also told you about a diversion provider who introduced a proposal that would “save the state 1.2 billion” by moving intermediate-care level residents (and the funding from the nursing home line item) out of nursing homes and into the least cost-effective home and community-based program. FHCA and its advocacy partner, Our Florida Promise (OFP), mounted a campaign to educate lawmakers and the public at large about the medical complexities of today’s nursing home residents and how such a proposal would have risked their well-being and eliminated patient choice. Legislators agreed, and when the initial budget was developed, no new slots for diversion were included. Additional funding was provided for other more cost-effective home and community-based programs.
SB 752, the Medicaid Fraud bill, passed the Senate with amendments included that would minimize any potential negative impact to nursing home providers; however, the bill died in the House. SB 2272, the "Pill Mill Bill," originally included language which put a 72-hour limit on the prescribing of controlled substances. After FHCA staff and lobby team members held several meetings with lawmakers, this language was amended out of the bill. SB 2678, which modifies the definition of mental illness to exclude head injury and dementia and would change the law regarding who can be referred for treatment under the Baker Act, was withdrawn.
SB 2034, which would effectively have ended the use and enforcement of pre-dispute arbitration agreements in health care settings by allowing the agreement to be rescinded at any time, was never heard in committee. This is a result of a coordinated effort among the leadership of FHCA/OFP, FHCA members, staff and lobby team sharing a unified message about the importance of arbitration clauses in long term care settings, which ensure that scarce resources go toward improving resident care rather than escalating costs associated with lawsuits.
Other bills of interest to members that were not passed by the 2010 Legislature include SB 1102 and HB 817, which created a new set of transfer/discharge requirements for Assisted Living Facilities. Patterned after the nursing home requirements, these bills would have created an excessive regulatory environment for ALFs.
Other Tracked Bills
Prior to the session, FHCA reported on legislation filed (SB 656/HB 529) which would have created an exemption from the public records law for identifying information regarding the Long Term Care Ombudsman. Both bills stalled early on in session, as public records bills are usually reserved for those public officials who could be put in positions of grave public danger.
The 2010 session began with Florida Legislators unanimously passing and the Governor signing shortly thereafter HB 7033, which provides Florida employers with immediate relief from unprecedented unemployment compensation tax increases that they were facing this year. Among other things, the bill reduces the amount of each employee’s wages upon which the employer pays the Unemployment Compensation tax – from $8,500 back down to $7,000 for 2010 and 2011, and 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.
HB 945, which requires Automated External Defibrillators to be placed in Assisted Living Facilities, passed; however, this will not become effective until July 1, 2011.
You can read about all the bills we tracked and their outcomes by downloading our complete legislative tracking list here.
Provider Program Legislative Scorecard
If you want to watch the final hours of the 2010 legislative session unfold, be sure to click here to view our final Provider Program so you can hear reports from FHCA President Deborah Franklin, staff and lobby team members on how we fared this year in regards to the budget and other issues.
FHCA will be compiling our new 2010 Legislative Scorecard in the coming weeks to measure lawmaker’s support for the Association’s priorities. Their votes on the issues that impact our profession will be calculated on a five-star rating scale, just as you are rated on the quality care outcomes you provide to your residents. Each FHCA member, along with all Florida lawmakers, will receive a copy of the 2010 Legislative Scorecard very soon.
Throughout the entire 60-day session, the commitment of FHCA membes to advocate on behalf of your residents, your staff and your profession truly helped us succeed in reducing the level of funding cuts as well as preventing harmful legislation from surfacing. Whether you traveled to Tallahassee for a Lobby Wednesday, assisted with our media outreach, or called or e-mailed a legislator from back home, you helped make a difference and ensured FHCA spoke with a strong, far-reaching message showing that Florida's long term care providers are united and will do what it takes to preserve quality care for Florida's frail elders.