Tuesday, November 30, 2010

Years after Katrina, one federal program still misses the mark

Today ends the 2010 hurricane season, and thankfully no major storms impacted Florida or the United States this year. It’s hard to believe, however, that five years ago, Hurricane Katrina pounded the shores of the Gulf Coast, leaving destruction and devastation in its path and forcing a record number of people out of their homes. While the massive storm revealed several shortcomings of the federal government’s disaster response, the restoring and rebuilding effort continues today. However, several disparities remain. One of these disparities affects Florida’s most vulnerable population — seniors and individuals with developmental disabilities.

One would assume that emergency federal aid is distributed to all those in need, without regard to the classification of their living environment. Sadly, this is not the case. Current federal law has long prohibited aid to nearly three-quarters of our nation’s post-acute care, long term care, and assisted living providers who care for some of the country’s most vulnerable citizens. This assistance, which is provided in accordance with the Stafford Act, is designed to address the immediate needs of those affected by a disaster, including evacuation, shelter, and nutrition. Unfortunately, it precludes access for for-profit long term care providers including “medical, rehabilitation, and temporary or permanent custodial care facilities… for the aged and disabled,” from accessing these resources.

Disasters like Hurricane Katrina wreak havoc indiscriminately, impacting individuals whether they live in a for-profit or not-for-profit facility. Florida’s nearly 700 long term care facilities must cope with the same results with limited physical, financial and human resources. Caring for individuals who are frail, elderly or have a disability can be challenging even under the best of circumstances. When disaster strikes, those challenges are magnified and limited resources only makes matters worse.

Just like not-for-profit providers, for-profit providers of long term and post acute care play a critical role in caring for Florida’s nearly 71,000 long term care residents. This is all the more important, given that Florida’s nursing and rehabilitation facilities have evolved to meet the special demands and needs of our aging population, including a greater focus on post-acute care. About 80 percent of Florida’s Medicaid recipients receive care in for-profit facilities. These residents have a number of special needs and require 24-hour care, 7 days a week. It’s important that their care is not interrupted by denial of access to critical aid during a disaster.

FHCA is confident that, despite such limitations, facilities have contingency plans in place to ensure critical health care services are continually provided during an emergency. In fact, since Hurricane Katrina, the Association has developed a number of resources to assist facilities with emergency preparedness, thanks to partnerships with such groups as the John A. Hartford Foundation, Florida Department of Health, University of South Florida and Florida Power & Light. These include the Emergency Management Guide for Nursing Homes and the accompanying software, the Nursing Home Incident Command System and other online resources which can be found on the FHCA website at http://www.fhca.org/.

Given Florida’s Medicaid budget and the more than $16 billion in federal Medicare cuts to skilled nursing care over the next decade, we do not have the same confidence about the economic stability, which is necessary for facilities to implement such plans.

While the Stafford Act shows good intent, it misses the mark in providing emergency disaster relief to all nursing facility patients. A bill sponsored by Representative Ron Paul (R-TX) would rectify this inherent disparity in federal law, ensuring all long term care providers have access to disaster relief funding when needed to protect vulnerable patients and residents during a disaster. We hope Congress will do its part to ensure that the mistakes of the past do not repeat in the future by passing this bill to ensure that all providers of long term and post acute care to Florida’s most vulnerable citizens have access to critical aid when they most need it.

Thursday, November 18, 2010

FHCA presents the long term care perspective as lawmakers consider Medicaid reform

This week, lawmakers convened for a special legislative session which focused primarily on overriding vetoes. The Legislature passed a Medicaid Memorial (SB 4A), which urges the Congress to amend Medicaid law and lays out guidelines for Medicaid reform that the Legislature will use during the 2011 session.

Yesterday, Sen. Joe Negron (R-28) hosted a committee meeting inviting representatives from long term care, hospitals, managed care groups, AARP and others to discuss the current Medicaid program and possibilities for reform. FHCA Treasurer Joe Mitchell testified on behalf of FHCA, providing an overview of our demographics, including the fact that since 2001, nursing home expenditures in the Medicaid budget have fallen from 19 percent to 15 percent, despite the growing aging population requiring long term care services.

He also provided them with an update of the work the Association has been doing over the past year in meeting with HMOs, including traveling to Arizona as well as researching other state's managed care programs and engaging in dialogue with a number of stakeholders across the long term care continuum. He reiterated the point that, as lawmakers move through this arduous process, the steady improvements to nursing home quality care cannot be jeopardized.

Much of the questions and discussion among lawmakers during the committee meeting were reflective of the messages that long term care providers have been sharing with them over the past year through ongoing meetings and facility tours. It was evident that they were well educated about the complex care and commitment to quality our members provide to the residents in your care. As plans for holiday activities begin for FHCA member facilities, we encourage you to keep inviting your local legislators into your buildings to keep up this momentum and strengthen those relationships which are vital to our long term care issues this session.

Tuesday, November 16, 2010

Fixes to SNF Medicare payment system and resolution to therapy cap funding are immediate needs for seniors and caregivers

FHCA's national affiliate, American Health Care Association (AHCA), and the Alliance for Quality Nursing Home Care today urged the U.S. Congress to fully implement the new Medicare payment system for skilled nursing facilities (SNFs) in addition to extending the Medicare Part B therapy exceptions process.

“The groundwork for fully implementing the new RUG IV payment system has been laid,” said Bruce Yarwood, President & CEO of AHCA and Alan G. Rosenbloom, President of the Alliance. “There is no cost to this necessary change. We are almost there. Congress is too close to fail on this. So we urge congressional leaders to bring these two measures across the finish line in these final days so we can continue doing what we do best – delivering exceptional care to residents and patients.”

Failure to act, they added, would bring about “an operational nightmare for facilities,” and require the Centers for Medicare and Medicaid Services (CMS) to modify the payment system yet again, making payment policies even more uncertain. Acting to ensure patients and caregivers were protected in the face of sweeping modifications during unsettling economic times, in 2009 SNF providers sought a one-year delay in implementing two of three regulatory changes to the SNF Medicare Payment system. However, only one of the changes was delayed. The House has passed this technical fix, and there is unanimity among the SNF community, CMS and the Medicare Payment Advisory Committee (MedPAC) to address the matter. The Senate’s failure to act is the last remaining impediment to a resolution.

In addition, Yarwood and Rosenbloom said Congress must act by December 31, 2010 in regard to Medicare Part B therapy exceptions process, or Medicare patients will be limited in the amount of Part B physical, occupational, and speech-language therapies they are allowed to receive that helps restore them to their highest level of functioning.

"For skilled nursing facility patients, the December 31 deadline is critical, since the health care reform law only extends the exceptions process until that time,” continued the AHCA and Alliance leaders. “Congress must not allow its unfinished business to impede the ability of Medicare beneficiaries to access the professional therapy services they require to maximize their quality of life and functional independence.”

Legislators convene for special session

Well, just like death and taxes, which never go away, neither does the Florida Legislature. Today, new and returning Senators and Representatives descended upon the Florida Capitol today for their official “swearing in” and for the special session. There are no health care issues that affect nursing homes or assisted living facilities on the agenda for today's special session, so we are just watching the day's events unfold.  It is exciting as we see the new Freshman, especially Representative Shawn Harrison-one of our FHCA members - as they are sworn into office.  This new class of legislators gives you the opportunity to educate them about long term care.  Visit Online Sunshine and read about your local lawmaker, and if you have not done so, invite them out to your facility before March so they can learn about long term care and have you as their resource on these important issues in the upcoming legislative session.

Monday, November 8, 2010

House releases legislative calendar

Now that the elections are over, the Florida Legislature is making plans for the upcoming weeks and the 2011 Session. The House of Representatives has released their schedule for committee meetings, and you can view the Online Sunshine page for a list of those dates. The Senate has not yet released their schedule, but traditionally their meetings coincide with the House.

The Online Sunshine page also has the new structure of the House committees. Chairmen have not yet been announced but that will be coming soon. Check back often to see the new releases coming out from the Senate as well.

This information will help you as you continue to invite legislators into your facilities for holiday events or other important occasions. This is the time to continue that effort before lawmakers come to Tallahassee for the beginning of the 2011 session on Tuesday, March 8th.

Friday, November 5, 2010

House and Senate Leaders Announce Special Session

Incoming Senate President Mike Haridopolos (R-26) and House Speaker Dean Cannon (R-35) held a press briefing this week to announce a one-day special session on November 16th to override nine of Gov. Charlie Crist's vetoed bills from earlier this year. These nine bills, none of which impact long term care, passed with overwhelming support and were described as “good ideas” and “good public policy” by Speaker Cannon. The leaders said the Legislature would not consider more controversial vetoed bills, such as the teacher merit pay or ultrasounds for women seeking abortion, bills (The Ultrasound bill contains several nursing home regulatory reform issues supported by FHCA).

In addition to these bills, the Legislature will consider restoring only one budget item: a $9.7 million budget line item for Shands, the teaching hospital at the University of Florida. Governor Crist cut the appropriation, and several lawmakers have said restoring it was a top priority.

The leaders also stated that they will consider a resolution to Congress asking that Florida have more discretion in how the Medicaid program is run. They discussed that, during their state tour, they found many problems with Medicaid, including access, tort, quality and rules. They want to be able to provide more flexibility, which is currently getting blocked on a federal level by the Centers for Medicare & Medicaid Services (CMS). They want to take the “good parts” of the current Medicaid Pilot Program and make it statewide. They also want tort reform in Medicaid. They don’t want to change/create new policy when so much has already been done. Speaker Cannon said that they can’t afford to let people not be included in the plan. During the briefing, Rep. Denise Grimsley (R-77) was mentioned as the key person to develop a bill in this regard.

With respect to nursing home care, there are no plans to override the Governor’s veto of the Medicaid funding cuts or any bills impacting long term care. During the special session, legislators will craft a document to send to Congress that will serve as a roadmap for Medicaid reform efforts. No substantive Medicaid reform will occur in the special session, however.

The one-day special session will coincide with organizational session, November 16th.

2010 General Election Update

The 2010 election results are in, and winners in key Florida cabinet races include: Rick Scott (R) for Governor; Pam Bondi (R) for Attorney General; Jeff Atwater (R) for Chief Financial Officer; and Adam Putnam (R) for Commissioner of Agriculture.
At the federal level, Marco Rubio (R) handily won the race for Florida's U.S. Senate seat. Florida Republicans picked up four seats in Congress, helping to shift the balance of power to a GOP-controlled U.S. House. Long term care providers lost a strong advocate, Cong. Ron Klein (D), in Fort Lauderdale. However, Cong. Kathy Castor (D), a strong supporter of our issues, was re-elected, and David Rivera (R), another supporter at the statewide level, will head to Washington to represent a Miami district in Congress.

In the Florida Legislature, FHCA Associate Member Shawn Harrison (R) was elected to represent House District 60, which is good news. Overall, the Republicans picked up two additional Senate seats, changing the current Senate makeup from 26 Republicans and 14 Democrats to 28 Republicans and 12 Democrats. On the House side, the current makeup of 76 Republicans and 44 Democrats will change to 81 Republicans and 39 Democrats. As a result, on both the House and Senate side, Democrats will not be able to procedurally block any efforts by the Republican leadership. In addition, Republicans will have a veto override majority if they stick together.

For the constitutional amendments, Amendment 4, Hometown Democracy, was defeated. This is good news for long term care providers as it would have led to an undue burden for nursing homes and other businesses seeking to expand their facilities. Voters decided to keep the class size requirement the same and rejected Amendment 8, as well as Amendment 1, while Amendments 2, 5 and 6 passed.

For a complete list of all the election results, click here.