Thursday, January 27, 2011

Legislative budget requests, Medicaid reform workshops on the agenda this week

Legislators held a number of committee meetings this week, with FHCA staff and lobby team members up at the Capitol keeping apprised of any items related to long term care. During Tuesday's House Healthcare Appropriations meeting, state agencies were asked to review with legislators their priority list of budget cuts. AHCA presented their issues related to nursing home cuts, which included a freeze on nursing home rates and a rate cut that amounted to a total of $231.9 million. They also recommended reducing the number of paid bed hold days for hospitalization from eight to five.

The Agency for Health Care Administration's (AHCA) legislative budget request was developed late last year prior to the Governor's election. Gov. Scott has until February 7th to submit his budget to the Legislature, which may be different from the issues previously developed by AHCA.

On Tuesday, FHCA Treasurer Joe Mitchell testified before the House Health & Services Committee, which was conducting a workshop on Medicaid reform using a managed care system. Joe noted that nursing home enrollment is not the reason for growth in the Medicaid budget. In fact, the Medicaid nursing home line item is down from 19 percent in 2001 to less than 15 percent in 2009. He provided demographics about long term care residents in Florida, pointing out that a recent OPPAGA study found that just over 1.3 percent of elibible nursing home residents could actually be safely transitioned out of faciities and into a home and community-based setting. Rep. Schenck (R-44), chairman of the committee, indicated that it would be several years before the phase-in of long term care and that there would be additional opportunities to provide input.

FHCA encourages its members to continue meeting with lawmakers before they head to Tallahassee in March. Consider inviting them into your facility for a tour, meet with them at their district office or attend your local legislative delegation meetings. Building those relationships now will add to the success of your experience at FHCA's 2011 Lobby Wednesdays, which begin February 9th and run through April 13th. For more information about Lobby Wednesdays, visit the FHCA website.

Friday, January 21, 2011

Jobless loan adds more to lawmakers' budget challenges this session

Last week's legislative committee meetings included an update on the newest projection for the state's budget shortfall, which is now estimated at $3.6 billion. Another problem the business community will face this year is the unemployment compensation fund deficit. Currently, Florida has borrowed over $2 billion from the federal government to pay unemployment compensation benefits. Unfortunately, this loan must be repaid. Employers can expect to receive notices regarding a special assessment sometime in February, which will likely total between $10.00 and $13.00 per employee. It must be collected by June 30, 2011, paid to the federal government no later than September 2011 and is retroactive to January 1, 2011. If, however, Congress chooses to extend the interest-free period on the loan, this assessment will likely be cancelled.
In addition to this, there is another retroactive assessment looming. In November, Florida will have its federal unemployment tax credit reduced by .3%, making the effective FUTA rate 1.1%, instead of .8%. Federal law requires that if a state has outstanding advances owed to the federal government (and as noted above, Florida owes the feds over $2 billion), the FUTA tax credit is reduced by .3% per year, until the advance is paid off. This loss of the FUTA credit is expected to be implemented in November, also retroactive to January 1, 2011. FHCA will continue to work with the business community on these important issues and will keep you updated as more information becomes available.

In the meantime, we encourage FHCA members to make plans to attend our January 28th Legislative Meetings & Webcast. This is going to be one of the most challenging sessions for long term care providers, and we’ll need everyone’s active participation in our grassroots advocacy. This event will help you stay informed on the most important issues that affect providers legislatively and will ensure we are all speaking with a strong, united and consistent voice.

Along with important updates on reimbursement, Medicaid reform, regulatory relief and tort reform, there will be a legislator at each of the 14 locations. This is an excellent opportunity for FHCA members to meet them and express your views on potential legislation that impacts your facility operations and resident quality care. Lawmakers want to hear from you, their local constituents, about the issues that affect them so they can best represent you in Tallahassee. The nominal registration fee includes lunch and 3 CEUs, but please be sure to register by midnight on Tuesday, January 25th, to guarantee your luncheon spot. Click here to register online or here to download the registration brochure.

Friday, January 14, 2011

Committees begin discussion on Medicaid reform timelines

This week, legislators held a number of health care-related committee meetings, and FHCA staff and lobby team members were on hand to listen to presentations on the state budget, Medicaid, government operations, rule setting

Sen. Joe Negron (R-28), chairman of the Senate Budget Subcommittee on Health and Human Services Appropriations, kicked off his meeting on Wednesday telling audience members that there needs to be a transfer of priority in revenue from health and human services to education, criminal justice, transportation, economic development and other parts of the budget. The HHS Appropriations Committee is charged with developing a budget to help fund the state's $20.2 billion Medicaid program. The committee is also working on a Medicaid reform proposal, and Sen. Negron said he hopes to have a bill out in time for a February committee hearing.

Also during the meeting, the Florida Legislature's Office Of Program Policy Analysis And Government Accountability gave a report on nursing home residents and potential cost savings. The report found that a small percentage of people receiving nursing home services may have the potential to return to the community. OPPAGA's analysis of 53,026 people who received nursing home services in calendar year 2009 found that approximately 1.3 percent (or 713 people) had the potential to transition to community placements based on the MDS.

Sen. Negron noted that the report supports his position that nursing home residents cannot be safely moved to other settings. Sen. Don Gaetz (R-6) asked OPPAGA to restudy the Nursing Home Diversion program to determine if it is truly a substitute for nursing home care rather than just an added cost for the Medicaid program, since many people entering the Diversion program would not have actually gone into a nursing home.

Thursday, the House Health & Human Services Committee met, and Chairman Robert Schenk (R-44) said that his committee will use last year's House bill as a starting point for creating their Medicaid reform bill. Rep. Schenk stated that all Medicaid beneficiaries will be moved over to managed care, with long term care and developmental disabilities transitioned in over five years. Next week, the Committee will take public testimony, after which they will begin developing a committee bill. The subcommittees also plan to hold workshops on the bill.

With legislators beginning to lay out timelines for crafting their Medicaid reform proposals, now, more than ever, we need our members to register for FHCA's January 28th Legislative Meetings & Webcast, which will update you on the challenges facing long term care this session and help you learn how to effectively communicate our issues. The in-person portion of the event will include an opportunity to network with a local legislator and discuss effective grassroots advocacy with your long term care peers. Legislators confirmed to participate so far include Sen. Anitere Flores (R-Miami), Sen. Ellyn Bogdanoff (R-Ft. Lauderdale), Rep. Jim Frishe (R-St. Petersburg), Rep. Elizabeth Porter (R-Gainesville) and Rep. Marti Coley (R-Panama City). Click here to register online.

Tuesday, January 11, 2011

Culture change movement will enhance lives of nursing home residents - young and old

Florida is the oldest state in the U.S., with over 4.4 million seniors and over half a million of them with Alzheimer’s or related dementias. Florida’s population will grow by 5.1 million by 2030 and 64 percent will be seniors. The needs for long term care will only increase. Nearly two-thirds of Americans over age 65 will require long term care at some point in time. This includes nursing home care, assisted living facility and home and community-based services.

Many believe that long term care services are for elders over 65. Actually, 40 percent of people currently receiving long term care services are adults younger than 65. This includes persons of all ages requiring 24-hour skilled nursing home care as indicated in the Associated Press story which ran on January 7, 2011 about the young man who residing at the Sarasota facility with other seniors.

The Culture Change movement being promoted within long term care is gaining momentum in changing traditional operations that focus on ensuring the safety of residents with rigid timelines, such as meal times at specified hours and only menus that are nutritionally sound and medically compliant, as well as overall regulatory compliance. The focus is changing to give nursing home residents greater control over their daily lives – such as when they want to be in their room, bathe, be woken up or other personalized activities. They have more choices in meal selections and other activities of daily living. Additionally, the front line workers who provide the bulk of the care are being given greater autonomy in caring for their assigned residents to encourage staffing consistencies and strong friendships with residents.

Many nursing homes having aging physical structures which have been renovated a number of times. Medicaid as the primary funding source of long term care is already being targeted for reductions across the states. Resources are not available to replace the majority of the traditional facilities. However, the Culture Change focus is on change from within. The purpose is to improve the quality of life of residents with more choices and more involvement in the day-to-day planning of their activities and their lives. It is called “person-centered care” and is for all ages.

As the state’s first and largest advocacy organization representing over 550 of Florida’s long term care facilities, Florida Health Care Association would like to reach out to our communities to become friends and supporters of our state’s nearly 71,000 nursing home residents, especially the younger persons being cared for 24 hours a day. The availability of volunteers to take residents on outings would enhance the day of many. Let’s work together in our move toward Culture Change, make a positive difference and enrich the lives of nursing home residents. Visit the consumer section of the FHCA website to find a nursing home in your area and become a volunteer.

J. Emmett Reed, CAE
FHCA Executive Director

Friday, January 7, 2011

Here we go...

Tallahassee was bustling with inaugural activity this week as Governor Rick Scott, Chief Financial Officer Jeff Atwater, Attorney General Pam Bondi and Agriculture Commissioner Adam Putnam were sworn into office. During his inauguration speech, Gov. Scott's message focused on creating jobs through lower taxes, leaner government and a concerted economic development effort aimed at making it easier for companies to come to Florida.

Within an hour of taking the oath of office on Tuesday, Gov. Scott got to work by signing four executive orders. The governor's first order freezes rules and sets up an Office of Fiscal Accountability and Regulatory Reform to determine if existing and proposed rules have an effect on jobs. Other orders adopt a tougher ethics code, reaffirm a continuation of open government and a ban on hiring discrimination based on race, gender, creed, color or national origin. The orders cover agencies under the governor's control but not those he jointly oversees with the three-member Cabinet nor constitutional, legislative and judicial agencies.

Lawmakers also got to work this week, filing bills including HB 119 by Rep. Matt Hudson (R-101), which contains several important nursing home deregulations Provisions included in the bill are similar to those from Rep. Hudson's bill last year, which was vetoed by the Governor after a last-minute controversial ultrasound amendment was added.

FHCA encourages its members to continue meeting with lawmakers before they head to Tallahassee in March. Consider inviting them into your facility for a tour, meet with them at their district office or attend your local legislative delegation meetings. Building those relationships now will add to the success of your experience at FHCA's 2011 Lobby Wednesdays, which begin February 9th and run through April 13th. For more information about Lobby Wednesdays, visit the FHCA website.