Friday, February 25, 2011

FHCA Provider Program - An Update on the Senate Medicaid Reform Plan

Nursing homes provide quality, efficient care to Florida's most vulnerable seniors

Marilyn Wood, president of Opis Management Resources, which operates 10 skilled nursing facilities and one assisted living facility, testified before the Senate HHS Committee on Wednesday, expressing concerns that the current Senate Medicaid reform bill as written threatens quality nursing home care. "The only way managed care as envisioned in this bill would achieve the mandated 7% savings is to cut provider rates, which would force reduced services for frail, vulnerable seniors." Watch her testimony below.

Wednesday, February 23, 2011

Long term care providers urge lawmakers to Safeguard Our Seniors and protect nursing home quality care under Medicaid reform

As the state Legislature considers comprehensive Medicaid reform, Florida Health Care Association, the state’s first and largest advocacy organization representing long term care providers and the frail elders they serve, is launching a campaign to raise awareness about the quality care in Florida’s nursing homes – care that is delivered efficiently and for seniors with 24-7 medical needs, could not be delivered safely elsewhere.

The “Safeguard Our Seniors” Campaign will educate the public and policymakers about the type of residents cared for in nursing homes today – vulnerable, frail elders with complex medical needs. Studies from the Legislature’s Office of Program Policy Analysis and Government Accountability have shown that just over 1% of nursing home residents could be safely transitioned into community settings. In 2009, the Nursing Home Transition Program confirmed this analysis, indicating that the majority of individuals in nursing homes are there because they need to be. They are more physically frail and there is no alternative for them to receive that same level of complex care in a safe and quality environment.

The Campaign comes on the heels of the Senate’s release of its Medicaid reform plan, which raised concern among providers as to its ability to guarantee a 7 percent savings in its first year of implementation without negatively affecting quality care. In testimony today before the Senate Health and Human Services Appropriations Committee, Marilyn Wood, President & CEO of Opis Management Resources, which operates 11 skilled nursing facilities in Florida, and a member of Florida Health Care Association’s Executive Committee, noted that “given the fact that all studies point to nursing home residents being appropriately placed, we believe that a 7 percent mandated savings can only be achieved during the first year by cutting provider rates. Additional cuts on top of those mandated savings would be needed to offset managed care companies’ administrative costs.

Wood noted that nursing homes are extremely sensitive to Medicaid rate reductions, since nearly 60 percent of nursing home residents rely on Medicaid to cover their health care costs. Twenty four percent of facilities are operating with negative margins, and “with nearly 70-percent of nursing home operating costs paying for labor – nurses, CNAs and other staff working to provide quality care – there is nowhere else for us to trim costs without cutting services and caregiver jobs and putting quality care for the residents at risk.”

“We understand the difficult position facing the Legislature as they work to reign in the Medicaid program,” she said. “But we are in the business of providing efficient and quality care to our state’s most vulnerable citizens. We will continue to work with [lawmakers] to achieve a successful Medicaid reform program; however, we must safeguard our seniors to ensure the plan does not undo the steady improvements we have made to quality nursing home care over the past 10 years.”

The Safeguard Our Seniors campaign will feature a website containing demographic information about quality and efficient delivery of nursing home care in Florida, links to recent reports on Medicaid reform and managed long term care, and an opportunity for visitors to contact their lawmakers and express their concerns. Visit the site at

For more information about the Safeguard Our Seniors Campaign or to acquire a copy of the testimony delivered by Marilyn Wood, contact Kristen Knapp at (850) 224-3907 or

Friday, February 18, 2011

Medicaid reform should safeguard our seniors' quality nursing home care

Yesterday, Sen. Joe Negron, (R-28), chair of the Senate Subcommittee on Health and Human Services Appropriation, released the Senate's Medicaid reform proposal (see pages 11-15 of the summary for the long term care provisions). The bill moves all Medicaid recipients into managed care, including long term care, with the exception of the developmentally disabled. Full implementation is expected to be completed by March 2013, with the long term care Medicaid population as the last segment brought under managed care.

Florida Health Care Association is concerned that the bill mandates a guaranteed 7% savings for all managed care entities contracting with the State. Given that residents in nursing homes require 24-hour skilled care based on their medical needs, and are appropriately placed, we can conclude that the only way to achieve those savings would be to reduce provider payment levels. In addition to the guaranteed 7% savings, managed care companies would also have to save enough to cover their administrative costs and profit. We oppose a managed care program that ultimately would result in the inability to provide safe and efficient quality care to the residents we serve.

The Senate bill also calls for Florida to begin running the Medicaid program itself by the end of the year (Dec. 31st) if Washington doesn't allow the state more flexibility. This could put billions of dollars in federal funding, for the state's Medicaid program, including that for quality nursing home care, at risk.

FHCA Provider Program - Florida Leaders kick off FHCA Lobby Wednesdays

Thursday, February 10, 2011

Study shows managed care could affect access, quality of care for seniors needing long term care

A recent study released by the Claude Pepper Data Center underscores Florida long term care provider’s ability to effectively manage long term care costs and cautions lawmakers to ensure access to current and future quality services based on the needs of today’s long term care residents. The study reviews Florida’s long term care landscape, including its demographic makeup, regulatory environment and quality of care measures, and benchmarks it against Arizona and Wisconsin, two states with practical experience with Medicaid managed long term care.

“Florida’s nursing homes are a vital part of the long term care system; they provide good quality care for our state’s frail elders and as the state’s 14th largest employer, good jobs for Florida workers,” said Emmett Reed, Florida Health Care Association Executive Director. “We agree the Medicaid program is in need of reform; however, the growth in Medicaid has not been caused by an increase in nursing home enrollment, but rather an increase in Florida’s unemployment, which is causing more individuals to rely on Medicaid as a safety net to cover their health care needs.”

The study found that the average Medicaid nursing home caseload has decreased from 47,059 in 2001 to 42,661 in 2010. Reed emphasized that today’s nursing homes serve an important post acute care role, with 84 percent of admissions coming directly from the hospital and one-third of those patients returning home following a short-term stay. Over 75 percent of the long term care population, however, has Alzheimer’s or related dementias with no one to care for them in any other setting. Most of the remaining individuals require 24-hour skilled long term care, with an increasing number of those being younger persons with disabilities.

The study raises important considerations related to Medicaid managed long term care and current and future access based on adequate supply of services. Reed noted that Florida has among the lowest over-65 population to nursing home bed population ratio in the country, measuring in at 2 percent compared to 3.5 percent nationally. “Florida is a leader in ensuring individuals requiring long term care services receive the most appropriate care in the least restrictive setting based on their medical needs,” he said. A recent report presented by the Legislature’s Office of Program Policy and Government Analysis (OPPAGA) showed that just 1.3 percent of those who received nursing home care in 2009 (just over 700) had the potential to safely transition into community placement based on their needs assessment.

The effort to transition nursing home residents back to the community have required assisted living facilities (ALF) to offer a wider range of care; however, the study notes that the “typical” nursing home resident could not receive the appropriate medical care in an assisted living facility (ALF) where nursing services are limited and state and federal oversight of those services is less intense.

It also cites the lack of availability of ALFs as a major challenge for a statewide implementation of managed long term care, since approximately one-third of Florida’s licensed ALFs are located in Miami-Dade County, leaving large areas of the state unserved or underserved with available ALF beds. Additionally, many ALFs target the private market and are unwilling to accept Medicaid payments according to “A National Study for Assisted Living for the Frail Elderly,” Hawkes, Rose and Phillips 1999.

When it came to quality of care measures, Florida has a higher mandatory staffing minimum of Certified Nursing Assistants than in Arizona and Wisconsin, and Florida’s direct care outcomes, such as “new fractures, falls physical functioning and the quality of life indicator of activities” were better than those quality measures reported for Arizona and Wisconsin. The study also noted that there is no comparable data for assisted living facilities, and the Hawkes, et al survey found that only 40 percent of ALFs employed a full-time registered nurse.

“We will continue to work with lawmakers to explore ways to reform the Medicaid system in Florida,” said Emmett Reed, Executive Director of Florida Health Care Association. “Florida’s nursing homes care for the state’s most vulnerable population, and this study shows the need for lawmakers to carefully consider the complexity of this issue and the individuals we care for in our facilities.”

Governor's budget includes across-the-board cuts to providers

Governor Rick Scott released his budget Monday, which included a 5 percent reduction of nursing home reimbursement rates ($140.6 million). Hospice rates are indirectly reduced $11.8 million as a result of the nursing home rate reduction, and the number of bed-hold days are being reduced from 8 days to 5 days, resulting in a reduction of $5.3 million.

Florida Health Care Association anticipated funding cuts given the magnitude of  the budget deficit the state is facing. Nursing homes’ financial stability is always sensitive to cuts in the Medicaid budget, since two-thirds of the residents we care for rely on Medicaid to cover the cost of their care. There is also the concern that funding cuts could have an impact on caregiver jobs, since nursing homes devote a full 70 percent of operating expenses to wages, benefits and other labor costs. Long term care is the state's 14th largest employer, so stable Medicaid funding not only is important to helping us provide quality care but also support jobs in our local communities.

Medicaid funding plays a key role in supporting the health care needs of the elderly and people with disabilities, 60 percent of who rely on Medicaid to cover the cost of their long term care services.  The Legislature must bring stability to the Medicaid program to ensure long term care providers have the resources needed to continue providing quality care to our state’s seniors. As Florida’s Baby Boomer population continues to age, the potential for increased job growth – a priority of Florida’s Governor – is huge; however, adequate Medicaid funding is needed to meet the demand for quality long term care services in the coming years.