Tuesday, May 6, 2014

2014 Legislative Wrap Up Report

The 2014 legislative session officially ended Friday, May 2, with the Legislature passing the $77.1 billion budget for 2014-2015. The budget was the largest in state history, and, along with important funding for nursing home care, the budget includes additional money for public schools, child-protective investigators and restoring the Everglades and other waterways. The Legislature approved $500 million in tax cuts, including a $400 million rollback in auto registration fees that will kick in this fall. Lawmakers also approved smaller proposals, such as holding a back-to-school tax holiday in August, a three-day sales tax holiday in September on the purchase of energy efficient appliances, and a nine-day sales tax holiday on the sale of hurricane preparation supplies such as batteries and generators.

Florida Health Care Association saw significant results on our top legislative priorities, including protecting Medicaid funding for nursing home care, and the passage of nursing home litigation reform and changes to the Certificate of Need law. Our success with advancing our legislative agenda is a result of the Association’s strength in numbers, comprehensive strategies and a unified message when it comes to educating lawmakers about the challenges that long term care providers face.


Governor Rick Scott released his initial budget in January, which fully funded the estimated 2014-2015 expenditures for nursing homes, including full inflation, established a single rate setting period effective September 1, and provided funding to develop Resource Utilization Groups for nursing facility services under Medicaid.

The initial budgets released by the House and Senate in March also called for the full funding of nursing homes as provided under current law, including the expected inflationary increase. The House, however, required a reconciliation of prior year nursing home quality assessment payments, which would have been the equivalent of a $64.3 million funding cut to providers’ Medicaid rates. Early into the budget conference, the House receded to the Senate position to preserve Medicaid funding for nursing home care, which means a nearly $65 million funding cut was averted.

The final $77.1 billion budget (HB 5001) provides $3.12 billion1 for nursing home care, which, as indicated, reflects full funding of workload and price level increases (inflation) and includes an increase in funding of $35.4 million to increase the personal needs allowance from $35 to $105 per month for residents in institutional settings.

The budget continues the Special Medicaid Payment Program for governmentally owned nursing homes and increases the nursing home quality assessment by approximately $40.5 million, to a total of $470.7 million. The nursing home quality assessment rate would increase to approximately $27.26 per non-Medicare patient day ($3.09 per non-Medicare patient day for high Medicaid volume facilities) which provides for rate “buyback” of approximately $664.5 million, compared to $585.4 million in the current year. The net result is an additional $79.1 million ($4.96 per Medicaid patient day) increase in the amount of prior year rate reductions to be restored.2

The budget also includes a transition to a single rate setting period effective September 1 of each year. Medicaid rates will be established for a six-month period beginning July 1, 2014, for an eight-month period beginning January 1, 2015, and for a 12-month period effective September 1, 2015 and each September 1 thereafter.

Funding was also provided to assess services, quality of services, and cost effectiveness as it relates to the SMMC LTC Program as required by CMS ($200,000), for the Aging Resource Centers to assist seniors enrolling in the SMMC LTC program ($1.3 million), to increase Assistive Care Services rates ($8.4 million), to serve additional elders on the Medicaid Long Term Care waitlist who have been classified as a priority score of five or higher ($12.6 million), and to fund the Program of All-Inclusive Care for the Elderly (PACE) ($36.5 million). (Funding for PACE was increased $13 million for 200 slots in Palm Beach county, 30 slots in Lee county, 10 slots in Collier county, 10 slots in Charlotte county, 125 slots in Miami-Dade county, 125 slots in Broward county, and 100 slots in Pinellas county.) Funding was not provided to develop RUGs or a RUGs-based payment system for Medicaid.

1 Total funding for nursing home care consists of $550.5 million provided on Line 241 of the bill for fee-for-service Nursing Home Care paid by the Medicaid contractor and $2.6 billion on Line 242 of the bill for Prepaid Health Plan/Long Term Care paid by the SMMC LTC Plans. Total funding provided for Prepaid Health Plan/Long Term Care is $3.41 billion.
2 These estimates are based on the modeling done in early January and will vary based upon cost-reports submitted for the July rate setting.


HB 569 by Rep. Matt Gaetz (R-4) and Senate Bill 670 by Sen. John Thrasher (R-6) focused on responsible nursing home litigation reform. The bills moved swiftly though committees with limited debate and little opposition. On April 24, CS/CS/SB 670 passed the Legislature by a vast majority and now awaits the Governor’s signature. FHCA has been in ongoing discussions with the Governor’s office and all indications are that he will sign the bill into law, which would become effective immediately.

This legislation was a result of months of behind the scenes negotiations between FHCA and members of the Florida Justice Association to develop language that would be agreeable to House and Senate sponsors, as well as leadership, along with other interested stakeholders. FHCA’s strong relationships with legislators; partnerships with consumer and business advocacy groups, including AARP, the Florida Chamber of Commerce and Associated Industries of Florida; effective media relations; and an extensive grassroots advocacy network were each a significant force in the passage of this legislation.

The bill will introduce realistic and responsible limits to lawsuits against nursing homes and will:
  • Ensure that residents can pursue lawsuits against those directly at fault for negative events, while preventing claims against passive investors and others who have nothing to do with the incident.
  • Require a trial court to hold a hearing and weigh admissible evidence before a punitive damage motion can move forward, clarifying the process without changing any standards.
  • Utilize the regulatory process to ensure that judgments are paid by giving the state Agency for Health Care Administration the authority to revoke the license of any nursing home operator who doesn’t pay a final judgment, arbitration award or settlement.
  • Establish a workable framework for providing appropriate medical records to family members.
Related legislation also passing the Legislature and awaiting the Governor's signature is CS/CS/SB 1012 by Sen. Garrett Richter (R-23). One provision of this legislation created a new section of law stating that a financial institution is not civilly liable to a third party for the actions or operations of a person solely by virtue of extending a loan or a line of credit to such person.


Certificate of Need (CON) reform was a priority for FHCA, given that the current CON law was set to expire in March of 2014, when the Statewide Long Term Care Managed Care Program became fully effective. In the fall of 2013, FHCA reconvened its Certificate of Need task force, which offered legislators recommended language to update the certificate of need process to reflect changes in elderly demographics in our state and our changing long term care delivery system. As a result, SB 268 was filed by Sen. Denise Grimsley (R-21) and HB 287 was filed by Rep. Frank Artiles (R-118).

The two identical bills passed unanimously in all committees and ultimately CS/CS/HB 287 was passed unanimously out of the House and the Senate and now awaits the Governor’s signature. CS/CS/HB 287 by Rep. Frank Artiles/Sen. Denise Grimsley provides greater flexibility for nursing homes to move beds to follow population trends and creates incentives for nursing home providers to replace older nursing homes with modern buildings to meet the needs of Florida’s elder population. Specifically:

Section 1 of the bill requires CON rule changes to encourage the construction of new nursing homes and to provide for flexibility in creating new facility construction.
  • Reduces the goal subdistrict average occupancy from 94% to 92%.
  • Allows aggregation of bed need across subdistrict lines for purposes of proposing new nursing homes, with direction as to location when need is aggregated.
  • Gives an additional positive factor to an applicant who will delicense/relinquish beds in an over-bedded area of the state when applying for a CON in an area where need is published.
Section 2 of the bill makes statutory changes that modify and/or add provisions for projects that are subject to either expedited CON review or are exempt from CON review.
  • Allows expedited CON review of nursing home replacements within a 30 mile radius, without regard to district lines. If the replacement is proposed for a different subdistrict, the target subdistrict must have at least an 85% occupancy level.
  • Allows expedited CON review of nursing home replacements beyond 30 miles in the same subdistrict or in geographically contiguous subdistricts within the same district as long as the target subdistrict has an 85% occupancy level.
  • Allows expedited CON review of nursing home bed relocations to either another facility or to establish a new facility within a 30 mile radius, without regard to district lines. The total number of beds in the state may not increase.
  • Establishes an exemption to add up to 30 beds or 25% of the licensed bed complement of a facility being replaced with a new building.
  • Reduces the required 12-month occupancy from 96% to 94% for the addition of small numbers of nursing home beds for existing facilities to be exempt from CON review. (Additions are allowed in increments of 10 beds or 10 percent or for Gold Seal 20 beds or 10 percent of the number of licensed beds, whichever is greater.)
Section 3 establishes a new limitation on nursing home certificates of need.
  • Limits the approval of certificates of need for new nursing home beds for the three-year period from July 1, 2014 to June 30, 2017 once the cumulative number of beds approved equals or exceeds 3,750 during a batch cycle.
Section 4 deletes the statutory language related to the moratorium on the construction of new nursing home beds which is repealed per current statute upon statewide implementation of the Medicaid managed care program.


Assisted Living Facility reform failed to pass the Legislature for the third year in a row. While the Senate version (SB 248 by Sen. Eleanor Sobel, D-33) passed out of the Senate in mid-April, the House version (HB 573 by Rep. Larry Ahern, R-66)) had language that did not match. Rep. Ahern went above and beyond expectations to keep the legislation moving until the very last minute; however, lawmakers were unable to work out their differences before time ran out and the 2014 session drew to a close.   

Members of the Association’s FCAL Committee took an active role in advocating for the passage of ALF reform this session, offering recommended language and reviewed proposals as legislation was developed and amended. FHCA’s ALF members also took part in our grassroots advocacy initiatives, meeting with lawmakers during a special ALF Lobby Day; testifying before committees on the importance of passing legislation; offering guest editorials to the media to raise the public’s awareness about the issue; and sending dedicated emails to lawmakers about the importance of passing ALF reform. FHCA made this issue a priority this year and gave our best efforts, and we are grateful to our members for their continued support and encouragement throughout the process.

It’s too soon to tell if legislators will revisit ALF reform in 2015. In the meantime, FHCA’s ALF members will continue their focus of providing Florida’s seniors high-quality care that respects their desire to age with dignity.


In January, the Senate Committee on Children, Families and Elder Affairs took up the issue of medically fragile children, with particular discussion surrounding children who are cared for in pediatric nursing facilities. The discussion stemmed from the lawsuit filed last year against the Agency for Health Care Administration (AHCA) by the U.S. Department of Justice. AHCA Secretary Elizabeth Dudek defended the agency's position regarding the less than 150 children with significant disabilities who reside in these facilities.

Members of FHCA’s Pediatric Task Force participated in the Senate meeting, offering important information about the children cared for in these facilities, including their medical complexities, as well as the rehabilitative services they provide to help children gain the ability to return home to their families.

Throughout session, FHCA continued its role of advocating on behalf of its pediatric nursing facility members, both in the Legislature and the media. FHCA was able to prevent unfriendly amendments which would have impeded on a parent's right to choose the setting in which their child would receive services and would have moved the children being cared for in pediatric nursing facilities into foster care.

FHCA’s Pediatric Task Force will continue its work over the summer to ensure this membership segment is well represented by the Association.


This year, the Legislature filed 1,812 bills, with just 264 passing both chambers. As often happens near the end of session, good bills get stuck on the calendar and "trains" are created to band together those issues that are somewhat related and important to many legislators. Such was the case with FHCA's regulatory issues.

Language related to the Governor's Gold Seal Award program would have allowed for a facility with verified complaints reported to the Office of the State Long-Term Care Ombudsman to be recognized as a Gold Seal Program Facility if within the 30 months before the application was submitted, those complaints were resolved.

Changes to the Board of Nursing Home Administrators would have allowed for a candidate to qualify for the NHA examination with a Master’s Degree in certain areas, not just a Bachelor’s Degree and would have increased the number of administrators on the Board of NHA from three to four (currently, this is the only board within the Department of Health where the licensed professional is a minority on the board).

FHCA worked tirelessly until the final hours of session to identify vehicles to support these important issues. These changes were tacked on as amendments to nearly every bill moving on the last day; however, the sheer volume of the health care train caused legislation to die when the Senate failed to take it up at 10:35pm on Friday.

FHCA recognizes the importance of these changes to our members and expects them to be included in our 2015 legislative agenda.

Unfriendly Legislation
SB 1154 by Sen. Darren Soto (D-14)/HB 787 by Rep. Joe Saunders (D-49) would have required a nursing homes to display posters and send letters to family members indicating they are on the AHCA "Watch list."  SB 400 by Sen. Dwight Bullard (D-39)/HB 563 by Rep. Hazelle Rogers (D-95) would have mandated AHCA to impose a $1 million civil penalty should the agency have determined that a resident died as a result of abuse and neglect; however, these bills failed to get any traction this year as well. FHCA was able to prevent these unfriendly bills from advancing, thanks to our members’ success with educating legislators about the challenges they would have imposed.

Other Tracked Bills
While going farther in the process than ever before, the Legislature again failed to authorize ARNPs to prescribe controlled substances or to initiate involuntary Baker Act transfers (HB 829 by Rep. Daphne Campbell, D-108/SB 1544 by Sen. Oscar Braynon, D-36)

Additional legislation related to ARNPs would have expanded the scope of nurse practitioners, giving them authority to prescribe certain medications without physician supervision (SB 1352 by Sen. Denise Grimsley/HB 7071 by Rep. Cary Pigman, R-55). The legislation faced heavy opposition from the Florida Medical Association, however, and it died in the Senate.

Legislation to increase regulation regarding Hepatitis C screening (SB 824 by Sen. Arthenia Joyner, D-19); HIV testing (HB 1225 by Rep. Joe Saunders/SB 1470 by Sen. Geraldine Thompson, D-12) and infectious disease reporting (HB 647 by Rep. Janet Adkins, R-11/SB 992 by Sen. Aaron Bean, R-) also failed to move far in the business-friendly Legislature.


The passage of our top legislative priorities and our ability to preserve Medicaid funding for nursing home care is attributed to the tremendous work of FHCA's members, staff and lobby team.

FHCA is proud to be the state's leading advocate for long term care and to represent the majority of Florida's nursing homes, as well as a core group of assisted living facilities, for the important work they do. On behalf of the entire team at Florida Health Care Association, we want to thank our members for their ongoing encouragement, support and resources that allow us to advocate on their behalf.

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