Tuesday, May 19, 2015

Governor signs two pro-long term care bills into law

Last week, Governor Scott approved SB 332 by Sen. Denise Grimsley (R-21) relating to vaccines in nursing centers. The law, which becomes effective July 1, 2015, will giving nursing centers flexibility by allowing all new, eligible nursing center admissions to be vaccinated with any pneumococcal vaccination, as long as the vaccine is recommended by the Centers for Disease Control and Prevention.

The Governor also approved SB 7018 by Sen. Eleanor Sobel (D-33), which provides a major rewrite to the State Long Term Care Ombudsman program. The law, which becomes effective July 1, 2015, also improves the Gold Seal process under the Governor's Panel on Excellence in Long-Term Care by clarifying the criteria at the application stage. As we've reported, some Gold Seal applications were denied if a center had an unresolved ombudsman complaint. That subjectivity has been eliminated by changing an "unresolved complaint" to "only complaints which result in a licensure citation."

Tuesday, May 12, 2015

Govenor Rick Scott Proclaims May 10-16, 2015 National Nursing Home Week

Florida nursing centers “Bring on the Fiesta” during National Nursing Home Week

Just one week after Cinco de Mayo, it’s time for a Fiesta! At skilled nursing centers across Florida, residents and staff are celebrating National Nursing Home Week. Celebrations started this past Sunday on Mother’s Day and will run through May 16. Centers are hosting activities using a theme of “Bring on the Fiesta,” with celebrations focused on “Familia, Vida and Amor” (family, life, love).

National Nursing Home Week is the perfect backdrop for embracing those three core values. Everyone can embody the spirit of “Familia, Vida and Amor” by visiting relatives, spending time with life-long friends and neighbors, and brightening the lives of loved ones (or even strangers) who reside in nearby skilled nursing centers.

The observance is a great opportunity for families, community members, youth and others to support nursing center residents and the dedicated staff who care for them on a daily basis. If you can’t visit in person, it’s still easy to make a phone call or send a greeting card or flowers. This special attention will make someone’s day and help enhance their quality of life.

It will also provide you the opportunity to see the abundance of life, care and compassion and the strong sense of community thriving in our state’s nursing centers. This spirit is leading to improved health outcomes for our state’s seniors, and that benefits everyone. So “Bring on the Fiesta,” and make someone’s day extra-special.

Learn more about Florida skilled nursing centers by visiting our website - ElderCareFlorida.com.

By J. Emmett Reed, CAE 

Wednesday, May 6, 2015

FHCA 2015 Legislative Wrap Up Report

The 2015 Florida legislative session ended prematurely with the House and Senate at a stalemate over a new state budget and health care programs. After weeks of disagreement over Medicaid expansion and federal funding related to the hospital Low Income Pool program, the House unexpectedly adjourned three days earlier than the scheduled May 1st end to the regular session. The Senate chose to stay through the full 60-day timeframe, passing a limited number of bills on Wednesday before officially adjourning at 11:59 p.m. on May 1.
The Florida Constitution mandates that the Legislature must pass a balanced budget before July 1, 2015. Because the House and Senate adjourned without passing a budget, the Legislature will be called into a special session sometime in early-to-mid June to pass the 2015-16 state budget. Either the Governor will call the Legislature back into a special session or Senate President Andy Gardiner (R-13) and House Speaker Steve Crisafulli (R-51) will jointly call legislators back. 
The standstill over the state budget did not affect FHCA's ability to pass legislation that will have a positive impact on your operations and care delivery. Your tremendous involvement in our Lobby Wednesdays, combined with the comprehensive pre-session strategy put forth by the FHCA/Our Florida Promise leadership and the effectiveness of our government affairs team, all contributed to successful outcomes for long term care.
*Please note that although these legislative measures have been approved by both chambers, the Governor must take action for final approval (sign the bill, allow it to become law without his signature or veto the bill). FHCA will provide updates on the Governor's action and effective dates on the bills we’ve reported on below.

HB 309 by Rep. Shawn Harrison (R-63)/Sen. Don Gaetz (R-1)

This priority issue for FHCA will protect seniors from unexpected medical bills. HB 309 requires hospitals, at the time of discharge, to educate the patient or the patient's proxy about the individual's admission status. The information must be documented in the patient's discharge papers and education shall also be provided through brochures, signage or other forms of communication.
Medicare will not cover the cost of post-acute rehabilitation care in a skilled nursing center following a qualifying three-day inpatient hospital stay if a beneficiary is classified as outpatient under observation status. Seniors are often unaware the hospital classified them as an outpatient under “observation” until they are discharged and transferred to a skilled nursing center for rehabilitation.
While legislation at the federal level would deem time an individual spends under observation status as eligible to count toward satisfying the three-day stay requirement, this notification at the state level will ensure seniors are properly informed and protected from serious financial burdens.

SB 332 by Sen. Denise Grimsley (R-21)/Rep. Mike Miller (R-47)

SB 332 removes a current statutory requirement that skilled nursing centers must vaccinate all eligible new admissions with the pneumococcal polysaccharide vaccination (PPV - a name brand vaccine). It instead allows all new, eligible nursing center admissions to be vaccinated with any pneumococcal vaccination, as long as the vaccine is recommended by the Centers for Disease Control and Prevention.

SB 7018 by Sen. Eleanor Sobel (D-33)/Rep. Ken Roberson (R-75)

After several years of failed attempts, Sen. Sobel and Rep. Roberson were successful in passing a major rewrite to Florida's Ombudsman statute. SB 7018 will transfer the Ombudsman Council's responsibilities to state representatives of the Office of the State Long Term Care Ombudsman. The bill revises the operating structure and internal procedures of the State Long-Term Care Ombudsman Program (LTCOP), housed in the Department of Elder Affairs (DOEA), to reflect current practices, maximize operational and program efficiencies and conform to the federal Older Americans Act. The bill also revises the appointment process for three at-large positions to the State Long-Term Care Council, whereby the appointments are no longer made by the Governor but rather the Secretary of DOEA.
FHCA worked with Sen. Sobel to amend the bill to improve the Governor's Panel on Excellence for Long-Term Care Gold Seal process by clarifying the criteria in the application process. Previously, some Gold Seal applications were denied if a center had an unresolved ombudsman complaint. The final legislation eliminates subjectivity by changing an "unresolved complaint" to "only complaints which result in a licensure citation."

HB 1001 by Rep. Larry Ahern (R-66)/Sen. Eleanor Sobel (D-33)

After more than four years of attempting to reform the state's regulatory system for assisted living facilities, the Florida Legislature passed HB 1001 by Rep. Larry Ahern/Sen. Eleanor Sobel. HB 1001, which contained recommendations from FHCA's Florida Center for Assisted Living (FCAL) Committee members, is an excellent step toward promoting ALF accountability without imposing unnecessary regulatory burdens. At the same time, this important legislation will preserve resident quality care and a level of independence these individuals expect from their ALF home.

Among other provisions, the bill:
  • Allows ALF staff to better assist residents with self-administration of medication;
  • Requires ALFs to inform new residents, upon admission to the facility, that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right;
  • Allows nurses to practice within their full scope of licensure in assisted living facilities with limited nursing specialty licenses (LNS);
  • Gives the Agency for Health Care Administration (AHCA) broader authority to issue moratoriums and to revoke licenses in certain circumstances; and
  • Requires AHCA to significantly enhance the information available about assisted living facilities to the public.
A more detailed section summary, as well as highlights of the landmark legislation, is available in the ALF Regulatory section of FHCA's website.

FHCA appreciates the important role members of the FCAL and Legislative Committees played over the past four years, reviewing and offering input throughout the process to ensure the final bill would promote ALF accountability and allow greater services for ALF residents without imposing unnecessary regulatory burdens.

HB 749 by Rep. Charles Van Zant (R-19)/Sen. Thad Altman (R-16)

This legislation revamps the contracts between Continuing Care Communities' (CCC) residents and providers. HB 749 makes several changes to ch. 651, F.S, including changing the name of Continuing Care Retirement Communities (CCRC) to Continuing Care Communities. For specific details on HB 749, contact Carol Berkowitz of our staff.

HB 269 by Rep. Ray Pilon (R-72)/Sen. Jeff Brandes (R-22)

The bill creates the "Right to Try Act," which provides a framework in which an eligible patient with a terminal illness would be able to access experimental drugs, biological products and devices from the manufacturer after phase one clinical trials (meaning the FDA may not have approved the drug).

In the early part of session, an amendment was added to the Senate companion bill authorizing Physician Order for Life Sustaining Treatment (POLST) forms in Florida Law. The amendment would have required health professional staff to honor either the Do Not Resuscitate Orders (DNROs) or the POLST document in the same manner. FHCA’s Legislative Committee expressed concern that the amendment as proposed would lead to confusion, especially with the choice of multiple forms. FHCA worked with Sen. Aaron Bean (R-4), who amended the bill to delete the language recognizing the use of the POLST.

The POLST form is currently accepted in more than 20 states, making this issue likely to arise again next session. Going forward, FHCA will work with all parties to ensure that, as POLST is integrated in Florida, it stays consistent with other forms of advance directives.
Read more about POLST in the May issue of FHCA's Pulse newsletter.


Watch List: SB 862 by Sen. Darren Soto (D-14)/HB 1061 by Rep. Dwight Dudley (D-68)
While this bill would have required nursing centers to post Gold Seal designations in public access, it also would have mandated those centers on the AHCA Watch List to post a notice in similar areas and notify designated family members describing deficiencies. FHCA worked with Sen. Soto and Rep. Dudley to help them understand our concerns with this legislation, as we believe the Watch list to be an outdated tool, given the 30-month requirement, and that it is often confusing to consumers since the federal five-star rating scale more accurately reflects a center's quality measures. In the end, the bill failed to be heard by any committee and died at the end of session.


Unfortunately, the meltdown of negotiations and abrupt termination of the regular legislative session resulted in many good bills dying. These included:


The passage of many pro-long term care bills is attributed to the tremendous work of our members, staff and lobby team. The pre-session work of FHCA and Our Florida Promise leadership, along with the members involved in our Legislative, Reimbursement and FCAL Committees, was tremendous. At the same time, to our members back home who helped educate legislators through pre-session center tours and legislator meetings, we appreciate the support. In the end, this advance work helped House and Senate bill sponsors to develop legislation that was reasonable and able to be supported by a vast majority of lawmakers, Republicans and Democrats alike.

FHCA also wants to thank the nearly 500 members who traveled to Tallahassee to advocate for the issues and tell your stories. Lobby Wednesdays, sponsored by Bouchard Insurance and Cotler Healthcare and Development, is an integral part of our legislative strategy and helps our key messages resonate when legislators prepare to cast their votes. Many of our associate members also joined us in our efforts, speaking side-by-side with facility staff about the important link between Medicaid funding and quality care.
Be sure to watch our special edition of the FHCA Provider Program, sponsored by Bouchard Insurance, which features exciting member interviews and highlights this year's Lobby Wednesday visits.

When legislators return to Tallahassee for a special session, you can be assured that FHCA will remain in the midst of budget negotiations to protect the Medicaid funding that is vital to the care you deliver. In particular, we'll continue asking lawmakers to restore the two prior-year rates cuts amounting to $61 million when budget deliberations resume. Additionally, FHCA will work with legislators on how to move forward with the development of a prospective payment system for nursing centers, which is proposed in the House budget.
FHCA is proud to represent our members for the important work you do. On behalf of the entire team at Florida Health Care Association, we want to thank you for the ongoing encouragement, support and resources that allow us to advocate on your behalf.