Wednesday, June 17, 2015

FHCA Special Legislative Session Report

Lawmakers are expected to end the 2015 special legislative session this Friday, June 19. At that point, the mandatory 72-hour "cooling off" period ends and both chambers can vote on the $78.7 billion budget. After the final votes, the budget will then be sent to Governor Rick Scott for review and approval.

The contention among lawmakers heading into the special session took its toll on health care. The debates over Medicaid expansion broke down and not a single health care bill passed out of the special session. Much of the Legislature's focus was on replacing lost dollars for the hospital Low Income Pool program, as well as tax cuts and education.

Medicaid Funding
FHCA is pleased to report that, in the end, funding for nursing center care was preserved. The budget contained no Medicaid funding cuts and all workload and price level (inflation) increases were fully funded.

Unfortunately, there was no new money appropriated for the restoration of prior year skilled nursing center funding reductions. This became an impossible task, given the required funding of over $400 million in state dollars to replace some of the lost federal monies from the Low Income Pool fund. The LIP fund is being reduced from over $2 billion in 2014-2015 to approximately $1 billion in 2015-2016.

Quality Assessment
FHCA’s Government Affairs team was successful in amending the Medicaid conforming bill to change the due date of the Nursing Facility Quality Assessment (NFQA) from the 15th to the 20th day of each month to match the new Medicaid Managed Care payment timeframes.  Originally, the NFQA was due approximately five days after Medicaid paid provider claims. With the implementation of Medicaid Reform, long term care managed care plans are required to pay nursing center claims within 10 days after receipt (which frequently occurs after the 15th of the month). This change should ensure providers have sufficient cash flow to pay the NFQA timely and will help alleviate late payment penalties.

Medicaid Prospective Payment System
FHCA also successfully advocated for the removal of the proposed study to develop a new Medicaid prospective payment system (PPS) for nursing center services. The Governor’s original PPS proposal was designed to reduce the variance in Medicaid payments to different nursing centers for similar residents and to eliminate retrospective rate adjustments. Further, the original House language required that the study develop a transition plan to implement the new PPS in a budget-neutral manor.

FHCA conceptually supports the creation of an appropriately designed PPS methodology that is fully funded, and eliminating the proposed study will ensure our experts on PPS methodologies are an integral part of developing the PPS model. Accordingly, FHCA has created a Medicaid Prospective Payment Workgroup under the FHCA Reimbursement Committee that is charged with creating a proposed payment model and making recommendations to the FHCA Reimbursement Committee, Our Florida Promise Board of Directors and FHCA Board of Directors prior to the next legislative session. This Workgroup is chaired by Doug Burr and Joe Lubarsky, nationally recognized for his payment system design, is serving as consultant.

Veterans' Nursing Homes
The budget conferees ultimately removed language that would have given the Director of the Florida Department of Veteran’s Affairs the authority to contract out the management of the State Veterans’ nursing homes and assisted living facility.  This provision was eliminated for procedural reasons, as legislators decided such a major policy change should be made in statute and not through the budget.  Leadership has offered to work with FHCA next session to pursue a bill. 

Planning Ahead
FHCA will be developing its 2015 Legislative Scorecard in the coming weeks, which is an effective tool to help you better understand how legislators voted on all the issues affecting long term care this session. Additionally, we’ll be highlighting the regular and special legislative sessions during the FHCA Annual Conference on Tuesday, August 4, during the Legislative Update Mega Session. Along with a recap of the budget and the bills that passed, attendees will also learn more about the impact of these legislative changes. Current political leaders and future candidates have also been invited to attend, so make plans to join us.

While the session has finally come to a close, the work is not done. Legislators will now return to their districts, and FHCA wants to encourage its members to invite them into your nursing center so we can continue educating them about what's important to long term care. The 2016 legislative session will begin in January, with committee weeks expected to start in less than three months. FHCA and our advocacy partner, Our Florida Promise, have already begun laying the groundwork for next session. Your support of our advocacy efforts, through legislative tours to your center or meetings with lawmakers in their district, is a critical part of our strategy to keep lawmakers informed about the important work you do in caring for Florida's frail elders.