Wednesday, February 15, 2017

Legislators Should Act Carefully on Changes Affecting Care Options for Frail Elders

Today FHCA provided legislators with invaluable information and insights to help shape crucial policy discussions affecting the care of Florida’s most frail residents.  In presentations to two House panels, the association detailed why nursing centers should be removed from any repeal of the Certificate of Need process and offered recommendations on the state’s proposal for a Prospective Payment System for nursing center reimbursement.

The Association, representing 82% of Florida nursing centers and the elderly they serve, told House members that both the quality of care for the state’s seniors and the health of the nursing centers that care for them could be significantly impacted by proposals under consideration. The association is advocating for an exemption from any proposal that eliminates the Certificate of Need (CON) process and supports efforts to move to a Prospective Payment System (PPS) for delivery of nursing center care.

“Repealing nursing home Certificate of Need will most certainly result in unmanaged growth, low occupancy rates, inefficiencies in how buildings operate and a reduction in the value of our state’s nursing centers. All of this will greatly impact how quality care is provided to our state’s seniors,” Emmett Reed, FHCA’s executive director, told members of the House Health Innovations Subcommittee.

CON repeal has affected elder care in other states, Reed noted. For example, Texas operates twice as many nursing centers as Florida but is plagued by facilities that have beds that remain empty and deliver a poor quality of care. Indiana was forced to impose a moratorium on building nursing centers due to unmanaged growth 16 years after it repealed it CON process.

FHCA speakers also noted that by promoting an environment in which new nursing centers must lure elders to fill costly beds, repeal of CON for nursing centers would run contrary to Florida’s long-standing commitment to enabling elders to remain in their homes or in community-based care for as long as possible.

“Florida has attained a system that strikes the right balance. Those who can be cared for in a home and community-based setting are receiving it there – and those who come to my nursing center and others around the state do so because that is the only place they can safely receive the more specialized care they need,” said Ari Hollander, CFO of Stirling Long Term Care, which operates three centers in south Florida.

The House Heath Care Appropriations Subcommittee received a report on the Navigant model for a Prospective Payment System for nursing center reimbursement, developed for the Agency for Health Care Administration. FHCA representatives supported the concept of a PPS approach to foster higher quality with reasonable Medicaid reimbursement rates, but offered recommended changes to that approach to avoid placing undue financial burdens on nursing centers as they transition to the new system.

“The current cost-based system is antiquated. It involves multiple audits, with some of those audits looking at books dating back several years and resulting in underpayments with no ability to financially recoup those monies paid out to cover resident care costs. We support a prospective payment system, where we will know the amount of our payment to cover the cost of care – and the state will have budget predictability, as well,” said Andy Weisman, president of NuVision Management which operates six nursing centers in Florida.

James Aschenbeck of Signature HealthCARE, who is chair of FHCA’s Reimbursement Committee, warned that any transition to a PPS system should include a three-year transition period and additional funding to pay for the nursing staff who provide hands-on care. “We believe any reimbursement system must take into consideration the current financial landscape of nursing center care in order to achieve its goals and become the payment norm of the future,” he said.

Jamey Richardson, president of Gulf Coast Health Care which operates 33 nursing centers in Florida, shared how their support of the Navigant model will come at a cost of Medicaid rate reductions amounting to $6.7 million once the PPS is fully implemented. “Despite this short-term revenue loss, we support the Navigant model because it recognizes and rewards both efficiency and high-quality outcomes…and we know we will be able to adjust to remain successful in how we deliver quality care to our residents with the recommendations put forth by Florida Health Care Association.”

More information on how the Certificate of Need issue may affect the care of Floridians in skilled nursing centers can be found at To learn more about the Prospective Payment System and FHCA’s recommended changes to the Navigant PPS model, visit

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