FHCA Capitol Connection

FHCA Provider Program: House Budget Released, Members Recap Legislator Visits

2012-01-27T12:18:00.000-08:00

FHCA Executive Director Emmett Reed reports on the impact the House proposed budget has on Medicaid funding for nursing home care. Also, both first-time and experienced Lobby Wednesday participants talk about their lawmakers visits.

House Releases Initial Budget

2012-01-24T09:01:00.000-08:00

Today, the House released its initial proposed budget, which contains a 2.5 percent cut to nursing home Medicaid reimbursement rates ($76.1 million). The proposal fully funds price level increases (inflationary increases) and transfers funding for nursing home case load growth to home and community-based programs (no negative impact to nursing home rates). The initial documents released today do not indicate changes in the amounts to be collected via the Nursing Home Quality Assessment Program; however, it is anticipated that the program will be fully maximized at the 6 percent statutory level. The budget uses the transferred case load funds to provide for an additional 1,000 Nursing Home Diversion slots, an additional 207 Assisted Living Medicaid Waiver slots, 1,250 Aged and Disabled Adult Medicaid Waiver slots, and 150 new PACE slots for Lee and Collier counties. The proposed budget also reduces the Nursing Home Diversion rates by 4 percent and uses those savings to fund an additional 1,415 Diversion slots.

The Senate is expected to release their proposal later this week, and FHCA will have more information when that becomes available.

FHCA Provider Program Update: Nursing Home Quality Efficiency Bills Advance

2012-01-20T13:03:00.000-08:00

Executive Director Emmett Reed speaks with Rep. Jim Frishe (R-54), HB 621 sponsor, along with FHCA's Lobby Wednesday participants during week two of the 2012 legislative session.

SB 482 advances

2012-01-19T12:04:00.000-08:00

Today, SB 482 by Sen. Jack Latvala (R-16), The Nursing Home Quality Efficiency Act, passed favorably out of the Senate Committee on Health Regulation, despite opposition from trial attorneys and other opponents who are misinformed about this issue. Neither SB 482 or its House companion, HB 621, impact resident care; they simply eliminate requirements that duplicate federal law, with some of those requirements being as much as ten years out of date. FHCA will keep you updated on the progress of these important bills, which put patients ahead of paperwork, as they continue making their way through the process.

HB 621 Passes Second Committee

2012-01-17T12:39:00.000-08:00

HB 621, the Nursing Home Quality Efficiency Act, passed its second committee stop this afternoon, with the Health & Human Services Appropriations Subcommittee voting 14-1 to pass the measure. Bill sponsor Rep. Jim Frishe (R-54) shared important information with the committee about how this bill eliminates outdated reports and requirements in nursing homes (some being 10 years out of date) that are duplicative of federal law/regulations. FHCA supports this bill which would help facilities alleviate some of the cost burdens that come with duplicative requirements and excessive paperwork, allowing staff to "Put Patients Ahead of Paperwork" and focus more time on resident care. The Senate companion, SB 482 by Sen. Jack Latvala (R-16), is expected to be heard by the Senate Health Regulation Committee on Thursday.

FHCA Provider Program: 2012 Legislative Session Begins

2012-01-13T12:25:00.000-08:00

FHCA Executive Director Emmett Reed gives a preview of week one of the 2012 legislative session and the priorities for long term care providers this year.

Bill that puts patients ahead of paperwork passes House subcommittee

2012-01-12T08:17:00.000-08:00

On Thursday, the House Health & Human Services Quality Subcommittee heard HB 621 by Rep. Jim Frishe (R-54), the Nursing Home Quality Efficiency Act which eliminates some outdated reports and requirements in nursing homes which duplicate federal law/regulations. FHCA supports this bill which would help facilities alleviate some of the cost burdens that come with duplicative requirements and excessive paperwork, allowing staff more time to focus on resident care.

Rep. Frishe, Matt Hudson (R-101) and Ronald "Doc" Renuart (R-18) spoke favorably on this important issue, and during the meeting, Florida Catholic Conference and Florida Association of Homes and Services for the Aging stood in support of the bill. Standing in opposition were AARP, SEIU and the Florida Justice Association. Back and forth testimony during the meeting gave way to common misconceptions about the regulatory environments in nursing homes and assisted living facilities, causing Rep. Renuart to clarify for the committee and audience members present the differences between these two care settings, including the significant oversight process for nursing homes that have been in place since landmark elder care reform was passed in 2001 (SB 1202), which have resulted in substantial improvements in resident quality care.

The bill passed, and its companion, SB 482 by Sen. Jack Latvala (R-16), is expected to be heard in the Senate next week.

Protecting Medicaid funding, putting patients ahead of paper top FHCA's 2012 legislative agenda

2012-01-05T11:54:00.000-08:00

Florida Health Care Association (FHCA) today released its priorities for the 2012 legislative session. Topping the list will be to prevent reductions to Medicaid funding for high-quality nursing home care, given the significant funding cuts long term care providers have experienced over the past six months. A 6.5 percent cut to nursing home Medicaid funding during the 2011 legislative session resulted in a $187.5 million reduction that took effect July 1, 2011. In October, federal regulation resulted in a $332 million cut to facilities’ Medicare reimbursements, and with Congress looking at more ways to reduce the federal deficit, facilities could see further reductions.

“Nursing homes have been hit with a tsunami of funding cuts to our Medicaid and Medicare reimbursements over the past six months,” said Emmett Reed, Executive Director of Florida Health Care Association, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “If we see more cuts this session, many facilities will have to make difficult decisions which could restrict future access to care; our state’s seniors deserve better.”

Protecting Funding for Nursing Home Quality Care: Florida nursing homes lose an average of $23.97 per patient day or nearly $575,000 annually due to Medicaid under-funding. For a typical nursing home, 70 percent of costs pay for the staff working in the facility to deliver care, with 40 percent of those costs dedicated to direct-care workers. Funding cuts could mean layoffs for frontline caregivers and other employees at a time when Floridians need jobs. Lack of adequate funding could also mean sending seniors and people with disabilities to long term care hospitals or other higher cost settings for those services. With 60 percent of nursing home residents relying on Medicaid as their safety net for their long term health care needs, FHCA is urging legislators to preserve Medicaid funding to protect residents’ high-quality care, ensure future access to care and maintain the jobs of frontline caregivers.

Put Patients Ahead of Paperwork (HB 621/SB 482): Landmark elder care reform passed by the Florida Legislature in 2001 (SB 1202) has resulted in tougher regulation, increased staffing requirements and quality improvement and risk management programs, all of which are enforced through a combined state and federal survey process of the Agency for Health Care Administration. Nursing home care has steadily improved as a result. The benefits of improved oversight of the quality of care for residents, however, have resulted in duplicative requirements and regulations. FHCA supports HB 621 by Rep. Jim Frishe (R-54) and SB 482 by Sen. Jack Latvala (R-16) which would eliminate duplicative paperwork and outdated reports, allowing caregivers working in nursing homes to focus more time on providing resident quality care.

Alternative Funding Resources (HB 1055/SB 1756): FHCA supports SB 1756 by Sen. Joe Negron (R-28) and HB 1055 by Rep. Rachel Burgin (R-56), which would allow life insurance policies to be used for payment of long term care services and would help the state with its growing Medicaid budget deficit by providing alternative resources for individuals to pay for nursing home care.

“Our members are committed to caring for Florida’s most vulnerable population at a level of quality they expect and deserve,” Reed continued. “This session we’ll see hundreds of nursing home employees and family members join us at the Capitol as we continue educating lawmakers about the impact funding cuts are having on facilities' ability to maintain an adequate workforce and continue delivering high-quality care to our state's seniors.”

To learn more about FHCA’s 2012 legislative priorities, find resources to advocate for protecting Medicaid funding to nursing home care and learn more about being involved in FHCA’s Safeguard Our Seniors grassroots campaign, visit http://www.safeguardourseniors.org/

Tell Congress to Oppose Reductions to Nursing Facility Bad Debt Reimbursement

2011-12-13T08:50:00.000-08:00

Late last week, House Republicans released HR 3630, the Middle Class Tax Relief & Job Creation Act of 2011, which reduces nursing facility bad debt reimbursement. While the bill extends the payroll tax cut, extends the therapy caps exception process and provides the doc fix, it uses skilled nursing centers, as well as other providers, as a pay-for.

Florida facilities are struggling due to the funding reductions we’ve already sustained - $187.5 million to Medicaid and $332 million to Medicare in the past six months alone. HR 3630 threatens bad debt reimbursement for Florida nursing homes and will result in an estimated $172.8 million funding cut over the next three years. A reduction of this magnitude will seriously jeopardize our ongoing quality improvement efforts, put jobs of frontline caregivers at risk and threaten our state’s seniors and individuals’ with disabilities access to nursing home care.

The House could vote on this bill anyday, so please CLICK HERE to contact Congress and tell them to oppose the provision in the bill which reduces bad debt reimbursements for skilled nursing facilities!

Share this message with your coworkers, residents and their family members and ask them to do the same.

Florida’s nursing homes provide important health care services to seniors and people with disabilities and also provide secure jobs for over 259,000 citizens in our state. While real choices need to be made to help our country at this critical time, those choices should not overwhelmingly impact the Greatest Generation or those who care for them.

Governor's Budget Recommendations

2011-12-07T14:01:00.001-08:00

Today, Gov. Rick Scott proposed a $66.4 billion budget for next year, down from this year's $69.1 billion budget. The budget contains no cuts to Medicaid funding for nursing home care. It restores previous cuts to education by $1 billion, would cut 2,800 actual filled state jobs "all over" government and would rely on cuts in health care spending and the prison system.

While the Governor's budget does not negatively impact nursing home funding, we want to remind our FHCA members that both the House and Senate will come out with their respective budgets not long after the session begins in January. It's important that we continue educating lawmakers about the impact the July 1st $187.5 million Medicaid cut, together with the October 1st $332 million Medicare cut, is having on facilities' ability to maintain an adequate workforce and continue delivering high-quality care to our state's seniors.

In the meantime, watch our video message by clicking here and learn how you can get involved this legislative session, which kicks off January 10, 2012. You'll hear from Sen. Thad Altman (R-24) as he shares his thoughts about the high-quality care delivered by and economic impact of Florida's long term care facilities. You'll also learn more about our 2012 legislative priorities and how you can get involved in our grassroots activities, including:

2012 Lobby Wednesdays - Click here to learn more.
Get the Facts Campaign - Spread the word about these important LTC facts.
Safeguard Our Seniors website - Find the tools you need to advocate for our profession.

It's going to take all of us working together and staying informed to make a difference.

A Pre-Session Message from Emmett Reed

2011-12-06T06:05:00.001-08:00

FHCA Executive Director Emmett Reed wants to encourage all those who work in and support long term care in Florida to get involved this legislative session, which kicks off January 10, 2012. Listen to his important message and hear what Sen. Thad Altman (R-24) shares about the high-quality care delivered by and economic impact of Florida's long term care facilities. You'll also learn more about our 2012 legislative priorities and how you can get involved in our grassroots activities.

Get the Facts on long term care

2011-11-21T12:30:00.001-08:00

Today, FHCA launched its "Get the Facts" social media campaign to share facts about long term care in Florida – including the impact that Medicaid/Medicare funding cuts are having on facilities’ ability to continue delivering high-quality care. The campaign will highlight long term care statistics in Florida, information related to FHCA’s legislative priorities, including reimbursement and regulatory efficiencies, the differences between nursing homes and assisted living facilities and more. Follow FHCA on Twitter or “Like” Florida Health Care Association on Facebook to follow the campaign and retweet/share these facts with your followers and friends, using the hashtag #GetTheFacts.

Florida long term care providers take to the nation's capital to urge Congress to protect Medicaid and Medicare funding.

2011-10-18T08:21:00.000-07:00

Hear from FHCA Executive Director Emmett Reed on members traveling to Washington, DC, to urge Members of Congress to protect and preserve Medicare and Medicaid funding for long term care services. The message: The combination of state and federal funding cuts are taking their toll on our ability to deliver high-quality care and support vital caregiver jobs. Help take action today. Click here to send a message to your Member of Congress and help stand up for our state's seniors and people with disabilities.

Newest Ad in “Care Not Cuts” Informational Campaign highlights skilled nursing facilities post-acute care focus

2011-10-04T13:19:00.000-07:00

FHCA's national affiliate, American Health Care Association, launched the latest TV spot in its nationwide information "Care Not Cuts" ad campaign to increase awareness regarding skilled nursing facilities’ growing prominence in post-acute care and warn against additional cuts to the sector.

“We must shed current perceptions that nursing homes are only for those who need long term care. Skilled nursing facilities are also a place where people can rehabilitate and receive necessary treatment before returning home,” said Governor Mark Parkinson, President & CEO of AHCA. “Congress must especially be aware of this progression of care because additional cuts to skilled nursing facilities would only drive up health care and taxpayers costs. Restricting access to skilled nursing facilities will force more seniors to remain in the hospital for longer, pricier periods of time, or go home before they’re fully recovered; eventually sending them back to the expensive emergency room.”

Airing throughout the Washington, DC, Beltway beginning today, “Rehab” was filmed at Southlake Nursing & Rehabilitation Center in Jacksonville and features a senior who, after being in the hospital, received his post-acute care from a nursing home and then returned home. To learn more about the "Care Not Cuts" campaign, visit the website at http://www.carenotcuts.org/.

Tell Congress to Protect Quality Nursing Home Care, Preserve Caregiver Jobs

2011-10-04T05:39:00.000-07:00

Congress is currently debating potential additional cuts to nursing homes and assisted living facilities, after already being dealt billions of dollars in cuts. While we understand the need for sacrifice, Florida's long term care facilities are already struggling from a drastic $187.5 million state Medicaid cut that went into effect earlier this year. The combination of that reduction on top of Medicare cuts from health care reform and federal regulation is taking its toll. The long term care profession simply cannot sustain additional cuts at this time without jeopardizing care and access for seniors, along with the jobs of caregivers committed to delivering that high quality care.
A group of long term care advocates from Florida will be traveling to Washington, DC, over the next several weeks to share our concerns with Congress. You can help have your voice heard by taking action today -- Click here to contact your Member of Congress and tell them to preserve, protect and defend quality nursing home care and assisted living care services for seniors and people with disabilities.

Please join us in telling Congress that continuous cuts threaten access to quality care for Florida's growing population of seniors and access to quality jobs for Florida's long term care workforce. You can also pass this link along to others and ask their help with standing up for those who cannot care for themselves.

Jobs at risk as more cuts loom for Florida seniors’ Medicare and Medicaid-financed skilled nursing care

2011-09-29T10:30:00.000-07:00

As economic conditions remain unstable for Florida and the nation, both Congress’ deficit reduction “super committee” and the White House have proposed yet another round of cuts to skilled nursing Medicare/Medicaid benefits for Florida’s seniors. Florida facilities are already reeling from a series of recent budgetary actions, with a $331.8 million cut to seniors’ Medicare-funded skilled nursing care set to take effect October 1. The proposed cuts being discussed in Washington as a way to reduce the nation’s deficit will severely jeopardize Florida’s oldest, sickest seniors – especially when combined with the growing pressure on our state Medicaid budget. In July, Florida’s Medicaid funding for seniors’ skilled nursing care was slashed by $187.5 million.

Protecting vulnerable seniors is a critical priority from which we must never deviate. Yet, they will suffer the most if further cuts are made to Medicare- or Medicaid-funded skilled nursing care. Facilities are already struggling to provide high quality care at the level today’s seniors expect and deserve, and the combination of additional Medicare cuts on top of the stress already placed on seniors’ state Medicaid benefits will severely undercut facility staffing efforts.

Throughout Florida and across America, frontline caregivers make a key difference in patient care – and these proposed cuts present a clear and present danger to their jobs. Seventy percent of facility costs go to pay for the people working to care for Florida’s 71,000+ seniors and people with disabilities in our state’s skilled nursing facilities. With both federal and state officials pushing policies to promote job creation in our country, more proposed cuts to Medicare and Medicaid are simply counterproductive.

Too many Floridians have lost their jobs or had their homes foreclosed, and the road to recovery has been much too slow going. More cuts to Medicare and Medicaid will sidetrack our state’s ability to support good-paying health care jobs – 178,000 in Florida’s long term care facilities alone. As the Executive Director of the Florida Health Care Association, I am alarmed that nurses and caregivers will no longer be able to perform their vital services if the burden of cost savings continues to be unfairly placed on their service. Cutting out the people who provide great care will do nothing to protect our seniors.

Now, more than ever, older Americans need advocates - in Washington and in our state capital - to address the care needs of the first wave of Baby Boomers who turned 65 this year. Our social service safety net, particularly for the frail elderly, is already stretched way too thin. It needs to be shored up, not shot down.

Please contact your Members of Congress. The message is clear: Any further cuts at the federal or state level to Medicare or Medicaid threaten an already fragile long-term care system with unthinkable and tragic results. Further cuts threaten caregiver jobs, place quality of care at risk and very soon will limit access to people who need skilled nursing care.

J. Emmett Reed, CAE
FHCA Executive Director

New Ad Campaign Urges “Care Not Cuts”

2011-08-29T09:25:00.000-07:00

Long term, post-acute care sector launches fall media effort to help preserve, protect, defend seniors’ access to quality skilled nursing and rehabilitative care in Florida

The long term and post-acute care profession is uniting to launch a nationwide informational campaign, “Care Not Cuts,” and is running its first ad in the state of Florida beginning today. As Congress begins to examine ways to reduce the federal deficit, the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care (Alliance) have partnered with the state affiliate, the Florida Health Care Association (FHCA), to ensure federal lawmakers understand the vital need to preserve, protect and defend U.S. seniors’ access to quality skilled nursing and rehabilitative care.

“Already coping with billions of dollars in reductions from health care reform, federal regulations and a State Medicaid crisis, our facilities are feeling the impact,” said Emmett Reed, Executive Director of FHCA. “This campaign raises awareness among Florida’s Congressional delegation that we cannot sustain any more cuts, and who better to deliver this message than the dedicated caregivers who serve our seniors every single day?”

Beginning today and continuing through September 6, the first TV spot of the multi-month campaign, “Nurses,” features frontline caregivers. The text of the spot is as follows:

I work as a rehabilitation nurse. I love what I do.

In the last five years, nursing homes have absorbed billions in Medicare and Medicaid cuts.
Even so, we’ve maintained high quality care.

Now, there’s talk of more, deeper cuts. I understand the need for sacrifice.

We’ve given our fair share, and more.

But as a nurse who cares for her patients, I can tell you another round of deep cuts that target nursing homes simply goes too far.

In Florida, other caregivers are sharing similar concerns about the impact additional cuts would have on the residents they care for each day.

“Working in a nursing home is not just a job; it’s a calling,” said Lisa McFall, RN, of Palm Garden in Orlando. “It’s so rewarding to interact with my residents and make certain I’m helping them enjoy a good quality of life every day. However, I am deeply concerned that additional cuts to nursing homes may make it difficult for me to do this job that I love. These residents become like family, and I want to help protect and care for them.”

Reed said the informational campaign will proceed throughout the remainder of 2011 to draw attention to the fact local nursing homes and assisted living facilities are a critical part of the health care continuum, offering high-quality patient care and rehabilitation in a cost-effective manner. Long term and post-acute care facilities serve as a cornerstone of local communities’ employment base – reliably providing more than 178,000 jobs in Florida.

To view “Nurses,” please visit http://www.carenotcuts.org/.

CMS Issues Final Rule on Medicare Payments to Skilled Nursing Facilities

2011-08-01T13:07:00.000-07:00

Federal Agency Drastically Reduces Skilled Nursing Facility Payments

J. Emmett Reed, Executive Director of Florida Health Care Association (FHCA), issued the following statement in response to the release of the Skilled Nursing Facility Prospective Payment System final rule for FY 2012 by the Centers for Medicare & Medicaid Services (CMS):

“In its Final Rule, the Centers for Medicare and Medicaid Services will cause long term care facilities to see a significant reduction in Medicare funding for skilled nursing care of nearly $4 billion beginning October 1, 2011. Facilities in Florida are already experiencing a drastic $187.5 million cut to state Medicaid funding that went into effect July 1. The CMS reductions will threaten our facilities’ ability to continue delivering quality care to Florida’s seniors and puts thousands of long term care jobs at risk, particularly since Medicare funding helps to prop up Medicaid, which has historically underfunded nursing home care. FHCA will continue advocating on behalf of Florida’s long term care facilities in hopes that lawmakers at the state and federal level will see the importance of preserving much-needed funding so seniors can have access to quality long term care both today and in the future.”

Action Needed: Contact the White House and CMS Today to Protect Long Term Care Medicare Funding

2011-07-26T08:10:00.000-07:00

We are just days away from the Centers for Medicare and Medicaid Services (CMS) issuing the SNF PPS final rule. The current CMS rule states that reimbursement rates must be cut immediately by approximately 12.8 percent, or nearly $4.5 billion. This would negatively impact nursing facilities, the economic benefits they bring to communities and the care they provide to millions of older Americans. As Washington focuses on the debt, it is critical that we continue to draw attention to this issue. The White House and CMS are currently working through the final details; NOW is the time to weigh in with these offices. You can make a difference by sending a letter today.

Please show them that we care, and tell them that they must do the right thing. Help send a letter today by clicking here.

Florida Long Term Care Leaders Praise Reps. Buchanan, Castor, Miller, Nugent, Posey, Wilson and Young, along with Sen. Nelson, for Signing Key Letter to CMS

2011-07-01T10:36:00.000-07:00

Bipartisan letter calls for the rejection of proposed Medicare cuts that threaten jobs, access to skilled nursing care

On the heels of a media event addressing concerns over the state Medicaid nursing home funding cuts that take effect today, Florida Health Care Association (FHCA) praised Members of the Florida delegation, U.S. Reps. Vern Buchanan (R), Kathy Castor (D), Jeff Miller (R), Rich Nugent (R), Bill Posey (R), Frederica Wilson (D), and Bill Young (R) for their support of the bipartisan letter to the Centers for Medicare and Medicaid Services (CMS), as the federal health agency considers a proposal that would cut Medicare reimbursement to skilled nursing facilities immediately by 12.8 percent for Fiscal Year 2012. The Florida Representatives were seven of the 152 Representatives to sign onto the letter to CMS, which urges the agency to consider all of the appropriate data before adopting deep Medicare payment cuts to skilled nursing facilities. FHCA also praised Sen. Bill Nelson (D) for joining the effort by sending a similar letter to CMS.

“We thank these Members of Congress for carrying our voice in Washington and for their continued efforts to ensure the growing needs of our nation’s most vulnerable frail, elderly seniors and individuals with disabilities are protected,” said Emmett Reed, Executive Director of FHCA. “Medicaid and Medicare funding are inextricably linked, and their recognition of the potential devastation this proposal could inflict on Florida’s nursing facilities, as well as the quality of care they provide and the number of jobs they contribute, could make the difference in finding a more measured approach to their Medicare payment system.”

In an unprecedented move in late April, CMS proposed a drastic, immediate cut to the nation’s skilled nursing facilities by more than $4 billion. The agency’s proposal is based on less than one year of data when, historically, CMS bases decisions on a full year of data. If the proposal were adopted, nursing facilities would be forced to make significant operational changes, putting more than 100,000 jobs in multiple professions at risk.

FHCA and its national organization, the American Health Care Association (AHCA), are advocating that CMS slow down the process and follow its traditional practices of examining the entire data before implementing a reduction to nursing facilities. The associations aim to help CMS reach its goal of budget neutrality within the Medicare payment system, but through a more measured, targeted approach by dispersing the reduction over multiple years.

The bipartisan letter sent to CMS Administrator Donald Berwick, which is similar to the letter sent individually by Sen. Bill Nelson, was co-signed by Representatives Buchanan, Castor, Miller, Nugent, Posey, Wilson, and Young and states:

“Financial stability is critical to ensuring sustainable, quality long-term care for Medicare beneficiaries in nursing facilities. The men and women who work in these facilities, approximately 3.1 million Americans, are responsible for serving some of the frailest members of our society. We must ensure that the services they provide to Medicare beneficiaries are preserved.

“On behalf of our constituents who receive care in SNFs, we request the agency take a more measured approach and delay any proposed cuts pending a review of data from a full year. If, after reviewing additional data, CMS ultimately determines that comprehensive information supports the need to adjust payments to SNFs, then it should follow its common practice of implementing the reduction over a period of two or three years in order to reduce the potential impact on nursing facility services.”

Governor vetoes background screening legislation

2011-06-24T08:13:00.000-07:00

Yesterday, Governor Scott vetoed the Background Screening Bill (SB1992), saying in his veto letter that the state has an obligation to ensure that "these vulnerable members of our communities are protected, especially in their homes."

As a result of the Governor's veto, the new requirements under the legislation are void, including:
* Flexibility for an employer to fill a position before the employee has completed the screening process,
* The modified timeline for the Level II screening of persons, and
* The preclusion of CNAs from having to undergo duplicative background screenings for both employment and testing.

Facilities should refer to the original Agency for Health Care Administration letter on background screening requirements that went into effect August 1, 2010, which includes the timeline for screening requirements (requires Level 2 rescreening every 5 years. Health care providers have until July 31, 2015 to conduct Level 2 rescreening on current employees hired prior to August 1, 2010). These and other resources on background screening can be found under the Members Only Regulatory link under the Facility Operations tab of the FHCA website.

FHCA had convened a coalition of health care and other providers to identify recommended fixes to current background screening requirements and is disappointed by the Governor's veto of the legislation, which would have provided for a number of fixes to the current system. The bill contained several good provisions for FHCA members; however, the Governor was not in agreement with the portion of the bill which allowed volunteers to have contact with vulnerable persons and be exempt from the screening process. This provision was not a focus of FHCA’s advocacy efforts. The Governor has said he will issue an executive order retaining a portion of the bill that sets up an interagency workgroup to streamline background checks and share information, which is good news.

Ask your Representative to sign on to the Latham-Neal letter to CMS and protect LTC services for our nation's seniors

2011-06-02T09:44:00.000-07:00

Skilled nursing facilities are facing a potentially drastic Medicare funding cut under the CMS SNF Prospective Payment System proposed rule for FY 2012. Under the April 28th SNF PPS proposed rule for FY 2012, the Centers for Medicare and Medicaid Services offered two options. Under option one, FY 2012 Medicare payments to SNFs would be reduced by $3.94 billion or a total of 11.3% lower than FY 2011. Under option two, CMS would increase rates 1.5% in the Medicare market basket for an increase of $530 million in FY 2012. The unprecedented difference between the two proposed rules could put skilled nursing facilities and their residents at risk should the large cut be enacted.

U.S. Reps. Tom Latham (R-IA) and Richard Neal (D-MA) are circulating a bipartisan letter to CMS Administrator Dr. Donald Berwick urging the agency to delay an exceptionally high proposed Medicare payment cut to skilled nursing facilities that is based upon limited data.

Please click here to take action and ask your Representative to sign on to the Dear Colleague letter to CMS regarding proposed cuts to Medicare. We must ensure that our nation’s seniors continue to have access to the critical health care services provided by skilled nursing facilities. This request is time-sensitive; ask that Members sign on today.

Agency hosts public meetings on Medicaid Managed Care

2011-06-02T09:39:00.000-07:00

The Agency for Health Care Administration is holding public meetings across the state from June 10-17th on Medicaid Managed Care. The meetings will kick off in Tallahassee and will take place in a number of cities, including Ft. Lauderdale, Miami, Jacksonville, Orlando and Tampa, with the final meeting taking place in Ft. Myers.During the 2011 legislative session, lawmakers passed a major overhaul of the existing Medicaid program. AHCA is directed to submit any waiver it may need for the new Medicaid program to the federal government by August 1. Before the state submits a waiver it is required to hold the meetings and obtain public input. FHCA members can access a schedule of upcoming meeting dates and locations here.

Nursing homes will ‘fulfill the promise’ in spite of tough budget outcomes

2011-05-13T11:30:00.000-07:00

Guest editorial, Tallahassee Democrat, May 12, 2011
By J. Emmett Reed, CAE

This week is National Nursing Home Week, which is typically filled with celebrations to honor the staff, family members and volunteers who make a difference in the lives of our state’s nearly 71,000 nursing home residents. But with the sting of the 2011 legislative session still being felt across Florida, many celebrations will ring hollow as nursing homes look to cope with the Legislature’s $187.5 million funding cut that will come their way in July.

This year’s theme is “Fulfilling the Promise.” Ironically for the past three years, nursing homes have been asking lawmakers to keep their promise and protect the funding that is critical to resident quality care. Nursing homes have done their part to assist by contributing to the state’s General Revenue through the Nursing Home Quality Assessment, where they essentially tax themselves to draw down additional federal funds. Since tougher standards on nursing home staffing were put into place in 2001, long term care providers have gladly kept their end of the promise, hiring nearly 11,000 nurses and CNAs to provide that direct quality care to residents.

In the final days of session, AARP was highly critical of changes proposed by the Legislature to nursing home care, which everyone recognizes is among the nation’s best. More recently, they’ve also criticized legislators for reducing the amount of staff required in nursing homes which are the direct result of significant funding cuts. Nobody is happy with the budget cuts made by the Legislature to long term care. We would have preferred legislators maintain the funding and staffing requirements, and in fact over 400 long term care professionals descended upon the Capitol fighting budget cuts throughout the entire 60 day session. I am dismayed that AARP was not beside us opposing these cuts and in the very end, rose up in indignation against the reduced staffing that resulted from these cuts. Medicaid providers must be compensated to pay for the level of staff necessary to provide excellent care, and it is my hope all parties work constructively toward that goal.

The reality is that nursing homes, unfortunately, will find a way to do more with less. They will continue to operate efficiently while improving the quality of care and quality of life for their residents. With 70 percent of nursing homes costs paying for the people working in the facility, reducing pay or even staff will become a reality. Because of government limitations, valuable caregivers who work in nursing homes are paid less than they deserve, despite the physical and emotional challenges of caring for residents. Facilities will also struggle to continue the programs that offer quality of life, which is just as important as health care. Most will lack the ability to invest in improvements.

In a week designated to celebrate nursing homes, we will still recognize the vital role they play in our state’s health care system. Not only as a place for the frail elderly who cannot care for themselves, but as a cost-effective setting for patients with short term rehabilitative needs. But with Florida on the verge of a boom in the elderly population, this year’s National Nursing Home Week message is not one of celebration, but rather caution to legislators, AARP and other advocates – don’t abandon Florida's seniors. Nursing homes will continue to do their part to “Fulfill the Promise” and keep that commitment to delivering quality long term care for years to come, and we thank them for all they do to provide compassionate, quality health care to our frailest elders. But the state must keep its promise as well, and we hope as revenues begin to return to normal, legislators will stand up for our state’s seniors and restore funding for quality care to ensure they are able to live out their later years with dignity.

2011 Legislative Session: Medicaid Reform and Long Term Care

2011-05-13T11:27:00.000-07:00

In the final week leading up to the end of the 60-day session, legislators held closed negotiations before reaching an agreement on how to overhaul the state’s $22 billion Medicaid program. HBs 7107 and 7109 passed along mostly party lines, and FHCA is pleased to report that the final legislation includes most of the important long term care provisions that were developed by the Association’s Long Term Care Reform Task Force and adopted by the FHCA Board of Directors and Our Florida Promise Steering Committee. Below is an analysis of what's included in the final legislation:

Establishes the statewide, integrated managed care program for all covered Medicaid services, including long term care services.
AHCA shall begin implementation of the long term care managed care program by July 1, 2012 (required to provide notice of invitations to negotiate), with full implementation in all regions by October 1, 2013.
Medicaid recipients 65 years of age or older or eligible for Medicaid by reason of a disability and determined by the CARES Program to meet the requirements for nursing facility care are eligible.
All Medicaid recipients who are either residing in a nursing facility or enrolled in a Medicaid waiver program on the date long term care managed care plans become available in their region are automatically eligible to participate for up to 12 months without being re-evaluated for their need of nursing facility care.
Establishes eleven (11) regions with a minimum of two plans for each region.
Plans must offer network contracts to all nursing homes, hospices and aging network service providers that have previously participated in home and community-based waivers in their region for the initial period between October 1, 2013 and September 30, 2014. Plans may exclude providers after this period for failure to meet quality or performance criteria.
Nursing homes and hospices that are enrolled Medicaid providers must participate in all eligible plans selected in their region.
Plans shall monitor quality and performance of each participating provider using measures adopted by and collected by AHCA and any additional measures mutually agreed upon by the provider and the plan. (This provision should prevent duplicative surveys.)
Plans must pay nursing homes an amount equal to the nursing facility-specific payment rates set by AHCA; however, mutually acceptable higher rates may be negotiated for medically complex care.
For recipients residing in a nursing facility and receiving hospice services, the plan must pay the hospice provider a per diem rate set by AHCA minus the nursing facility component and shall pay the nursing facility the applicable state rate.
Plans must ensure that electronic nursing home and hospice claims that contain sufficient information for processing are paid within 10 business days after receipt.
AHCA must establish nursing facility specific payment rates for each licensed nursing home based on facility costs adjusted for inflation and other factors as authorized in the General Appropriations Act. Payments to long term care managed care plans shall be reconciled to reimburse actual payments to nursing facilities.
AHCA must establish hospice payment rates and payments to long term care managed care plans shall be reconciled to reimburse actual payments to hospices.
AHCA shall periodically adjust payment rates to the managed care plans to account for changes in the level of care for each managed care plan and shall make an incentive adjustment to encourage the increased use of home and community-based services. (Specific percentage adjustments are detailed in the bill until such time that no more than 35% of the plan’s enrollees are placed in institutional settings.)
By August 1, 2011, AHCA must establish the technical advisory workgroup to assist in the development of the long term care managed care program. The workgroup will address the following:

Method of determining Medicaid eligibility.
Method for managing Medicare coinsurance crossover claims.
Uniform requirements for claims submissions and payments, including electronic funds transfers and claims processing.
Process for enrollment of and payment for individuals pending determination of Medicaid eligibility.

Continues the Comprehensive Assessment and Review for Long Term Care Services (CARES) program. Allows for the contracting of any function of the CARES program.
Effective July 1, 2012, AHCA may not impose conditions or sanction on providers for failure to meet CON conditions related to minimum Medicaid occupancy.
Extends the CON moratorium on nursing home beds.

To read more about how long term care fared in the 2011 legislative session, click here to read FHCA's 2011 Legislative Session Wrap-Up Report.

2011 Legislative Session: Budget Wrap Up

2011-05-13T11:23:00.000-07:00

The budget (SB 2000) provides $2.727 billion for nursing home care which reflects a 6.5 percent cut ($187.5 million) to nursing home funding, which amounts to an average reduction of $288,932 annually per facility or $12.07 per Medicaid patient day. FHCA has developed documents estimating the impact of the 6.5 percent reduction, including facility-specific impacts by House and Senate district and summaries by county, which you can access by clicking here.

The budget does not eliminate nor modify bed hold policy and funding. Adult vision, hearing and dental services were fully funded. Also included in the budget are $26.1 million for the Assistive Care Services, $35.1 million for the Assisted Living Facility Waiver, $355.8 million for the Capitated Nursing Home Diversion Waiver and $14.3 million for the Program of All-Inclusive Care for the Elderly (PACE). Nursing home funding for case load growth was utilized to fund 1,000 additional Diversion Waiver slots, 1,250 additional Aging and Disabled Waiver slots and 275 additional PACE slots. And finally, there were no funding cuts to the Medically Needy and MEDS-AD programs.

The budget conforming bill (SB 2144) includes language that modifies staffing to lower the combined average weekly nursing and CNA staffing standard from 3.9 to 3.6 hours per patient day. The daily nursing standard of 1.0 hours per patient day remains unchanged, and the daily CNA staffing standard will be reduced from 2.7 to 2.5 hours per patient day.

The conforming bill also expands the Quality Assessment to the maximum federal allowance which will increase the total annual assessment from $349 million to $381 million, allowing most of the prior year rate cuts to be bought back.

To read more about how long term care fared in the 2011 legislative session, click here to read FHCA's 2011 Legislative Session Wrap-Up Report.

FHCA Provider Program

2011-05-06T12:34:00.000-07:00

Hear an update on long term care as the 2011 Legislative Session draws to a close.

State budget update: nursing homes will see 6.5 percent funding cut

2011-05-04T06:23:00.000-07:00

The House and Senate finalized the budget Tuesday. Nursing homes will see a 6.5 percent cut ($187.5 million) to Medicaid funding, which amounts to a reduction of $288,932 annually per facility or $12.07 per Medicaid patient day. The budget conforming bill is expected to include language to give providers some ability to offset these reductions with staffing flexibility to meet the needs of residents. With nearly 70 percent of nursing homes' operating costs paying for the people delivering resident quality care, facilities will have a difficult time recouping from this level of funding cut - forty percent of nursing homes statewide will begin operating with negative margins. Some facilities stand to lose as much as $1.2 million. FHCA has developed documents estimating the impact of the 6.5 percent funding cut, including facility details by House and Senate district and summaries by county, which you can access by clicking here.

With the close of the 2011 session just a few days away, FHCA is still working vigorously to advance tort reform as another means to help facilities reduce their costs. On Monday, the full House passed HB 661 by Reps. Matt Gaetz and Shawn Harrison. FHCA is still hopeful that the Senate companion, SB 1396, can be withdrawn from committee and voted on the Senate floor. Please continue with your calls and emails to Senators and ask them to support HB 661/SB 1396 with NO amendments. You can use the alert we’ve drafted to send the message by clicking here. Lawsuits do nothing to improve quality care, and every dollar not spent on litigation can be used for the health care needs of patients and residents.

Legislative Alert - Help Advance Nursing Home Tort Reform

2011-05-02T16:18:00.000-07:00

Email your Senator and ask them to support HB 661/SB 1396 to ensure precious Medicaid funding goes toward nursing home quality care and not lawsuits.

Today, nursing home tort reform moved a step closer as the full House passed HB 661 by Reps. Matt Gaetz and Shawn Harrison. PLEASE ACT NOW! Email your Senator and ask them to support HB 661/SB 1396 with NO amendments. Simply click here to use the message FHCA has developed or craft your own. We are in the final week of the legislative session and need to increase the number of voices speaking up for long term care to urge their support of nursing home tort reform. Lawsuits do nothing to improve quality resident care. Every dollar that is not used for lawsuits goes into the quality health care of our patients and residents. Thank you for taking action today and helping with this important issue.

The final countdown - budget and bills update

2011-05-02T08:09:00.000-07:00

Just one week remains in the 2011 legislative session, and final budget negotiations are expected to be finalized any day. If the Legislature is going to finish by Friday night, the final agreed-upon budget must be on lawmakers’ desks by Tuesday night to start the 72-hour waiting period before a vote can take place. Legislative leaders say they think they can finish “on time,” but haven’t said what time Tuesday they anticipate a final budget printing.

SB 1972, Medicaid Reform, is on the Senate Special Order calendar today; there is still no deal, but they are getting closer.

What happened last week . . .

On Wednesday, conferencing on the budget began and the House took an unfortunate position of cutting nursing home Medicaid funding by 8.5% ($245 million). Member action alerts were sent out asking for assistance with contacting key legislators in the budget decision-making process to urge them to reduce the nursing home funding cuts which threaten the financial viability of facilities and more importantly, resident quality care. Legislators must understand that cuts of this magnitude would result in facilities losing $377,831 annually, or $15.78 per patient day. Over the weekend, this issue was bumped to the Senate President and Speaker of the House.

Despite emotional testimony and debate, HB 661 by Reps. Matt Gaetz (R-4) and Shawn Harrison (R-60) passed favorably out of the House Health & Human Services Committee on Monday. On Friday, HB 661 rolled over to third reading after lawmakers debated the measure, with Democrats generally opposed to it and Republicans defending the measure. Several amendments that were offered by Rep. Mia Jones, D-Jacksonville to offer more protections to nursing home residents were rejected. The Senate companion, SB 1396, is still locked up in the Judiciary Committee, but FHCA is hopeful it will be withdrawn so the bill can move.

HB 119 (Rep. Matt Hudson, R-101), which contains important nursing home deregulation, passed in the House with a 106 yes/6 no vote. It is now in Senate messages. The Senate companion, SB 1736, is still in the Budget Committee, but the Senate President said bills in Budget can be heard on the floor.

On Wednesday, the Senate amended and approved SB 1992 by Sen. Ronda Storms (R-10) on background screening. The bill contains two amendments requested by FHCA to preclude CNAs from having to undergo duplicative background screenings for both employment and testing. In addition, the bill allows employers to hire persons prior to the screening completion if they will not be working with vulnerable adults. Finally, the bill creates an interagency work group designed to address problems of duplication and coordination among state agencies conducting background screening. SB 1992 passed its third reading on Thursday and now heads to the House, where its companion, HB 7233, awaits. We understand the House bill will be modified to reflect SB 1992 with no changes.

On Thursday, the full House passed HB 311 by Rep. Ken Roberson (R-71). This good bill eliminates municipalities' ability to impose an occupational licensure tax on certain employees, including your CNAs, working within business entities already paying the tax. The House has now sent the bill to the Senate. We are hopeful its companion, SB 582 by Sen. Nancy Detert, which has been waiting in the Senate Budget Committee, will now move.

FHCA will continue to keep you posted on the final outcome of the budget and the bills we're tracking. In the meantime, please continue contacting your legislators and ask them to reduce the nursing home funding cuts and support those bills that help preserve Medicaid funding needed to continue resident quality care. Click here to TAKE ACTION!

FHCA Provider Program - Live from the Capitol 4th Floor

2011-04-29T13:56:00.000-07:00

Hear a live update from Executive Director Emmett Reed on our long term care priorities - budget, tort reform, regulatory - along with member interviews.

URGENT ACTION NEEDED: Urge Your Legislators to Reduce the Nursing Home Funding Cuts

2011-04-28T06:06:00.000-07:00

Conferencing has begun on the budget and the House has taken a position of cutting nursing home Medicaid funding by 8.5% ($245 million). We need your immediate assistance with contacting key legislators in the budget decision-making process and asking them to reduce these nursing home funding cuts. Cuts of this magnitude would result in facilities losing $377,831 annually, or $15.78 per patient day. These cuts threaten the financial viability of our state's nursing homes and more importantly, resident quality care and vital caregiver jobs.

Please take action today:

Send an email to key legislators. You can use our Take Action link and email the message we've provided or write your own. Consider including the specific impact your facility will see from an 8.5% funding cut - click here for a detailed link with that information.

Forward the Take Action link to your staff and family members to help us increase their knowledge of the funding cuts at stake this session.

Post the alert on your Facebook page to perpetuate this message across your social media networks. We've made it simple -click here to post an update for your Facebook friends to see your call to action.

Tweet the message to your followers. You can click here and the message is ready for you to send.

Please take action today! Time is of the essence, as the budget will be finalized in the next few days. Thank you for helping us increase the number of voices speaking up for long term care.

Statement of the Florida Health Care Association on the Appointment of Jim Crochet as Florida’s Long Term Care Ombudsman

2011-04-27T08:18:00.000-07:00

The Florida Health Care Association commended the appointment of Jim Crochet as the Director of the Florida Long Term Care Ombudsman Program, citing his years’ of experience working with Florida’s long term care community and his understanding of the care needs of our state’s most vulnerable seniors.

“Speaking on behalf of those who provide quality long term care for current and future generations, we applaud Secretary Corley's appointment to lead the Florida Long Term Care Ombudsmen,” stated Emmett Reed, Executive Director of FHCA, Florida’s first and largest advocacy organization for long term care providers and the frail elders they serve. “Jim Crochet has a longstanding history of being accessible and fair when it comes to working with the long term care community. We look forward to working collaboratively with him and continuing our open dialogue with the Office of the Ombudsman to help ensure continued quality long term care for Florida’s aging population.”

FHCA Provider Program - Interview with Rep. Ken Roberson

2011-04-22T11:40:00.000-07:00

Hear an update on progress of several regulatory bills we're tracking, as well as an interview with Rep. Ken Roberson, R-Port Charlotte and Brynwood Center of Monticello CNAs.

Progress report on regulatory bills

2011-04-22T11:32:00.000-07:00

HB 119 by Rep. Matt Hudson (R-101), which contains important nursing home deregulations, passed its last committee of reference and is now available for the House floor calendar. As one of the few health care bills moving this session, we are very watchful that it does not become a vehicle for last minute amendments. The companion bill, SB 1736 by Sen. Jack Latvala (R-16), will be heard in its last committee, Senate Budget, on Tuesday.

HB 311 by Rep. Ken Roberson (R-71) also passed its last committee Thursday and is available for the House floor. This good bill eliminates municipalities' ability to impose an occupational licensure tax on certain employees, including your CNAs, working within business entities already paying the tax. Be sure to watch this week's Provider Program video update to catch an interview with Rep. Roberson on this important issue.

FHCA Provider Program - Week Six of the 2011 Session

2011-04-15T11:25:00.000-07:00

Hear an update on nursing home tort reform, FHCA Executive Director Emmett Reed interview with Sen. Thad Altman and Opis Management Resources employees' legislative experiences.

Federal News: Bipartisan Bill on Observation Stays Introduced in Both Houses

2011-04-14T11:31:00.000-07:00

Bipartisan legislation introduced in both Houses of Congress today would remedy the complex and confusing process resulting from observation status during a hospital stay. Introduced by Senators John Kerry (D-MA) and Olympia Snowe (R-ME) along with Representatives Joe Courtney (D-CT) and Tom Latham (R-IA), the Improving Access to Medicare Coverage Act of 2011 would rectify a confusing status that leaves seniors in a limbo land of healthcare delivery. The bill ensures that time spent under observation status in a hospital to count toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare.

Often patients are kept much longer than the prescribed limit for observation stays and are not informed of their admission status. In fact, from 2007-2009 the number of patients spending four or more days under observation status doubled.

Patients who need to enter a skilled nursing facility following an observation stay face the possibility that their care in the facility will not be covered by Medicare Part A because of the lack of hospital classification as an inpatient. This can result in patient confusion and the possibility of not receiving appropriate and necessary skilled nursing care. In some instances, patients arrive at a nursing facility, and because Medicare will not cover the benefit they are forced to pay out-of-pocket.

“There is a growing trend harming seniors who need critical skilled nursing care following a hospital stay that often leaves them in a no-mans land,” stated Governor Mark Parkinson, President and CEO of American Health Care Association, FHCA's national affiliate. “Sens. Kerry and Snowe and Reps. Courtney and Latham recognize this problem and how deep it runs, and we applaud their efforts ensuring that we can not ask the elderly and frail to pay with his or her health. The post-acute care profession is eager to work with our Congressional champions, hospitals, physicians and CMS to ensure that beneficiaries are not deprived of necessary and appropriate Medicare-covered post-acute care because of lengthy observation stays.”

Long Term Care Employees to Legislature: Medicaid Funding Cuts Put Jobs at Risk

2011-04-13T08:18:00.000-07:00

Impact on nursing home resident quality care, frontline jobs is topic of legislative visits

Over 75 long term care employees from Opis Management Resources, which operates 11 skilled nursing facilities in Florida, are meeting with their local legislators today to talk about the impact Medicaid funding cuts would have on caregiver jobs and resident quality care/quality of life. Nearly 50 percent of nursing home costs pay for legislatively-mandated direct care staffing, with Florida having one of the highest staffing ratios in the country. Those staffing mandates have resulted in the hiring of over 11,000 new nurses and Certified Nursing Assistants, and today, Florida’s nursing homes employ nearly 259,000 direct- and indirect-care workers. The proposed Medicaid funding cuts ($202 million in the House; $144 million in the Senate), however, would essentially eliminate an amount equal to the annual funding provided for the increased staffing mandates created 10 years ago through the passage of landmark elder care reform.

“Florida’s long term care community is well-positioned to be a significant driver of economic recovery and job creation. We owe it to the growing number of seniors who require quality long term care – and the jobs of frontline caregivers providing that care - to maintain stable Medicaid funding,” said Emmett Reed, Executive Director of the Florida Health Care Association (FHCA), the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “We understand the difficult decisions lawmakers face this session, but our first responsibility must be to protect precious Medicaid dollars for our most vulnerable seniors with no other safety net to cover their health care needs.”

A study conducted by researcher Eljay, LLC, projects that under the Legislature’s proposed cuts to Medicaid nursing home funding, over one-third of Florida’s facilities would experience negative margins, and nearly 50 percent of all facilities would have margins of less than 2.5 percent. A recent report by the Florida Health Care Association indicates that some facilities would lose as much as $1.2 million if the proposed budget cuts go into effect. Facilities which are already operating at a deficit when it comes to Medicaid residents will have no ability to recoup from these significant reductions, putting quality care for residents and vital caregiver jobs at risk.

Opis facility administrators, nurses and staff will also speak of other long term care services that would likely need to be eliminated, including resident activity programs, facility renovations or culture change improvements that model person-centered care. “Quality care in Florida’s nursing homes is good, and we want to keep it that way,” said Marilyn Wood, president of Opis Management Resources, and FHCA Executive Committee member. “Without critical funding, however, a secure and quality health care delivery system for Florida’s aging baby boomers is at risk.”

Over 400 long term care professionals have traveled to Tallahassee over the course of the 2011 legislative session to take part in FHCA’s Lobby Wednesdays. Opis skilled nursing facilities represented as part of this week’s grassroots initiative included Bayview Center and Ruleme Center (Eustis), Bridgeview Center and Coquina Center (Ormond Beach), Fairway Oaks Center (Tampa), Highlands Lake Center (Lakeland), Indian River Center (West Melbourne), Island Lake Center (Longwood), Riverwood Center (Jacksonville) and Tierra Pines Center (Largo).

FHCA Praises Senate Health Regulation Committee for Advancing Important Tort Reform

2011-04-12T17:21:00.000-07:00

Fresh off the heels of a New England Journal of Medicine study that shows litigation, or the threat of litigation, doesn't lead to improvements in patient care, the Florida Health Care Association today praised Sen. Rene Garcia (R-40), Chairman of the Senate Health Regulation Committee, and Sen. Ellyn Bodganoff (R-25), sponsor, for their leadership in moving forward on the Nursing Home Litigation Reform bill (SB 1396).

“This study shows that a facility's quality care does not deter the frequency of lawsuits, demonstrating the need for tort reform,” stated Emmett Reed, Executive Director of Florida Health Care Association, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “Lawsuits do nothing but improve the wealth of lawyers, demoralize staff and takes resources away from facilities providing good care.”

Prior to the passage of landmark elder care reform in 2001 (SB 1202), a torrent of litigation was draining precious taxpayer resources, demoralizing staff, pitting families against staff and increasing costs. SB 1202 mandated nursing home staffing increases and implemented tougher regulations, mandatory risk management and quality improvement programs, which together have resulted in quality care improvements in Florida’s nursing homes, which today have among the highest staffing ratios in the country. Nursing Home Litigation Reform will eliminate loopholes in that law to artificially inflate the costs of defending litigation and the value of claims brought against nursing homes by predatory trial attorneys.

“Every dollar that does not go toward lawsuits is directed toward patient care,” Reed continued. “We applaud Senators Garcia and Bogdanoff, and the members of the committee, for advancing this good bill and ensuring state and federal funding is used as it should be – on quality nursing home care for our state’s seniors.”

FHCA Provider Program - LTC Staff, Family Members on Capitol Experience

2011-04-08T12:33:00.000-07:00

Long term care staff and family members meet with lawmakers to discuss important LTC issues, including the quality care Florida's nursing homes deliver.

Update on workforce-related bills we're tracking

2011-04-08T11:50:00.000-07:00

The Senate Budget Subcommittee on Finance & Tax voted this week to advance SB 582 by Sen. Nancy Detert (R-23), an important bill FHCA has been working on this session. The bill will exempt certain employees working for business entities, like your CNAs, from being inappropriately taxed under certain municipalities' occupational tax requirements for licensed professionals.

The House Health and Human Services Committee discussed a proposed committee bill on background screening on Wednesday. The PCB was the substance of SB 1992, which fixes a problem created last year with screenings related to the volunteers who deliver Meals on Wheels. The committee adopted an amendment at FHCA’s request to allow CNA applicants to use previous background screening reports if done within the past 90 days. Peggy Rigsby of our staff testified in support of this amendment and three other issues related to background screening that we are working to fix on members' behalf. The House companion just received a number, HB 7233, and has been referred to the House Judiciary Committee.

We'll keep you updated as progress on these important bills continue.

FHCA Provider Program - House Committee Passes Important Nursing Home Tort Reform

2011-04-01T13:07:00.000-07:00

Hear from FHCA Executive Director Emmett Reed on important bills related to nursing home tort reform. FHCA President Nina Willingham and Lobby Wednesday sponsor Ponce De Leon Risk Retention Group speak about the importance of this grassroots initiative.

Florida Health Care Association Praises House Civil Justice Subcommittee for Addressing Tort Reform

2011-04-01T10:06:00.000-07:00

Reducing predatory lawsuit costs key to saving taxpayer money and enhancing senior care

Citing the importance of preserving precious Medicaid dollars used for nursing home resident quality care, the Florida Health Care Association today praised Representative Eric Eisnaugle(R-40), Chairman of the House Civil Justice Subcommittee, and Reps. Matt Gaetz (R-4) and Shawn Harrison (R-60), sponsors, for their leadership in moving forward on the Nursing Home Litigation Reform bill (HB 661).

“Due to the important role Medicaid plays in long term care funding, comprehensive tort reform allows everyone to win by reducing costs and enhancing quality of care,” stated Emmett Reed, Executive Director of Florida Health Care Association, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “Every dollar that does not go toward predatory lawsuit costs is used for the quality health care of our patients and residents.”

Prior to the passage of landmark elder care reform in 2001 (SB 1202), torrent litigation was draining precious taxpayer resources, demoralizing staff, pitting families against staff and increasing costs. SB 1202 mandated nursing home staffing increases and implemented tougher regulations, mandatory risk management and quality improvement programs, which together have resulted in quality care improvements in Florida’s nursing homes, which today have among the highest staffing ratios in the country. Nursing Home Litigation Reform will eliminate loopholes in that law to artificially inflate the costs of defending litigation and the value of claims brought against nursing homes by predatory trial attorneys.

“Lawsuits and litigation do not improve anything except the wealth of the lawyer bringing the lawsuit,” Reed continued. “We applaud Representatives Eisnaugle, Gaetz and Harrison, and the members of the committee, for advancing this good bill and ensuring state and federal funding is used as it should be – on quality nursing home care for our state’s seniors.”

Senior Caregivers Bring Message to Lawmakers: Protect Nursing Home Quality Care by Reducing Medicaid Cuts/Ensuring Tort Provisions in Medicaid Reform

2011-03-30T06:11:00.000-07:00

Nursing home administrators, nursing staff and other long term care professionals will descend on Florida’s Capitol today to ask lawmakers to reduce the Medicaid funding cuts to preserve quality care and protect caregiver jobs in Florida’s nursing homes. The current Medicaid funding cuts contained in the House ($201 million) and Senate ($144 million) budget proposals would result in over one-third of facilities experiencing negative operating margins, and 50 percent of facilities having profit margins of less than 2.5 percent. A recent report by the Florida Health Care Association indicates that some facilities would lose as much as $1.2 million if the proposed budget cuts go into effect.

“Nearly 70 percent of nursing home costs go to pay for the people delivering quality care in those facilities each day,” said Emmett Reed, Executive Director of the Florida Health Care Association (FHCA), the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “While we understand the looming budget deficit our state is facing, these proposals fail to think of our state’s most vulnerable seniors, as well as those vital caregivers employed by our state’s 600+ long term care facilities, who all stand to lose from cutting Medicaid funding for nursing home care.”

Additionally, as the House and Senate continue discussions on their Medicaid reform bills, long term care advocates are urging the Senate to support the tort provisions contained in SB 1972, the Senate Medicaid reform bill, which would eliminate loopholes in the law which allow predatory trial attorneys to artificially inflate the costs of defending litigation and the value of claims brought against nursing homes.

“Due to the important role Medicaid plays in long term care funding, comprehensive tort reform allows everyone to win by reducing costs and enhancing quality of care,” Reed continued. “Every dollar that does not go toward predatory lawsuit costs is used for the quality health care of our patients and residents.”

Over 100 representatives from Page Healthcare in Ft. Myers, Life Care Centers of America, which operates 21 skilled nursing facilities in Florida, Lavie Management Services, which manages 53 facilities, and FHCA’s Districts II, IV and V in the Orlando, St. Petersburg and Tampa Bay areas, respectively, were in Tallahassee as part of FHCA’s Lobby Wednesdays. Representatives from Signature HealthCARE also took part in this weekly grassroots initiative, which will bring over 400 long term care professionals to Tallahassee over the course of the 2011 legislative session.

FHCA Provider Program - Budget Update and Lobby Wednesday Highlights

2011-03-25T09:00:00.000-07:00

Hear from FHCA Executive Director Emmett Reed, who gives an update on the House/Senate Medicaid funding cuts; over 80 members in town to advocate for long term care.

Reports Analyze Impact of House/Senate Nursing Home Funding Cuts; Quality Care for Vulnerable Seniors at Risk

2011-03-24T07:35:00.000-07:00

The steady gains in nursing home quality improvement and the financial stability of Florida's nearly 700 nursing homes are at risk as Florida legislators discuss Medicaid funding cuts to nursing home care. Currently, the Senate has proposed a $144 million cut and the House a $202 million cut to nursing homes. Some counties will experience as much as $23 million in reductions as shown in the recent reports by the Florida Health Care Association, which outline by Senate and House districts the estimated nursing home rate reductions, including a county-by-county analysis and facility-specific impact.

“We understand the challenges our Legislature is facing as they work to address the state’s significant budget shortfall, but we simply cannot put nursing home quality care at risk,” said Emmett Reed, Executive Director of the Florida Health Care Association, the state’s first and largest advocacy organization for Florida long term care providers. “These cuts would also negatively impact caregiver jobs and limit future access to quality long term care services, putting at risk our state’s ability to position itself as a future retirement destination for aging baby boomers. We simply cannot make tough times even tougher for our state’s most vulnerable seniors.”

Nursing homes are extremely sensitive to Medicaid rate reductions, since nearly 60 percent of residents rely on Medicaid to cover the cost of their long term care services. Medicaid often fails to cover the actual cost of providing nursing home care, with facilities losing an average of $11.87 a day or just over $280,000 per year. The Legislature’s proposed cuts would result in over one-third of Florida’s facilities experiencing negative margins, and nearly 50% of all facilities would face margins of less than 2.5%. With the majority of Florida’s nursing homes mandated by a minimum Medicaid patient occupancy requirement, facilities which are already operating at a deficit when it comes to Medicaid residents will have no ability to recoup from these significant reductions.

Additionally, wages and employee benefits, as well as energy, fuel, property taxes and other fixed costs, have increased at rates greater than Medicaid reimbursement. The Legislature’s proposed cuts are compounded by the elimination of the normal inflationary increases for facilities. Furthermore, seventy percent (70%) of nursing home operating costs are attributed to people working in facilities – nurses, CNAs and others – which means lack of adequate funding could result in job losses, putting resident quality care at risk. “Nursing homes are already doing more with less,” said Reed. “If Medicaid funding is cut, staff layoffs may occur, which would mean less available hands to do the critical work of caring for residents.”

“We urge Florida legislators to make funding decisions based upon the need to protect elderly constituents’ care and preserve good paying local jobs,” said Reed. “Quality in Florida’s nursing homes is good, and we want to keep it that way.”

Advocates for long term care promote nursing home quality, protections needed in Medicaid reform to State Legislature

2011-03-23T06:32:00.000-07:00

Almost 100 long term care professionals from across Florida are in Tallahassee today to advocate for the preservation of nursing home quality care as lawmakers advance their Medicaid reform bills and budget proposals begin to unfold. Administrators, Nurses, Activity Coordinators and other direct care workers will discuss with lawmakers the importance of delaying the long term care implementation under the House managed care bill, which would allow time to ensure important protections are in place to preserve the steady improvements that have been made in delivering quality nursing home care over the past 10 years.

“Florida’s nursing homes are efficient and deliver quality care to the state’s most vulnerable seniors,” said Emmett Reed, Executive Director of the Florida Health Care Association (FHCA), the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “We cannot resolve the state’s budget challenges on the backs of Florida’s nursing home residents - our Greatest Generation - lest we limit access for seniors turning to Florida for quality long term care services in the future.”

These senior care advocates will also address the current proposed Medicaid funding cuts, which amount to $141 million in the Senate and $200 million in the House. With nearly 70 percent of nursing home operating costs directed toward staffing, reductions of this level put quality care at risk. Other important proposals under consideration include the importance of meaningful tort reform to saving taxpayer dollars and enhancing senior care, as well as streamlining regulations and eliminating conflicting demands on valuable front-line caregivers who are spending time on unnecessary and duplicative processes, while at the same time giving regulators more time to spend on meaningful reviews of provider services.

Representatives from Cypress Health Group, which manages 18 skilled nursing facilities in Florida, Activity Professionals from across the state, along with long term care professionals from FHCA’s Districts XIII in the Okeechobee/St. Lucie area, are in Tallahassee as part of FHCA’s Lobby Wednesdays. This weekly grassroots initiative will bring nearly 400 long term care professionals to Tallahassee over the course of the 2011 legislative session.

FHCA Provider Program - Week Two Update

2011-03-18T11:33:00.000-07:00

Hear from FHCA Executive Director Emmett Reed on the House Medicaid managed care bill, members in town to advocate for long term care and other important bills we're tracking.

Long term care advocates visit Capitol; ask Legislature to protect nursing home quality care

2011-03-16T06:19:00.001-07:00

Advocates for Florida’s long term care profession traveled to Florida’s Capitol today to urge lawmakers to protect nursing home quality care as they consider Medicaid reform proposals and prepare to release their legislative budgets. More than 75 nursing home caregivers from across the state met with their local legislators to share the message that nursing homes are efficient and provide quality care to people whose 24-hour medical needs don’t allow for them to safely receive that care in alternative settings. As the Legislature works to overhaul the Medicaid program, protections must be made to safeguard the more than 71,000 frail, vulnerable seniors receiving quality care in Florida’s nursing homes, 60 percent of who rely on Medicaid as their only safety net to cover their health care needs.

“It is critical for lawmakers to recognize the link between stable Medicaid funding and quality care,” said Emmett Reed, Executive Director of the Florida Health Care Association (FHCA), the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “As the state looks for ways to decrease health care costs, we cannot risk current and future access to quality care for our state’s most vulnerable seniors.”

Other important proposals under consideration include meaningful tort reform to ensure that precious state and federal funding is used for continuing the steady improvements to nursing home resident quality care rather than predatory lawsuits. Providers also discussed a number of bills which would streamline the regulatory process and eliminate conflicting demands on valuable front-line caregivers who are spending time on unnecessary and duplicative processes when their time is better spent at the residents’ bedsides.

Representatives from Gulf Coast Health Care, which manages 34 skilled nursing facilities and three assisted living facilities in Florida, the Pines of Sarasota and Consulate Health Care, which manages 21 skilled nursing facilities in the state, along with long term care professionals from FHCA’s Districts IX in the Jacksonville area, were in Tallahassee as part of FHCA’s Lobby Wednesdays. This weekly grassroots initiative will bring nearly 400 long term care professionals to Tallahassee over the course of the 2011 legislative session. For more information about FHCA Lobby Wednesdays and the Association’s 2011 legislative priorities, click here.

FHCA Provider Program - Week One of the 2011 Legislative Session

2011-03-11T13:03:00.000-08:00

Hear from FHCA Executive Director Emmett Reed on the issues providers will be facing this session and how you can become an advocate for long term care.

Workforce bill passes first committee

2011-03-08T16:57:00.000-08:00

Today was the opening day of the 2011 Legislative Session in Tallahassee, and already one of FHCA's priority bills easily passed through its first committee. HB 311 by Rep. Ken Roberson (R-Port Charlotte) helps clarify how cities should apply occupational taxes to persons who are employees of businesses that already pay the tax. This is an important issue for nursing homes, whose Certified Nursing Assistants, for example, could be subject to such a tax as the local level without this exemption, thus negatively impacting their ability to work and the facility's ability to maintain an adequate workforce.

Speakers against the bill represented local city and county governments who discussed the “loss of revenue” they will experience under such exemptions. Rep. Eric Eisnaugle (R-Orlando) pointed out during the discussion that, while it might be a loss for the city government, it is a boon to small businesses and the citizens of Florida. HB 311 and its senate companion, SB 582 by Sen. Nancy Detert (R-Venice), are a priority for FHCA, as these bills would exempt CNAs from being inappropriately taxed, ensuring these caregivers don’t become a “pay for” solution for our local government’s economic challenges. The bill now moves on to the House Finance and Tax Committee, while SB 582 is currently in the Senate Community Affairs Committee.

House Medicaid Reform Bill - Long Term Care Analysis

2011-03-08T06:15:00.000-08:00

On Friday, the House released two proposed committee bills establishing the Medicaid program as a statewide, integrated managed care program for all covered services, including long term care services. The proposal would be fully implemented by October 1, 2016. The long term care component of the plan would require implementation to begin by July 1, 2012 with full implementation by October 1, 2013.

PCB HHSC 11-01 creates a new section of law entitled “Medicaid Managed Care” which creates provisions for the Medicaid managed medical assistance program, the long term care managed care program, and the managed long term care for persons with developmental disabilities program. The agency is required to adopt any rules necessary to comply with or administer the program and to apply for and implement state plan amendments or waivers of federal laws and regulations necessary to implement the program.

Specifically, sections 409.978-409.985 is created to describe the long term care managed care program. As noted, the agency shall begin implementation of the statewide program by July 1, 2012, with full implementation by October 1, 2013. Medicaid recipients requiring nursing facility care as determined by the CARES Program and who are either 65 years of age or older or eligible for Medicaid by reason of disability are eligible for the program. All Medicaid recipients who are either residing in a nursing facility or enrolled in a Medicaid waiver program on the date long term care managed care plans become available in their region are automatically eligible to participate for up to 24 months without being re-evaluated for their need of nursing facility care. The bill further defines the benefits available under the program.

The state will be divided into seven regions and a specified number of qualified plans will be procured for each of the seven regions. Qualified plans may be managed care entities or long term care provider service networks (owned by health care providers) or entities qualified under 42 C.F.R. part 422 as Medicare Advantage Preferred Provider Organizations, Medicare Advantage Provider-sponsored Organizations, or Medicare Advantage Special Needs Plans. Selected plans must offer a network contract to all nursing homes, hospices, and aging network service providers in their region for the period between October 1, 2013 and September 30, 2014 after a qualified plan is selected, but may exclude the provider from the network after 12 months of active participation for failure to meet quality or performance criteria. Nursing homes and hospices are required to participate in all qualified plans in the region in which the provider is located.

Plans are required to monitor the quality and performance of each participating provider using measures adopted by and collected by the agency, but may use additional measures that are mutually agreed upon by the provider and the plan.

Plans are required to pay nursing homes an amount equal to the nursing facility-specific payment rates set by the agency, but are allowed to pay mutually acceptable higher rates that may be negotiated for medically complex care. Incentives are provided to Plans to reduce institutional placement and increase the utilization of home and community based services with a stated goal of achieving no more than 35 percent institutional placement.

The bill also establishes a long term care managed care technical advisory workgroup to assist in developing Medicaid eligibility criteria, provider payment requirements (methodology and prompt payment), uniform requirements for claims submission and payments, and Medicaid enrollment pending determination of Medicaid eligibility.

PCB HHSC 11-02 is contingent on the passage of PCB 10-03 and makes the statutory changes necessary to implement the managed care program. This bill eliminates the language that created Florida Senior Care, extends the CON moratorium for additional community nursing home beds until October 1, 2016 or until after Medicaid managed long term care is implemented statewide, whichever is earlier, and prevents the agency from considering or imposing conditions related to patient day Medicaid utilization in making certificate of need determination effective July 1, 2012. (This appears to be intended to relieve providers of current licensure conditions related to minimum Medicaid utilization, but would need to be amended to clarify.)

PCB HHSC 11-02 also deletes many sections of current statute upon the implementation of the statewide managed care program including the long term care community diversion pilot program.

State of Reimbursement: Stable Funding Critical for Future of Long Term Care

2011-03-07T07:33:00.000-08:00

Final series’ installment brings attention to the link between adequate Medicaid funding and nursing home quality care

On the eve of the opening of the 2011 Legislative Session, Florida Health Care Association’s (FHCA) final installment in its State of Long Term Care series sheds light on the importance of steady and stable funding for Medicaid and Medicare to preserve the ongoing improvements that have been made to nursing home residents’ quality care.

“When the 2011 Legislature opens tomorrow, lawmakers must understand that quality care and adequate Medicaid funding work hand-in-hand,” stated Emmett Reed Executive Director of FHCA, Florida’s first and largest advocacy organization for long term care providers and the frail elders they serve. “Every one of us has had a parent or grandparent who has needed care in a facility. Millions of Floridians are soon going to need these services. The funding systems must be prepared for that.”

The State of Reimbursement Fact Sheet demonstrates how nursing homes are extremely sensitive to Medicaid rate reductions, since nearly 60 percent of residents rely on Medicaid to cover the cost of their long term care services. Medicaid often fails to cover the actual cost of providing that care, with facilities losing an average of $11.87 a day or just over $280,000 a year. Furthermore, 70 percent of nursing home operating costs are attributed to people working in facilities – nurses, CNAs and others – which means lack of adequate funding could result in job losses, putting resident quality care at risk.

The State of Reimbursement Fact Sheet also points to the importance of the Nursing Home Quality Assessment, which was created in 2009 to help nursing home care avert devastating Medicaid funding cuts. The Assessment has brought in an additional $622.5 million in federal Medicaid funding and helped save the State of Florida $219 million in General Revenue in the 2010-2011 Fiscal Year.

The week-long State of Long Term Care series will bring awareness to Florida’s long term care demographics, Medicaid reimbursement challenges, the economic impact of the profession and the steady improvements that have been made in quality care. For more information, follow the series here or at:

• http://www.fhca.org/
• www.facebook.com/FloridaHealthCareAssociation
• www.twitter.com/FHCA
• http://www.fhcacapitolconnection.blogspot.com/

FHCA Provider Program - Legislative Committee Chair Deborah Franklin, "Stay Informed, Get Involved and Make a Difference"

2011-03-04T09:38:00.000-08:00

State of Our Workforce: Long Term Care A Significant Driver of Economic Recovery and Job Creation

2011-03-04T06:37:00.000-08:00

Profession ranks as Florida’s 14th largest employer; generates $20.2b in economic activity

Stressing the important contributions nursing homes make to Florida’s economic activity, Florida Health Care Association today issued the third installment of their informational State of Long Term Care series. Florida’s long term care industry generates $20.2 billion in economic activity and supports and creates over 259,250 private sector jobs, a recent study by the American Health Care Association found. Florida Health Care Association is urging lawmakers to protect Medicaid funding streams to ensure these facilities can continue to play an important role in economic recovery while carrying out their commitment to provide quality care to Florida’s more than 71,000 long term care residents.

“Florida’s long term care community is well-positioned to be a significant driver of economic recovery and job creation, and preserving its ongoing economic stability should be a key policy priority,” said Emmett Reed, Executive Director of FHCA, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve “Nursing homes are not only vital to the economic and employment base of urban, suburban and rural communities across Florida, they are increasingly important to the growing number of citizens who require quality long term care– and the millions more who will need it in the years ahead.”

Emphasizing that the demand for long term care will only increase – with 64 percent of Florida’s population by 2030 being seniors– the State of Long Term Care Workforce/Economic Impact Fact Sheet highlights the importance of stable Medicaid funding in supporting the health care needs of frail elders, 60 percent of who rely on Medicaid to cover the cost of their long term care services. With business lines stretching well beyond health care into transportation, food service, real estate and other sectors that keep the economy strong, Florida’s long term care facilities rank 14th in terms of largest overall employment.

The week-long State of Long Term Care series will bring awareness to Florida’s long term care demographics, Medicaid reimbursement challenges, the economic impact of the profession and the steady improvements that have been made in quality care.

For more information, follow the series here and at:

• http://www.fhca.org/
• www.facebook.com/FloridaHealthCareAssociation
• www.twitter.com/FHCA

The State of Quality: Nursing Home Quality Care Improving, Resident Satisfaction on the Rise

2011-03-03T06:22:00.000-08:00

Second installment in long term care series shows increased staffing, quality improvement programs are making the difference

Emphasizing the increased number of direct caregivers working to provide quality care and the milestones in resident and staff satisfaction, Florida Health Care Association (FHCA) today issued the second installment of their informational State of Long Term Care series in advance of the opening of the 2011 legislative session next week.

“Florida’s nursing homes continue to make steady improvements to quality care. That speaks directly to the strong state of our profession and our commitment to meeting residents’ needs every day,” said Emmett Reed, Executive Director of FHCA, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “The Legislature, however, must ensure stable, adequate nursing home funding so that, as Florida’s Baby Boomers continue to age, they can expect to receive the same level of quality long term care services when the need arises.”

The State of Quality Fact Sheet highlights the measureable improvement that has occurred in nursing homes in 16 of 26 quality indicators nationwide between 2000 and 2009. Additionally, since the introduction of Florida’s increased nurse staffing levels and other quality standards in 2001, average deficiencies per facility have decreased and measures of resident care outcomes have also improved. Those mandated increased staffing standards have resulted in the creation of over 11,000 new Certified Nursing Assistant and 700 new nursing positions since 2001.

Research has also shown that family and resident satisfaction has steadily improved as a result of facilities utilizing quality improvement programs more broadly, resulting in improved quality of life for residents. The adoption of Culture Change (also known as person-centered care) in facilities is also leading to higher resident and staff satisfaction and better workforce performance, both of which can lead to quality care improvements.

The week-long State of Long Term Care series will bring awareness to Florida’s long term care demographics, Medicaid reimbursement challenges, the economic impact of the profession and the steady improvements that have been made in quality care.

For more information, follow the series here and at:

• http://www.fhca.org/
• www.facebook.com/FloridaHealthCareAssociation
• www.twitter.com/FHCA

The State of Aging & Long Term Care: Today's Nursing Home Deliver Efficient, Quality Care to Residents With Complex Medical Needs

2011-03-02T06:25:00.000-08:00

First installment in long term care series shows State of Florida over-65 population to nursing home bed population is among lowest in nation

Underscoring the State of Florida’s ability to ensure those needing long term care services receive the most appropriate care in the least restrictive setting and nursing homes’ ability to effectively deliver that high quality care, Florida Health Care Association (FHCA) today issued the first installment of their informational State of Long Term Care series in advance of the opening of the 2011 legislative session next week.

“Florida’s nursing homes are a vital part of the long term care system; they provide good quality care for our state’s most vulnerable citizens,” said Emmett Reed, Executive Director of FHCA, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “As the Legislature looks to overhaul the Medicaid system this session, we must safeguard our seniors to ensure that reform does not undo the steady improvements that have been made to quality nursing home care over the past 10 years.”

The State of Aging and Long Term Care Fact Sheet demonstrates that Florida’s over-65 population to nursing home bed population is among the lowest in the country at 2 percent versus 3.5 percent nationally. The Fact Sheet profiles today’s long term care resident, noting these individuals need assistance with 4.2 activities of daily living. With nursing homes playing an important post-acute care role and discharging patients at a higher rate today than ever before, this leaves only one third of today’s nursing home residents as the “long term care resident.” Often these individuals have Alzheimer’s or related dementias which require 24-hour skilled care and oversight, and as a result they could not be safely cared for in an assisted living facility (ALF) or at home.

A recent study by the Florida State University Claude Pepper Data Center presented before the legislative committees charged with architecting Medicaid reform proposals found that the average Medicaid nursing home caseload has decreased from 47,059 in 2001 to 42,661 in 2010. The study raises important considerations related to Medicaid managed long term care, pointing out that the effort to transition nursing home residents back to the community have required assisted living facilities (ALF) to offer a wider range of care. It notes, however, 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.

The week-long State of Long Term Care series will bring awareness to Florida’s long term care demographics, Medicaid reimbursement challenges, the economic impact of the profession and the steady improvements that have been made in quality care.

For more information, follow the series here or at:

• http://www.fhca.org/
• www.facebook.com/FloridaHealthCareAssociation
• www.twitter.com/FHCA

State of Long Term Care Series

2011-03-01T06:19:00.000-08:00

Millions of Floridians Impacted by Decisions Made During 2011 Legislature Will Need Long Term Care
Signature series sheds light on the complex world of long term care

In advance of the 2011 legislative session, Florida Health Care Association today is launching an informational series on the State of Long Term Care to bring awareness to Florida’s long term care demographics, Medicaid reimbursement challenges, the economic impact of the profession and the steady improvements that have been made in quality care. Florida is the oldest state in the U.S. with over 4.4 million seniors and over half a million with Alzheimer’s or related dementias. By 2030, Florida’s population will grow by 5.1 million and 64 percent will be seniors. The needs for long term care will only increase.

“The millions of Floridians’ affected by decisions the 2011 Legislature will make will require long term care and services at some point in their lives,” stated Emmett Reed, Executive Director of FHCA, the state’s first and largest advocacy organization for long term care providers and the frail elders they serve. “It is critical that stable funding for nursing home care remains in place. 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 continue the steady improvements that have been made in nursing home care and to meet the demand for quality long term care services in the future.”

Throughout its week-long State of Long Term Care series, FHCA will highlight trends in several areas of long term care, beginning March 2 with The State of Aging and Long Term Care, and continuing with:

• The State of Quality - (March 3)
• The State of Our Workforce/Economic Impact - (March 4)
• The State of Reimbursement - (March 7)

For more information, follow the series here or at:

• http://www.fhca.org/
• www.facebook.com/FloridaHealthCareAssociation
• www.twitter.com/FHCA

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

2011-02-25T12:37:00.000-08:00

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

2011-02-25T06:53:00.000-08:00

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.

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

2011-02-23T16:00:00.000-08:00

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 http://www.safeguardourseniors.org/.

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 kknapp@fhca.org.

Medicaid reform should safeguard our seniors' quality nursing home care

2011-02-18T12:59:00.000-08:00

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

2011-02-18T12:07:00.000-08:00

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

2011-02-10T12:05:00.000-08:00

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

2011-02-10T11:54:00.000-08:00

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.

Legislative budget requests, Medicaid reform workshops on the agenda this week

2011-01-27T08:29:00.000-08:00

Legislators held a number of committee meetings this week, with FHCA staff and lobby team members up at the Capitol keeping apprised of any items related to long term care. During Tuesday's House Healthcare Appropriations meeting, state agencies were asked to review with legislators their priority list of budget cuts. AHCA presented their issues related to nursing home cuts, which included a freeze on nursing home rates and a rate cut that amounted to a total of $231.9 million. They also recommended reducing the number of paid bed hold days for hospitalization from eight to five.

The Agency for Health Care Administration's (AHCA) legislative budget request was developed late last year prior to the Governor's election. Gov. Scott has until February 7th to submit his budget to the Legislature, which may be different from the issues previously developed by AHCA.

On Tuesday, FHCA Treasurer Joe Mitchell testified before the House Health & Services Committee, which was conducting a workshop on Medicaid reform using a managed care system. Joe noted that nursing home enrollment is not the reason for growth in the Medicaid budget. In fact, the Medicaid nursing home line item is down from 19 percent in 2001 to less than 15 percent in 2009. He provided demographics about long term care residents in Florida, pointing out that a recent OPPAGA study found that just over 1.3 percent of elibible nursing home residents could actually be safely transitioned out of faciities and into a home and community-based setting. Rep. Schenck (R-44), chairman of the committee, indicated that it would be several years before the phase-in of long term care and that there would be additional opportunities to provide input.

FHCA encourages its members to continue meeting with lawmakers before they head to Tallahassee in March. Consider inviting them into your facility for a tour, meet with them at their district office or attend your local legislative delegation meetings. Building those relationships now will add to the success of your experience at FHCA's 2011 Lobby Wednesdays, which begin February 9th and run through April 13th. For more information about Lobby Wednesdays, visit the FHCA website.

Jobless loan adds more to lawmakers' budget challenges this session

2011-01-21T06:06:00.000-08:00

Last week's legislative committee meetings included an update on the newest projection for the state's budget shortfall, which is now estimated at $3.6 billion. Another problem the business community will face this year is the unemployment compensation fund deficit. Currently, Florida has borrowed over $2 billion from the federal government to pay unemployment compensation benefits. Unfortunately, this loan must be repaid. Employers can expect to receive notices regarding a special assessment sometime in February, which will likely total between $10.00 and $13.00 per employee. It must be collected by June 30, 2011, paid to the federal government no later than September 2011 and is retroactive to January 1, 2011. If, however, Congress chooses to extend the interest-free period on the loan, this assessment will likely be cancelled.
In addition to this, there is another retroactive assessment looming. In November, Florida will have its federal unemployment tax credit reduced by .3%, making the effective FUTA rate 1.1%, instead of .8%. Federal law requires that if a state has outstanding advances owed to the federal government (and as noted above, Florida owes the feds over $2 billion), the FUTA tax credit is reduced by .3% per year, until the advance is paid off. This loss of the FUTA credit is expected to be implemented in November, also retroactive to January 1, 2011. FHCA will continue to work with the business community on these important issues and will keep you updated as more information becomes available.

In the meantime, we encourage FHCA members to make plans to attend our January 28th Legislative Meetings & Webcast. This is going to be one of the most challenging sessions for long term care providers, and we’ll need everyone’s active participation in our grassroots advocacy. This event will help you stay informed on the most important issues that affect providers legislatively and will ensure we are all speaking with a strong, united and consistent voice.

Along with important updates on reimbursement, Medicaid reform, regulatory relief and tort reform, there will be a legislator at each of the 14 locations. This is an excellent opportunity for FHCA members to meet them and express your views on potential legislation that impacts your facility operations and resident quality care. Lawmakers want to hear from you, their local constituents, about the issues that affect them so they can best represent you in Tallahassee. The nominal registration fee includes lunch and 3 CEUs, but please be sure to register by midnight on Tuesday, January 25th, to guarantee your luncheon spot. Click here to register online or here to download the registration brochure.

Committees begin discussion on Medicaid reform timelines

2011-01-14T11:34:00.000-08:00

This week, legislators held a number of health care-related committee meetings, and FHCA staff and lobby team members were on hand to listen to presentations on the state budget, Medicaid, government operations, rule setting

Sen. Joe Negron (R-28), chairman of the Senate Budget Subcommittee on Health and Human Services Appropriations, kicked off his meeting on Wednesday telling audience members that there needs to be a transfer of priority in revenue from health and human services to education, criminal justice, transportation, economic development and other parts of the budget. The HHS Appropriations Committee is charged with developing a budget to help fund the state's $20.2 billion Medicaid program. The committee is also working on a Medicaid reform proposal, and Sen. Negron said he hopes to have a bill out in time for a February committee hearing.

Also during the meeting, the Florida Legislature's Office Of Program Policy Analysis And Government Accountability gave a report on nursing home residents and potential cost savings. The report found that a small percentage of people receiving nursing home services may have the potential to return to the community. OPPAGA's analysis of 53,026 people who received nursing home services in calendar year 2009 found that approximately 1.3 percent (or 713 people) had the potential to transition to community placements based on the MDS.

Sen. Negron noted that the report supports his position that nursing home residents cannot be safely moved to other settings. Sen. Don Gaetz (R-6) asked OPPAGA to restudy the Nursing Home Diversion program to determine if it is truly a substitute for nursing home care rather than just an added cost for the Medicaid program, since many people entering the Diversion program would not have actually gone into a nursing home.

Thursday, the House Health & Human Services Committee met, and Chairman Robert Schenk (R-44) said that his committee will use last year's House bill as a starting point for creating their Medicaid reform bill. Rep. Schenk stated that all Medicaid beneficiaries will be moved over to managed care, with long term care and developmental disabilities transitioned in over five years. Next week, the Committee will take public testimony, after which they will begin developing a committee bill. The subcommittees also plan to hold workshops on the bill.

With legislators beginning to lay out timelines for crafting their Medicaid reform proposals, now, more than ever, we need our members to register for FHCA's January 28th Legislative Meetings & Webcast, which will update you on the challenges facing long term care this session and help you learn how to effectively communicate our issues. The in-person portion of the event will include an opportunity to network with a local legislator and discuss effective grassroots advocacy with your long term care peers. Legislators confirmed to participate so far include Sen. Anitere Flores (R-Miami), Sen. Ellyn Bogdanoff (R-Ft. Lauderdale), Rep. Jim Frishe (R-St. Petersburg), Rep. Elizabeth Porter (R-Gainesville) and Rep. Marti Coley (R-Panama City). Click here to register online.

Culture change movement will enhance lives of nursing home residents - young and old

2011-01-11T05:44:00.000-08:00

Florida is the oldest state in the U.S., with over 4.4 million seniors and over half a million of them with Alzheimer’s or related dementias. Florida’s population will grow by 5.1 million by 2030 and 64 percent will be seniors. The needs for long term care will only increase. Nearly two-thirds of Americans over age 65 will require long term care at some point in time. This includes nursing home care, assisted living facility and home and community-based services.

Many believe that long term care services are for elders over 65. Actually, 40 percent of people currently receiving long term care services are adults younger than 65. This includes persons of all ages requiring 24-hour skilled nursing home care as indicated in the Associated Press story which ran on January 7, 2011 about the young man who residing at the Sarasota facility with other seniors.

The Culture Change movement being promoted within long term care is gaining momentum in changing traditional operations that focus on ensuring the safety of residents with rigid timelines, such as meal times at specified hours and only menus that are nutritionally sound and medically compliant, as well as overall regulatory compliance. The focus is changing to give nursing home residents greater control over their daily lives – such as when they want to be in their room, bathe, be woken up or other personalized activities. They have more choices in meal selections and other activities of daily living. Additionally, the front line workers who provide the bulk of the care are being given greater autonomy in caring for their assigned residents to encourage staffing consistencies and strong friendships with residents.

Many nursing homes having aging physical structures which have been renovated a number of times. Medicaid as the primary funding source of long term care is already being targeted for reductions across the states. Resources are not available to replace the majority of the traditional facilities. However, the Culture Change focus is on change from within. The purpose is to improve the quality of life of residents with more choices and more involvement in the day-to-day planning of their activities and their lives. It is called “person-centered care” and is for all ages.

As the state’s first and largest advocacy organization representing over 550 of Florida’s long term care facilities, Florida Health Care Association would like to reach out to our communities to become friends and supporters of our state’s nearly 71,000 nursing home residents, especially the younger persons being cared for 24 hours a day. The availability of volunteers to take residents on outings would enhance the day of many. Let’s work together in our move toward Culture Change, make a positive difference and enrich the lives of nursing home residents. Visit the consumer section of the FHCA website to find a nursing home in your area and become a volunteer.

J. Emmett Reed, CAE
FHCA Executive Director

Here we go...

2011-01-07T10:39:00.000-08:00

Tallahassee was bustling with inaugural activity this week as Governor Rick Scott, Chief Financial Officer Jeff Atwater, Attorney General Pam Bondi and Agriculture Commissioner Adam Putnam were sworn into office. During his inauguration speech, Gov. Scott's message focused on creating jobs through lower taxes, leaner government and a concerted economic development effort aimed at making it easier for companies to come to Florida.

Within an hour of taking the oath of office on Tuesday, Gov. Scott got to work by signing four executive orders. The governor's first order freezes rules and sets up an Office of Fiscal Accountability and Regulatory Reform to determine if existing and proposed rules have an effect on jobs. Other orders adopt a tougher ethics code, reaffirm a continuation of open government and a ban on hiring discrimination based on race, gender, creed, color or national origin. The orders cover agencies under the governor's control but not those he jointly oversees with the three-member Cabinet nor constitutional, legislative and judicial agencies.

Lawmakers also got to work this week, filing bills including HB 119 by Rep. Matt Hudson (R-101), which contains several important nursing home deregulations Provisions included in the bill are similar to those from Rep. Hudson's bill last year, which was vetoed by the Governor after a last-minute controversial ultrasound amendment was added.

FHCA encourages its members to continue meeting with lawmakers before they head to Tallahassee in March. Consider inviting them into your facility for a tour, meet with them at their district office or attend your local legislative delegation meetings. Building those relationships now will add to the success of your experience at FHCA's 2011 Lobby Wednesdays, which begin February 9th and run through April 13th. For more information about Lobby Wednesdays, visit the FHCA website.

U.S. Senate/House Pass RUG IV, Therapy Cap Fix

2010-12-09T11:51:00.000-08:00

Yesterday, the U.S. Senate passed the Medicare and Medicaid Extenders Act of 2010 (H.R. 4994), which fully implements the new Medicare payment system and extends the critical Medicare Part B therapy exceptions process. The bill repeals the RUG IV implementation delay to October 1, 2011 and extends the current therapy caps exceptions process until December 31, 2011, opening the door for patients to continue receiving critical physical, occupational, and speech-language therapies. Today, the House passed the measure, enabling it to be sent to the White House where the President is expected to sign the bill.

Bruce Yarwood, President and CEO of the American Health Care Association, FHCA's national affiliate, released this statement in conjunction with Alan G. Rosenbloom, President of the Alliance for Quality Nursing Home Care and Cynthia Morton, Executive Vice President of the National Association for the Support of Long Term Care.

“The long term and post-acute care community praises the House of Representatives for passing legislation that fully implements a new Medicare payment system and extends the critical Medicare Part B therapy exceptions process. Our profession now has the tools to ensure that in 2011 we can continue delivering the comprehensive, complex and medically necessary health services America’s seniors need and deserve.”

Years after Katrina, one federal program still misses the mark

2010-11-30T05:58:00.000-08:00

Today ends the 2010 hurricane season, and thankfully no major storms impacted Florida or the United States this year. It’s hard to believe, however, that five years ago, Hurricane Katrina pounded the shores of the Gulf Coast, leaving destruction and devastation in its path and forcing a record number of people out of their homes. While the massive storm revealed several shortcomings of the federal government’s disaster response, the restoring and rebuilding effort continues today. However, several disparities remain. One of these disparities affects Florida’s most vulnerable population — seniors and individuals with developmental disabilities.

One would assume that emergency federal aid is distributed to all those in need, without regard to the classification of their living environment. Sadly, this is not the case. Current federal law has long prohibited aid to nearly three-quarters of our nation’s post-acute care, long term care, and assisted living providers who care for some of the country’s most vulnerable citizens. This assistance, which is provided in accordance with the Stafford Act, is designed to address the immediate needs of those affected by a disaster, including evacuation, shelter, and nutrition. Unfortunately, it precludes access for for-profit long term care providers including “medical, rehabilitation, and temporary or permanent custodial care facilities… for the aged and disabled,” from accessing these resources.

Disasters like Hurricane Katrina wreak havoc indiscriminately, impacting individuals whether they live in a for-profit or not-for-profit facility. Florida’s nearly 700 long term care facilities must cope with the same results with limited physical, financial and human resources. Caring for individuals who are frail, elderly or have a disability can be challenging even under the best of circumstances. When disaster strikes, those challenges are magnified and limited resources only makes matters worse.

Just like not-for-profit providers, for-profit providers of long term and post acute care play a critical role in caring for Florida’s nearly 71,000 long term care residents. This is all the more important, given that Florida’s nursing and rehabilitation facilities have evolved to meet the special demands and needs of our aging population, including a greater focus on post-acute care. About 80 percent of Florida’s Medicaid recipients receive care in for-profit facilities. These residents have a number of special needs and require 24-hour care, 7 days a week. It’s important that their care is not interrupted by denial of access to critical aid during a disaster.

FHCA is confident that, despite such limitations, facilities have contingency plans in place to ensure critical health care services are continually provided during an emergency. In fact, since Hurricane Katrina, the Association has developed a number of resources to assist facilities with emergency preparedness, thanks to partnerships with such groups as the John A. Hartford Foundation, Florida Department of Health, University of South Florida and Florida Power & Light. These include the Emergency Management Guide for Nursing Homes and the accompanying software, the Nursing Home Incident Command System and other online resources which can be found on the FHCA website at http://www.fhca.org/.

Given Florida’s Medicaid budget and the more than $16 billion in federal Medicare cuts to skilled nursing care over the next decade, we do not have the same confidence about the economic stability, which is necessary for facilities to implement such plans.

While the Stafford Act shows good intent, it misses the mark in providing emergency disaster relief to all nursing facility patients. A bill sponsored by Representative Ron Paul (R-TX) would rectify this inherent disparity in federal law, ensuring all long term care providers have access to disaster relief funding when needed to protect vulnerable patients and residents during a disaster. We hope Congress will do its part to ensure that the mistakes of the past do not repeat in the future by passing this bill to ensure that all providers of long term and post acute care to Florida’s most vulnerable citizens have access to critical aid when they most need it.

FHCA presents the long term care perspective as lawmakers consider Medicaid reform

2010-11-18T11:42:00.000-08:00

This week, lawmakers convened for a special legislative session which focused primarily on overriding vetoes. The Legislature passed a Medicaid Memorial (SB 4A), which urges the Congress to amend Medicaid law and lays out guidelines for Medicaid reform that the Legislature will use during the 2011 session.

Yesterday, Sen. Joe Negron (R-28) hosted a committee meeting inviting representatives from long term care, hospitals, managed care groups, AARP and others to discuss the current Medicaid program and possibilities for reform. FHCA Treasurer Joe Mitchell testified on behalf of FHCA, providing an overview of our demographics, including the fact that since 2001, nursing home expenditures in the Medicaid budget have fallen from 19 percent to 15 percent, despite the growing aging population requiring long term care services.

He also provided them with an update of the work the Association has been doing over the past year in meeting with HMOs, including traveling to Arizona as well as researching other state's managed care programs and engaging in dialogue with a number of stakeholders across the long term care continuum. He reiterated the point that, as lawmakers move through this arduous process, the steady improvements to nursing home quality care cannot be jeopardized.

Much of the questions and discussion among lawmakers during the committee meeting were reflective of the messages that long term care providers have been sharing with them over the past year through ongoing meetings and facility tours. It was evident that they were well educated about the complex care and commitment to quality our members provide to the residents in your care. As plans for holiday activities begin for FHCA member facilities, we encourage you to keep inviting your local legislators into your buildings to keep up this momentum and strengthen those relationships which are vital to our long term care issues this session.

Fixes to SNF Medicare payment system and resolution to therapy cap funding are immediate needs for seniors and caregivers

2010-11-16T11:32:00.000-08:00

FHCA's national affiliate, American Health Care Association (AHCA), and the Alliance for Quality Nursing Home Care today urged the U.S. Congress to fully implement the new Medicare payment system for skilled nursing facilities (SNFs) in addition to extending the Medicare Part B therapy exceptions process.

“The groundwork for fully implementing the new RUG IV payment system has been laid,” said Bruce Yarwood, President & CEO of AHCA and Alan G. Rosenbloom, President of the Alliance. “There is no cost to this necessary change. We are almost there. Congress is too close to fail on this. So we urge congressional leaders to bring these two measures across the finish line in these final days so we can continue doing what we do best – delivering exceptional care to residents and patients.”

Failure to act, they added, would bring about “an operational nightmare for facilities,” and require the Centers for Medicare and Medicaid Services (CMS) to modify the payment system yet again, making payment policies even more uncertain. Acting to ensure patients and caregivers were protected in the face of sweeping modifications during unsettling economic times, in 2009 SNF providers sought a one-year delay in implementing two of three regulatory changes to the SNF Medicare Payment system. However, only one of the changes was delayed. The House has passed this technical fix, and there is unanimity among the SNF community, CMS and the Medicare Payment Advisory Committee (MedPAC) to address the matter. The Senate’s failure to act is the last remaining impediment to a resolution.

In addition, Yarwood and Rosenbloom said Congress must act by December 31, 2010 in regard to Medicare Part B therapy exceptions process, or Medicare patients will be limited in the amount of Part B physical, occupational, and speech-language therapies they are allowed to receive that helps restore them to their highest level of functioning.

"For skilled nursing facility patients, the December 31 deadline is critical, since the health care reform law only extends the exceptions process until that time,” continued the AHCA and Alliance leaders. “Congress must not allow its unfinished business to impede the ability of Medicare beneficiaries to access the professional therapy services they require to maximize their quality of life and functional independence.”

Legislators convene for special session

2010-11-16T11:29:00.000-08:00

Well, just like death and taxes, which never go away, neither does the Florida Legislature. Today, new and returning Senators and Representatives descended upon the Florida Capitol today for their official “swearing in” and for the special session. There are no health care issues that affect nursing homes or assisted living facilities on the agenda for today's special session, so we are just watching the day's events unfold. It is exciting as we see the new Freshman, especially Representative Shawn Harrison-one of our FHCA members - as they are sworn into office. This new class of legislators gives you the opportunity to educate them about long term care. Visit Online Sunshine and read about your local lawmaker, and if you have not done so, invite them out to your facility before March so they can learn about long term care and have you as their resource on these important issues in the upcoming legislative session.

House releases legislative calendar

2010-11-08T06:47:00.000-08:00

Now that the elections are over, the Florida Legislature is making plans for the upcoming weeks and the 2011 Session. The House of Representatives has released their schedule for committee meetings, and you can view the Online Sunshine page for a list of those dates. The Senate has not yet released their schedule, but traditionally their meetings coincide with the House.

The Online Sunshine page also has the new structure of the House committees. Chairmen have not yet been announced but that will be coming soon. Check back often to see the new releases coming out from the Senate as well.

This information will help you as you continue to invite legislators into your facilities for holiday events or other important occasions. This is the time to continue that effort before lawmakers come to Tallahassee for the beginning of the 2011 session on Tuesday, March 8th.

House and Senate Leaders Announce Special Session

2010-11-05T07:32:00.000-07:00

Incoming Senate President Mike Haridopolos (R-26) and House Speaker Dean Cannon (R-35) held a press briefing this week to announce a one-day special session on November 16th to override nine of Gov. Charlie Crist's vetoed bills from earlier this year. These nine bills, none of which impact long term care, passed with overwhelming support and were described as “good ideas” and “good public policy” by Speaker Cannon. The leaders said the Legislature would not consider more controversial vetoed bills, such as the teacher merit pay or ultrasounds for women seeking abortion, bills (The Ultrasound bill contains several nursing home regulatory reform issues supported by FHCA).

In addition to these bills, the Legislature will consider restoring only one budget item: a $9.7 million budget line item for Shands, the teaching hospital at the University of Florida. Governor Crist cut the appropriation, and several lawmakers have said restoring it was a top priority.

The leaders also stated that they will consider a resolution to Congress asking that Florida have more discretion in how the Medicaid program is run. They discussed that, during their state tour, they found many problems with Medicaid, including access, tort, quality and rules. They want to be able to provide more flexibility, which is currently getting blocked on a federal level by the Centers for Medicare & Medicaid Services (CMS). They want to take the “good parts” of the current Medicaid Pilot Program and make it statewide. They also want tort reform in Medicaid. They don’t want to change/create new policy when so much has already been done. Speaker Cannon said that they can’t afford to let people not be included in the plan. During the briefing, Rep. Denise Grimsley (R-77) was mentioned as the key person to develop a bill in this regard.

With respect to nursing home care, there are no plans to override the Governor’s veto of the Medicaid funding cuts or any bills impacting long term care. During the special session, legislators will craft a document to send to Congress that will serve as a roadmap for Medicaid reform efforts. No substantive Medicaid reform will occur in the special session, however.

The one-day special session will coincide with organizational session, November 16th.

2010 General Election Update

2010-11-05T07:20:00.000-07:00

The 2010 election results are in, and winners in key Florida cabinet races include: Rick Scott (R) for Governor; Pam Bondi (R) for Attorney General; Jeff Atwater (R) for Chief Financial Officer; and Adam Putnam (R) for Commissioner of Agriculture.
At the federal level, Marco Rubio (R) handily won the race for Florida's U.S. Senate seat. Florida Republicans picked up four seats in Congress, helping to shift the balance of power to a GOP-controlled U.S. House. Long term care providers lost a strong advocate, Cong. Ron Klein (D), in Fort Lauderdale. However, Cong. Kathy Castor (D), a strong supporter of our issues, was re-elected, and David Rivera (R), another supporter at the statewide level, will head to Washington to represent a Miami district in Congress.

In the Florida Legislature, FHCA Associate Member Shawn Harrison (R) was elected to represent House District 60, which is good news. Overall, the Republicans picked up two additional Senate seats, changing the current Senate makeup from 26 Republicans and 14 Democrats to 28 Republicans and 12 Democrats. On the House side, the current makeup of 76 Republicans and 44 Democrats will change to 81 Republicans and 39 Democrats. As a result, on both the House and Senate side, Democrats will not be able to procedurally block any efforts by the Republican leadership. In addition, Republicans will have a veto override majority if they stick together.

For the constitutional amendments, Amendment 4, Hometown Democracy, was defeated. This is good news for long term care providers as it would have led to an undue burden for nursing homes and other businesses seeking to expand their facilities. Voters decided to keep the class size requirement the same and rejected Amendment 8, as well as Amendment 1, while Amendments 2, 5 and 6 passed.

For a complete list of all the election results, click here.

Promote Voter Turnout; Protect Long Term Care

2010-09-16T12:21:00.000-07:00

By Deborah Franklin, FHCA Immediate Past President

Voting is one of the most important rights and duty we have as American citizens. I find no greater satisfaction then going into the voting booth and exercising my right to choose my representative government. Unfortunately, voter turnout is typically low. Some people choose not to vote because they do not like any of the candidates, some forget to make the time and some don’t vote because they are not even registered.

It is important that each of us take an active role in encouraging our staff, residents and their family members to vote in the November 2nd election. We need pro-long term care candidates in office who understand the important work we do in caring for our state’s frail elders, and voting is the single most effective way to make our long term care voices heard.

The Florida Division of Elections website has information for voters, including a link you can share to help your staff, residents and family members register online. The last day to register to vote in the November 2nd General Election is October 4th. Absentee ballots can be requested in person, by telephone, by mail or online via your local Supervisor of Elections offices, which can also be found via the Division of Elections website. The final day to request absentee ballots is October 27th.

As you know, we face many challenges our profession. Year after year, we are fighting to preserve Medicaid reimbursement to ensure our residents receive the quality care they expect and deserve. We are continuously working to educate lawmakers about the duplicative regulations we endure, many of which take your staff’s valuable time away from the residents’ bedside. By encouraging your staff, your residents and their family members to register to vote and go to the polls or mail in their ballot for this critical election, we can send a message that Florida and our nation needs leaders who will not abandon our state's seniors and the dedicated professionals who care for them each day.

Please help your residents exercise their right to vote and promote the importance of casting that vote among your residents, staff and family members. Our profession, your voice and the voice of those who work and are cared for in your facility depends on it.

House Passes FMAP Extension - Long Term Care Community Applauds

2010-08-10T14:42:00.000-07:00

Washington, DC - Bruce Yarwood, President and CEO of FHCA's national affiliate, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), and Alan Rosenbloom, President of the Alliance for Quality Nursing Home Care, issued the following statement today applauding House passage of an extension of the enhanced Medicaid Federal Medical Assistance Percentage (FMAP):

“The rare return of the House today speaks to the importance of protecting our nation’s seniors in nursing and assisted living facilities. More than anyone else, Speaker Pelosi understood the severity of the financial situation facing the states today and did the right thing for America’s frail and elderly.

“As soon as the bill becomes law, $16 billion in additional Medicaid funding will be in the hands of governors grappling with difficult state fiscal crises and many priorities. The individuals who rely on Medicaid for skilled nursing care have more medically-complex needs than ever before, and this immediate infusion of funds is vital to ensuring their needs can be met. This funding is critical to preserving resident choice and maintaining home-and community-based services options.

“We applaud the Congressional champions who took a stand and voted for this legislation – not just for taking the time to understand the complexities of the issue and the threat to seniors’ care – but also for actually doing something to address the problem.

“Our work is not done. In the coming weeks, AHCA, NCAL and the Alliance will now turn our efforts to the state houses, urging governors to remember those living in nursing and assisted living facilities, and the citizens who care for them every day. We urge the nation’s governors to do what is necessary, and do what is right, to safeguard those who have contributed so greatly to society and who now need our protection and care.”

U.S. Senate Approves FMAP Extension

2010-08-05T13:18:00.000-07:00

With the Senate approval today to extend emergency Medicaid relief (FMAP) until June 30, 2011, FHCA joined its national affiliate, the American Health Care Association (AHCA), and the Alliance for Quality Nursing Home Care in praising the vote and urging the House of Representatives to follow suit, saying the additional $16.1 billion in federal funding will help the nation’s most vulnerable seniors retain access to quality care, while protecting key frontline health jobs.

“We applaud the Senate for taking action to pass this vital Medicaid relief, and urge the House to follow in the same manner. Every day that passes without an extension of this funding, seniors’ care is placed in jeopardy, facility staffing stability is compromised, and good, local health jobs are put at risk,” said Bruce Yarwood, President and CEO of AHCA. “The time to act is now. Our governors have repeatedly expressed the desperate need for relief, and we ask Congress to act on this critical health care policy matter.”

“Senate passage of this legislation brings us one step closer to providing the vital funding needed to protect every senior’s access to the skilled nursing and rehabilitative care they require and deserve,” said Alan G. Rosenbloom, President of the Alliance. “We thank those Senators who took this stand for seniors and urge the House to follow with swift passage as well.”

Yarwood and Rosenbloom pointed out that adequate Medicaid funding is directly linked with skilled nursing care and local caregiver job stability throughout America. Without the extension of emergency Medicaid relief, pressure mounts on governors to further reduce Medicaid-financed care and services.

A strong bipartisan majority of governors are adamant about the need for immediate action, as the National Governors’ Association (NGA) recently noted, “Funding for FMAP is a particularly effective tool because it immediately allows Governors to eliminate planned budget cuts required to meet balanced budget requirements and continue services for those with the greatest need.”

“We urge state legislatures and governors to use this increased funding to ensure our nation’s seniors receive the funding necessary to provide high quality care as well as job stability for frontline caregivers,” concluded Yarwood and Rosenbloom.

This measure will now return to the House of Representatives, where it could be considered as early as September when Members return from the August work period.

Driving for Quality Care

2010-06-29T06:07:00.000-07:00

FHCA's national affiliate, American Health Care Association, is launching "Driving for Quality Care," a nationwide petition tour and grassroots initiative to urge the President, Congress and America’s Governors to take steps to preserve and protect America’s long term and rehabilitative care services.

Tomorrow, June 30th at 11:00 am Eastern, the inaugural event of the Driving for Quality Care tour will be held at the Methodist Home, in Washington, DC. The RV will then travel cross-country with approximately 60 media/grassroots events in 40 states, including Florida in late July.

Visit the Driving for Quality Care website today to learn more about the route of the RV Tour, sign the petition, send a letter to Members of Congress, follow the tour via the blog and Facebook and view the latest video of AHCA/NCAL President & CEO preparing to launch the RV.

FHCA Praises Governor Crist for Vetoing Nursing Home Funding Cuts

2010-05-28T13:04:00.000-07:00

FHCA is pleased to report that during today's signing of the $70-billion 2010-11 budget, Governor Charlie Crist vetoed the reduction to the Medicaid reimbursement rates paid to nursing home providers.

In a statement to the media, FHCA Executive Director J. Emmett Reed said:

"As you know, adequate Medicaid funding is directly linked with high care quality and staffing stability, particularly since nursing homes devote a full 70 percent of operating expenses to wages, benefits and other labor costs. For the nearly 71,000 vulnerable frail, elders and Floridians with disabilities who depend upon on long term care and services, this veto represents the kind of help that is needed to protect their quality care and to preserve the jobs of the dedicated front line staff who are working to improve the quality of life for those entrusted to their care."

We applaud Governor Crist for his action to preserve much-needed Medicaid funding for nursing home care.

To read the press release about the Governor's budget signing, which includes the funding cut veto, click here.

Action needed now to ensure FMAP & RUG IV fix are included in “extender package”

2010-05-28T05:53:00.000-07:00

The future of the “extenders package” with a six-month extension of enhanced FMAP funds and elimination of the delay in RUG IV implementation is uncertain at this time. FHCA needs you to weigh in with House leadership and the House Blue Dogs (including FL Congressman Allen Boyd) to apply the pressure needed to ensure inclusion of these key provisions in a final package.

Congressional sources and the media are widely reporting that because of concerns over the cost of the extenders package which contains a limited “Doc fix,” the current version of the legislation has eliminated the FMAP extension. It is unclear whether the elimination of the RUG IV delay is included.

The inclusion of an FMAP extension is critical to helping Florida nursing homes avert significant Medicaid funding cuts, so please take a few moments TODAY to click on our Legislative Action Center and contact your members of Congress – especially leadership and Blue Dogs – and reinforce the need to include the six-month FMAP extension through June 30, 2011 and RUG IV October 2010 implementation in any final extenders package.

Extenders Package Addresses FMAP, RUG-IV, and Physician Fee Schedule

2010-05-21T08:01:00.000-07:00

Yesterday, the House and Senate reached agreement on the “extenders package” known as the American Jobs and Closing Tax Loopholes Act (H.R. 4213). The House will take up the bill early next week with the Senate to follow later in the week. FHCA is pleased to report that H.R. 4213 addresses three key issues for long term and post acute care: FMAP, elimination of the RUG-IV delay, and the physician fee schedule fix.

On FMAP, H.R. 4213 will extend the temporary Medicaid increase provided by the American Recovery and Reinvestment Act of 2009 for an additional 6 months December 31, 2010 through June 30, 2011. FHCA, its national affiliate American Health Care Association and a diverse group of provider and patient organizations have been pushing for this extension for several months through a variety of means.

Ongoing advocacy efforts on Capitol Hill also helped to eliminate the implementation delay of RUG-IV to October 1, 2011, which was contained in the Patient Protection and Affordable Care Act (PPACA). This ensures that RUG-IV and MDS 3.0 will be implemented together on October 1, 2010.

On the doc fix, a three year patch is included. The legislation will provide a 1.3% update effective June 1, 2010 and an additional 1.0% update on January 1, 2011. From 2012-2013, annual updates will be the two target methods contained in the Medicare Physician Payment Reform Act of 2009 although updates for both service categories cannot be negative in either of those years. During this period, physicians in Accountable Care Organizations may elect to establish ACO-specific spending targets in lieu of national spending targets. Following 2013, rates return to levels determined by the current Sustainable Growth Rate system.

FHCA still needs your help with urging your Members of Congress to support the American Jobs and Closing Tax Loopholes Act which contains the extension of the FMAP increase until June 30, 2011 and a provision to repeal the delay of RUGs IV allowing it to go into effect on October 1, 2010. Florida long term care providers need Congress to take swift action and vote on this issue before the Memorial Day holiday to help avert nearly $200 million in Medicaid funding cuts. Please click here to send -mails TODAY to your Members of Congress asking that they vote for this important legislation.

Urge Congress to Act Before Memorial Day to Pass the 6-Month FMAP Extension

2010-05-17T06:06:00.000-07:00

FHCA needs YOUR help today! It is critical that you contact Congress NOW and ask them vote before Memorial Day for the six-month extension of the temporary increase in the Federal Medical Assistance Percentages (FMAP).

Unless Congress acts soon, the current FMAP increase will EXPIRE on December 31, 2010. How Florida nursing homes fare in the state budget passed by our Legislature this session greatly depends on Congress' action. The increased funding from the FMAP six-month extension, along with the Nursing Home Quality Assessment, will allow providers to buy back the Medicaid rate cuts currently included in the state budget. Without this additional federal support, Florida long term care providers face a $199.5 million Medicaid funding cut, which would jeopardize care for our state's nearly 71,000 frail elders in nursing homes.

If Congress fails to pass the FMAP extension by June 30, 2010, nursing homes will experience a 7% Medicaid funding cut and suffer an average $9.00 per patient day rate cut effective July 1, 2010. However, the passage of the extended FMAP funding, in conjunction with the provider assessment, will ensure provider Medicaid rates are NOT REDUCED.

Please click here and contact your U.S. Representative and Senator today! You can use our pre-printed message or craft your own.

Time is of the essence, so please Take Action today! Ask Congress to act before Memorial Day and vote for the six-month extension of the enhanced FMAP funding.

FHCA 2010 Legislative Wrap-up

2010-05-05T06:59:00.000-07:00

Friday marked the end of the 2010 legislative session, when lawmakers approved the 2010-11 budget and voted on a number of bills we've been monitoring on your behalf. Below is a wrap-up of how long term care providers fared this session:

Protecting Nursing Home Funding

Prior to the start of the 2010 session, the state agencies' original budget exercises included a 10 percent cut to nursing homes' Medicaid reimbursement rates. When the session began and initial budgets were developed, the Senate proposed a 7 percent cut, while the House proposed a 4.5 percent cut to nursing home funding. The final 2010-11 budget approved by legislators contains a reduction from the original 7 percent funding cut to a lower, 5 percent cut, contingent upon Congress passing the extension of the enhanced FMAP. The budget does include language that will allow providers to buy the entire rate cut back using an expanded Nursing Home Quality Assessment, as long as Congress releases the FMAP funding.

It also includes a number of other items that were successfully advocated by FHCA, including a permanent fix to the lease bond which suspends annual payments as long as $25 million remains in the trust fund. It also establishes a total combined weekly average direct care staffing requirement of 3.9 hours per resident per day while maintaining the daily staffing minimums of 1.0 hours of direct licensed nursing staff and 2.7 hours of direct CNA staff, giving providers flexibility with their staffing needs.

We have heard media reports, however, that Governor Crist may veto the budget, in particular due to the nursing home funding cuts that are included. All of us will be watching to see what happens once the budget hits the Governor's desk, and FHCA will update members as we learn more.

Additionally, FHCA will begin turning its attention to Washington, DC, to advocate for Congress' passage of the FMAP extension. Next week, FHCA will be working with the American Health Care Association to coordinate a legislative fly-in to Washington, DC, for our Florida members, so stay tuned for more details on this. Additionally, if you haven't signed up for American Health Care Association's Congressional Briefing (June 8-9th), you may want to consider joining us to help relay this important message to Florida's Congressional delegation face-to-face. We'll also be asking your help with sending an e-mail to your Congressman, so be on the lookout for that alert soon.

Streamlining the Regulatory Process

HB 1143, the deregulation bill for which FHCA has been vigorously advocating on your behalf, passed on Friday despite a controversial "Ultrasound Amendment" that was added in the last 48 hours. We don't know whether or not the Governor will sign the bill as a result of the added amendment; however, we do know the bill still contains those important provisions we've been working on which help reduce duplicative inspections and requirements for long term care providers. These include giving AHCA more flexibility in conducting follow-up surveys by desk review, reducing duplicative inspections by Fire Marshals and the Department of Health and eliminating monthly reporting of liability claims. FHCA will keep you updated once we learn of the Governor's action on this bill.

Managed Care

Both the House and Senate's proposals to expand managed care failed this year. As we had reported, the House had developed a more comprehensive proposal to overhaul the Medicaid system, which included moving all Medicaid recipients into managed care over the next five years (with seniors requiring long term care services enrolled by 2015). Although these bills failed, the House had incorporated several provisions supported by FHCA which included multiple safeguards for nursing home residents who depend on Medicaid to cover the cost of their care. We can expect this will be a priority for 2011, so the onus will be on all of us to continue educating lawmakers about the complexities of the long term care system so they have a better understanding when this issue surfaces next year.

Strengthening Resident Protections

Background screening legislation (HB 7069) passed and is on its way to the Governor's desk for signature. Originally developed as extremely onerous to long term care providers, the final legislation contained multiple amendments with language suggested by FHCA that makes these requirements more acceptable. The bill establishes that all employees or contractors who provide personal care and employees with access to resident living areas or residents' property must have the Level 2 FBI check completed before they can begin work. The requirement applies to new employees as of August 1, 2010, and current employees must be screened by June 30, 2015. We expect the Governor will sign this bill, and FHCA will provide more information once it becomes available.

Preventing Harmful Legislation

Even before the legislative session began, FHCA was advocating to prevent harmful legislation from seeing the light of day. A proposal by SEIU would have added new reporting requirements for nursing homes, which would have been beneficial for trial lawyers attempting to sue other parties in nursing home claims. After discussions with FHCA representatives, potential sponsors decided not to introduce the bill.

We also told you about a diversion provider who introduced a proposal that would “save the state 1.2 billion” by moving intermediate-care level residents (and the funding from the nursing home line item) out of nursing homes and into the least cost-effective home and community-based program. FHCA and its advocacy partner, Our Florida Promise (OFP), mounted a campaign to educate lawmakers and the public at large about the medical complexities of today’s nursing home residents and how such a proposal would have risked their well-being and eliminated patient choice. Legislators agreed, and when the initial budget was developed, no new slots for diversion were included. Additional funding was provided for other more cost-effective home and community-based programs.

SB 752, the Medicaid Fraud bill, passed the Senate with amendments included that would minimize any potential negative impact to nursing home providers; however, the bill died in the House. SB 2272, the "Pill Mill Bill," originally included language which put a 72-hour limit on the prescribing of controlled substances. After FHCA staff and lobby team members held several meetings with lawmakers, this language was amended out of the bill. SB 2678, which modifies the definition of mental illness to exclude head injury and dementia and would change the law regarding who can be referred for treatment under the Baker Act, was withdrawn.

SB 2034, which would effectively have ended the use and enforcement of pre-dispute arbitration agreements in health care settings by allowing the agreement to be rescinded at any time, was never heard in committee. This is a result of a coordinated effort among the leadership of FHCA/OFP, FHCA members, staff and lobby team sharing a unified message about the importance of arbitration clauses in long term care settings, which ensure that scarce resources go toward improving resident care rather than escalating costs associated with lawsuits.

Other bills of interest to members that were not passed by the 2010 Legislature include SB 1102 and HB 817, which created a new set of transfer/discharge requirements for Assisted Living Facilities. Patterned after the nursing home requirements, these bills would have created an excessive regulatory environment for ALFs.

Other Tracked Bills

Prior to the session, FHCA reported on legislation filed (SB 656/HB 529) which would have created an exemption from the public records law for identifying information regarding the Long Term Care Ombudsman. Both bills stalled early on in session, as public records bills are usually reserved for those public officials who could be put in positions of grave public danger.

The 2010 session began with Florida Legislators unanimously passing and the Governor signing shortly thereafter HB 7033, which provides Florida employers with immediate relief from unprecedented unemployment compensation tax increases that they were facing this year. Among other things, the bill reduces the amount of each employee’s wages upon which the employer pays the Unemployment Compensation tax – from $8,500 back down to $7,000 for 2010 and 2011, and establishes a quarterly payment plan for 2010 and 2011 that lets employers spread out their unemployment compensation payments over the whole year without normal application of penalties or interest.

HB 945, which requires Automated External Defibrillators to be placed in Assisted Living Facilities, passed; however, this will not become effective until July 1, 2011.

You can read about all the bills we tracked and their outcomes by downloading our complete legislative tracking list here.

Provider Program Legislative Scorecard

If you want to watch the final hours of the 2010 legislative session unfold, be sure to click here to view our final Provider Program so you can hear reports from FHCA President Deborah Franklin, staff and lobby team members on how we fared this year in regards to the budget and other issues.

FHCA will be compiling our new 2010 Legislative Scorecard in the coming weeks to measure lawmaker’s support for the Association’s priorities. Their votes on the issues that impact our profession will be calculated on a five-star rating scale, just as you are rated on the quality care outcomes you provide to your residents. Each FHCA member, along with all Florida lawmakers, will receive a copy of the 2010 Legislative Scorecard very soon.

Thank You

Throughout the entire 60-day session, the commitment of FHCA membes to advocate on behalf of your residents, your staff and your profession truly helped us succeed in reducing the level of funding cuts as well as preventing harmful legislation from surfacing. Whether you traveled to Tallahassee for a Lobby Wednesday, assisted with our media outreach, or called or e-mailed a legislator from back home, you helped make a difference and ensured FHCA spoke with a strong, far-reaching message showing that Florida's long term care providers are united and will do what it takes to preserve quality care for Florida's frail elders.

Crist budget veto?

2010-04-29T09:44:00.000-07:00

As reported by Gary Fineout, The Current

Speculation mounts that Crist could veto budget

Gov. Charlie Crist’s emerging independence streak has some legislators wondering whether or not the governor plans to veto the nearly $70.4 billion state budget that lawmakers will approve on Friday.

Crist would not render a verdict, saying he had not yet been briefed on what had been included in the budget.

“I honestly don’t know at this point,’’ said Crist.

Saunders added that Crist would have valid reasons for the veto, ranging from the decision to raid the state’s road-building fund to cuts in funding for nursing homes.

Read more

The Drama Continues

2010-04-29T09:36:00.000-07:00

As Reported by Gary Fineout for The Current

The unfolding controversy over abortion has caused the Florida House to shut down on Thursday morning. House Democrats told Republican leaders that they would not go along with normal procedural moves to speed along consideration of bills unless House leaders agreed to not take up HB 1143. Under rules it takes a two-thirds vote to take up a bill and message and roll it to final passage. There are 44 Democrats in the 120-member House.

The procedural move prompted the House to recess shortly after it began work.
The Florida Senate on Wednesday tagged on several controversial amendments to the bill including a limit on tax deductions for employer health insurance plans that include coverage for abortions and requiring women seeking abortions to have ultrasounds. The Senate has not yet passed the bill and sent it back to the House, but the decision to add the provisions to HB 1143 caused a highly charged debate on the Senate floor that lasted more than two hours.

Deregulation Bill Dilemma

2010-04-28T18:21:00.000-07:00

HB 1143 by Representative Matt Hudson, the deregulation bill FHCA has been working on for months, had passed the House as we've previously reported. Today, its companion (SB 2434) was on the calendar in the Senate. When it came up, Senator Andy Gardiner accepted the House bill, and President Jeff Atwater moved into the amendatory process. That's when things got interesting.

A controversial amendment on blood banking by Senator Don Gaetz was added to the bill against the request of the sponsor (the House has previously said this language is not acceptable). Senator Gardiner then proceeded to add a controversial abortion amendment to the bill, and after nearly two hours of debate, the amendment passed. Immediately following, two other abortion-related items were amended on the bill. Suddenly, this deregulatory bill became the hottest topic of discussion on the fourth floor of the Capitol.

Will the Senate take off the blood banking language Thursday on third reading? Will the House kill the bill if it comes over with that language included? Does the House support the abortion language? What will Governor Crist do if the bill makes it to his desk? Suddenly nursing homes' deregulation issues are caught up in the middle of the pro choice/pro life debate. Who would have thought we'd see such a dilemma?

Stay tuned for more on Thursday, or watch it for yourself by visiting Online Sunshine at http://www.leg.state.fl.us/.

Sponsors say Fla. Medicaid overhaul dead for 2010

2010-04-26T07:17:00.000-07:00

The Associated Press

Published: Sunday, April 25, 2010 at 11:04 p.m.
Last Modified: Sunday, April 25, 2010 at 11:04 p.m.
( page of 3 )

TALLAHASSEE, Fla. — Sponsors of a massive House plan to overhaul Florida's Medicaid system on Sunday declared it dead for this year but said they'll try again in 2011. Click here to read more.

Regulatory bills update

2010-04-20T13:57:00.000-07:00

I know some of you might not believe this, but regulation can be exciting! And, deregulation even more so. FHCA was anticipating that HB 1143 by Rep. Matt Hudson would be heard on the House floor today. You may recall this is the AHCA deregulation bill, which has important provisions that eliminate duplicative inspections and paperwork for providers.

The bill was on the special order calendar, but rumors started early and when the Speaker came to the bill, it was temporarily postponed. It took some time to figure out what was going on, but late this afternoon we were assured by Rep. Hudson that although there are lots of health care amendments being filed on the bill, it is still in play. We hope it will come up for House passage soon and will continue to watch this and keep members up-to-date.

On the Senate side, the companion SB 2434 was on the agenda in Senate Ways and Means Committee and had EIGHT amendments filed on it. One amendment was added at FHCA’s request to place pediatric staffing standards in statute rather than rule, and it was the first one taken up by the committee. After it passed, all other amendments were objected to by Senator Gardiner and were withdrawn. This is good news as it makes the Senate bill much closer to the House version.
We are finally getting closer, so stay tuned for more to follow.

By Peggy Rigsby, FHCA Director of Government Services

Urge Legislators to Prevent Funding Cuts to Nursing Home Care

2010-04-20T10:16:00.000-07:00

Today we learned that the House has accepted the Florida Senate's proposed 7% ($200 million) funding cut to nursing home care. We need your help today with contacting your legislators and urging them to prevent these deep nursing home funding cuts as they prepare to finalize the 2010-11 budget. We still expect Congress to pass the six-month extension of the Federal Medical Assistance Percentage, and legislators should use that anticipated FMAP money to alleviate these deep cuts to nursing home care.

Help e-mail these important messages to your legislators:

Funding cuts could negatively impact caregiver jobs, since nursing homes devote 70% of operating costs to people - salaries, wages and benefits.
Florida's nursing home staffing standards are among the highest in the nation, and good care costs money. Staffing should fully funded.
The anticipated FMAP money should be used to fund the Medicaid program and help serve our most vulnerable citizens - frail elders who reside in our nursing homes, two-thirds of who rely on Medicaid to cover the cost of their care.

Click here and help send an e-mail to your lawmakers today and urge them to oppose these deep funding cuts. Lawmakers are conferencing on the budget this week, so time is of the essence.

Letters: Nursing-home bills would help sickest residents

2010-04-16T12:57:00.001-07:00

Letters: Nursing-home bills would help sickest residents

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Arbitration bill withdrawn

2010-04-14T08:13:00.000-07:00

On Tuesday, the Senate Health Regulation Committee was expected to hear SB 2034, which would effectively end the use and enforcement of pre-dispute arbitration agreements in health care settings by allowing the agreement to be rescinded at any time. Members of FHCA's Management Committee, staff and lobby team met with the bill sponsor, Senator Steve Wise, to discuss the importance of arbitration clauses in long term care settings, which ensure that scarce health care resources go toward improving resident care rather than become diverted to pay the escalating costs associated with lawsuits. At the same time, FHCA members across Florida were contacting their legislators to share this same message.

FHCA is grateful to Senator Wise, who during yesterday's committee meeting withdrew the bill. He has agreed to work with FHCA and other health care groups in the coming months to develop model arbitration agreements providers can use.

This is another example of how the Association's collective efforts to educate lawmakers about the important work you do in caring for your residents is so valuable to the legislative process.

FHCA analysis of House Medicaid reform proposal

2010-04-08T07:34:00.000-07:00

On Monday, the Select Policy Council on Strategic & Economic Planning released two proposed committee bills (attached) mandating Medicaid managed care coverage for all beneficiaries including seniors needing long term care services. The proposal would be fully implemented over a five year period, beginning with an expansion of the current “Medicaid Reform” pilot program to Miami-Dade counties in 2011. The long term care component of the plan would require implementation to begin by July 1, 2011 with full implementation by October 1, 2012. The Council workshopped the bills in their meeting Tuesday night and is expected to amend and vote on the bills during their meeting next Monday, April 12th.

PCB 10-03 creates a new section of law entitled “Medicaid Managed Care” which creates provisions for the Medicaid managed medical assistance program, the managed long term care program, and the managed long term care for persons with developmental disabilities program. The agency is required to adopt any rules necessary to comply with or administer the program and to apply for and implement state plan amendments or waivers of federal laws and regulations necessary to implement the program.

Specifically, sections 409.978-409.985 is created to describe the long term care managed care program. As noted, the agency shall begin implementation of the statewide program by July 1, 2011, with full implementation by October 1, 2012. Medicaid recipients requiring nursing facility care as determined by the CARES Program and who are either 65 years of age or older or eligible for Medicaid by reason of disability are eligible for the program. All Medicaid recipients who are either residing in a nursing facility or enrolled in a Medicaid waiver program on October 1, 2012 are automatically eligible. The bill further defines the benefits available under the program.

The state will be divided into six regions and a specified number of qualified plans will be procured for each of the six regions. Qualified plans may be managed care entities or long term care provider service networks (owned by health care providers) or entities qualified as Medicare Advantage Preferred Provider Organizations, or Medicare Advantage Special Needs Plans. Plans must offer a network contract to all nursing homes, hospices, and aging service providers in their region during the first contract period after a qualified plan is selected, but may exclude the provider from the network after 12 months for failure to meet quality or performance criteria. Nursing homes and hospices are required to participate in all qualified plans in the region in which the provider is located.

Plans are required to pay nursing homes an amount equal to the nursing facility-specific payment rates set by the agency. Incentives are provided to Plans to reduce institutional placement and increase the utilization of home and community based services. The bill also establishes medical loss ratios that require Plans to spend at least 80 percent of Medicaid premiums on medical services and direct care management or pay a fine.

PCB 10-04 is contingent on the passage of PCB 10-03 and makes the statutory changes necessary to implement the managed care program. This bill eliminates the language that created Florida Senior Care, but more importantly provides language that will allow nursing homes to be more competitive in a managed care environment. Specifically, the bill creates a nursing home licensure workgroup that will develop a plan for license flexibility to assist nursing homes with developing comprehensive long term service capabilities, extends the CON moratorium for additional community nursing home beds until October 1, 2015, and suspends any CON condition requiring maintenance of specific minimum Medicaid utilization effective July 1, 2011.

There are still several issues, such as prompt payment, electronic claims processing and EFT payments, patient responsibility, conflict resolution, etc. that FHCA will continue to address with legislators and staff as this process moves forward.

Budget cuts threaten nursing homes and elder care

2010-04-08T05:46:00.000-07:00

TALLAHASSEE (Bay News 9) -- State lawmakers are preparing to make deep budget cuts that could affect many of Florida's elderly.

If approved, the state House's budget plan will cut millions of dollars of funding from nursing homes.

Read more: Budget cuts threaten nursing homes and elder care

Lawmakers’ Bipartisan Letter Seeks Preservation of Robust Medicare, Medicaid Funding

2010-04-06T11:24:00.000-07:00

Florida Health Care Association joined its national affiliate - the American Health Care Association (AHCA) - in praising today a new bipartisan letter from U.S. Representatives Shelley Berkley (D-NV) and Shelley Moore Capito (R-WV) to House Budget Committee Chairman John Spratt (D-SC) and Ranking Member Paul Ryan (R-WI) asking them to help preserve Medicare and Medicaid funding for the long term care community as their Committee examines issues related to these important entitlement programs.

“By leading this new letter to Chairman Spratt and Ranking Member Ryan, Congresswomen Berkley and Capito are once again acting in an effective, bipartisan manner to ensure America’s oldest seniors in need of the most intensive skilled nursing care receive the vital Medicare and Medicaid funding they require – and we thank them for their long-standing efforts on their behalf,” stated Bruce Yarwood, President and CEO of AHCA. “The letter draws needed attention to the chronic Medicaid under funding crisis, which is increasingly problematic for patients and facilities at a time when, in just the past six months, Medicare-funded nursing home care has been cut by nearly $27 billion over ten years.”

States the letter from Representatives Berkley and Capito to Chairman Spratt and Ranking Member Ryan:

“Skilled nursing facilities (SNFs) face increasing pressures due to struggling state Medicaid programs coupled with Medicare funding reductions of more than $12 billion over ten years as of October 1, 2009. In fact, Medicaid fails to cover the cost of care for patients in nursing homes. In 2009, the shortfall was projected to be $4.6 billion nationwide or $14.17 per patient, per day. These combined Medicare-Medicaid funding cuts have had the effect of significantly reducing the resources available for providing skilled nursing care at a time when patients have more medically complex needs than ever before.

“Any further reductions will hurt a growing economic sector, since long term care added 50,200 jobs in 2009 alone while the country’s approximately 16,000 nursing facilities and 39,000 assisted living communities comprise 1.1 percent of our national Gross Domestic Product (GDP), or $153.8 billion. Because workforce expenses represent 70 percent of a facility’s total costs, any reductions in funding will result in workforce cutbacks which will not only severely compromise the ability of long term care to provide life-sustaining care services to frail, elderly and disabled patients and residents, but also will decrease the economic contributions of the sector.

“Please join us in requesting that the Budget Committee continue to support the long term care community through reasonable annual inflation adjustments and fair reimbursement for unpaid Medicare co-payments as they consider issues related to entitlement programs in preparing the Fiscal Year (FY) 2011 Budget Resolution.”

House to unveil Medicaid plan Tuesday; expects it to be part of end-game

2010-04-06T11:09:00.000-07:00

By John Kennedy
The News Service of Florida

The House will unveil a wide-ranging, multi-year effort Tuesday to revamp Florida's costly Medicaid program — a plan that surpasses the Senate's already ambitious approach to expand managed-care coverage for low-income Floridians, according to those familiar with the proposal.
The House plan is emerging publicly for the first time past the session's midpoint, in keeping with a strategy that last year had Speaker-designate Dean Cannon, R-Winter Park, float an offshore oil-drilling proposal as a multi-billion dollar budget balm in the session's waning days.

Read the full Palm Beach Post article: http://www.palmbeachpost.com/news/state/526753.html

Blended staffing ratio passes Senate, House to vote on budget today

2010-04-01T05:31:00.000-07:00

This was a short week for legislators, who took a brief respite from legislative activities for the Passover/Easter break. They returned to Tallahassee and promptly covered the budget, with both the Senate and House heading into session and addressing as part of the agenda their Medicaid conforming bills (SB 1464 and HB 5301), which directly impact our members.

Both bills contain language which would combine a total direct care staffing requirement of 3.9 hours per resident per day by maintaining the daily staffing minimums of 1.0 hours of direct licensed nursing staff and 2.7 hours of direct CNA staff. Over the past two weeks, FHCA has been testifying during committee meetings as to how this combined standard would give providers additional flexibility in meeting the needs of residents who require more skilled care with additional licensed nursing staff. All the while, members, staff and our lobby team have been actively working with lawmakers to ensure they understand the importance of this issue.

Wednesday on the Senate floor, amendments were filed which attempted to limit this language rather than make it permanent. Sen. Mike Bennett, R-Bradenton, said nursing homes have had to comply with increasingly higher staff ratios while seeing their Medicaid reimbursement rates lowered by the state. “Let's give them some flexibility,” said Bennett. “They want to have the ability to manage their staff with limited resources.” A debate ensued and in the end the amendments failed and SB 1464 passed 25-9.

In the House, HB 5301 rolled over to a third reading and is expected to be taken up today with the House in session again to vote on the budget. Stay tuned for a final outcome this afternoon.