The
Legislature officially adjourned today, March 11, to pass the final
$88.7 billion budget for the 2018-19 state fiscal year. The extension
was needed because the budget requires a 72-hour “cooling off” period,
and thus a final vote could not be taken on the originally scheduled end
date of March 9.
With just a few weeks left in the regular session, the
Legislature’s focus shifted with the tragedy that occurred at Marjory
Stoneman Douglas High School in Parkland. Gun control became a priority,
and legislators were grappling with ways to fund close to $400 million
in legislative proposals that addressed gun restrictions and school
safety.
Florida’s
long term care providers had our own set of challenges that started
well before the session began in January. The Hollywood Hills tragedy
that occurred during Hurricane Irma put nursing centers and assisted
living facilities (ALFs) in the spotlight, and more than 22 bills were
filed this session that focused on nursing center and ALF disaster
procedures. The Agency for Health Care Administration and Department of
Elder Affairs also filed modified Emergency Environmental Rules
requiring nursing centers and ALFs to maintain generators and adequate
fuel supply, and those rules needed legislative ratification to take
effect.
The
need for increased Medicaid funding topped the list of FHCA legislative
priorities, especially as providers prepared to transition to the new
Prospective Payment System in October. At the same time, complying with
the generator rules was expected to cost nursing centers close to $108
million, while ALFs would need more than $243 million to comply with the
requirements.
Personal
injury lawyers attempted to exploit the Hurricane Irma tragedy by
proposing legislation that threatened to diminish resources for long
term care residents. Several proposals sought to promote costly lawsuits
by mandating liability insurance minimums and repealing limitations on
punitive damage awards.
Approximately
25 bills with both a positive impact and negative effect on nursing
center and ALF regulations were also filed this session. FHCA worked to
advance the regulatory proposals that would enhance resident care and
safety, as well as support centers with their workforce needs. The
Association was successful in defeating the proposals that would have
been harmful to providers.
In
the end, FHCA worked with our legislative partners to secure a one-year
increase of nearly $138 million in Medicaid funding for nursing center
care. Championed in the Legislature by Senate President Joe
Negron (R-Palm City), the $127 million Medicaid increase will support
centers with their continuous quality improvement. An additional $9.8
million was also secured to help nursing centers transition to the
Prospective Payment System in October 2018.
Additionally,
nursing center residents will see another increase to their personal
needs allowance, up from $105 to $130 per month. That $25 increase will go a long way to help them pay for personal items that will improve their quality of life.
The
Legislature ratified the rules to maintain generators and adequate
fuel, which means nursing centers and ALFs must meet these requirements
when hurricane season begins on June 1, 2018. FHCA was actively
involved in the discussions with the administration, the agencies and
the Legislature which led to the final language. As a result, the final
rules contain several recommendations we received from members and
subject matter experts and stayed focused on what is best for keeping
residents safe during disasters.
FHCA
members played an important role helping us advance these key
priorities. Once again nearly 500 members took part in our Lobby
Wednesdays, helping tell the stories about quality, emergency
preparedness and making measurable improvements in residents’ health
care. We want to thank Bouchard Insurance, Health Care Professional
Consulting Services, Inc. and Medline Industries for their sponsorship
of Lobby Wednesdays. The ongoing commitment from our members and
sponsors is what makes this important grassroots initiative such a
success.
The
work you do is difficult, and it does not go unnoticed. FHCA makes it
our priority each year to lay out a legislative agenda that will help
you further enhance resident quality care and quality of life, as well
as support your operations. We’re proud to represent you at Florida’s
Capitol and appreciate your support toward the success of this year’s
long term care legislative priorities.
*Please
note that although these legislative measures have been approved by
both chambers, the Governor must take action for final approval (sign
the bill, allow it to become law without his signature or veto the
bill). Watch your weekly Focus on Florida e-newsletter for updates on
the Governor's action and effective dates on the bills we've reported on
below.
BUDGET
Governor Rick Scott released his initial budget in November, calling for full funding for nursing center care. The Governor's budget represented an increase of $4 billion over the current $83 billion budget, with the major driver being the increase in total Medicaid spending ($1.4 billion). The initial budget released by the House mirrored the Governor’s proposed budget for nursing center funding. The Senate, however, under the leadership of Senate President Joe Negron (R-Palm City), included an additional $130.4 million in funding for nursing center Medicaid rates, as well as $9.8 million to support providers in their transition to the Prospective Payment System in October.
The
extension of the 2018 session resulted from a breakdown in budget
negotiations over how to reimburse hospitals. The outcome for nursing
centers in the final budget were contingent on that formula. In the end,
nursing centers will see a significant increase of nearly $138 million
to their Medicaid rates thanks to champions in the Legislature,
including Senate President Joe Negron.
Senator
Negron led the way even before the session began to ensure a funding
increase, and he delivered on that promise. Senate leaders Rob Bradley
(R-Orange Park) and Anitere Flores (R-Miami), along with House Speaker
Richard Corcoran (R-Land O' Lakes) also played a key role during budget
negotiations, with Senator Bradley telling reporters that, "At the end
of the day, helping our elderly is more important to the Senate, and the
average Floridian, than a special interest fight over how to divide up a
static number of hospital dollars."
The 2018-2019 budget (HB 5001)
includes one year in new funding for nursing center rates in a variety
of ways, all of which take effect October 1, 2018, with the
implementation of the new Prospective Payment System (PPS).
- The budget includes $102 million in funding for increasing the direct care price level from 100% to 105% of the median, increasing the quality funds from 6% to 8.5% of non-property related costs, and funds to offset increased capital projects cost through the FRVS calculation (this could include, for example, the purchase of a generator).
- There is an additional $25 million that will increase the overall rates through the budget neutral adjustment.
- The budget also includes a separate $9.8 million in transition funding to support providers as they prepare the transition to the PPS.
- Also included is an increase to the personal needs allowance from $105 to $130 per month for all Medicaid residents, which is recurring dollars.
The budget appropriated $2 million for maintenance and repair projects at the State Veterans’ Nursing Homes, and $500,000 for preliminary engineering and site planning for a new Veterans’ Nursing Home in Marion County.
The budget also directs the Agency for Health Care Administration (AHCA) to seek authorization from the Centers for Medicare and Medicaid Services (CMS) to eliminate the Medicaid retroactive eligibility period (currently 90 days) for non-pregnant adults. Once approved by CMS, Medicaid eligibility will continue to begin the first day of the month in which a Medicaid application is submitted; however, there will be no retroactive period. This change is scheduled to take effect July 1, 2019.
Lastly, there is language in the budget that directs AHCA to use unexpended funds from the FY 2017-2018 nursing center budget line items to remit a Supplemental Quality Incentive Payment to nursing centers with an overall CMS Five-Star Rating score of “5” in the latest rating report. Each provider would be eligible for a pro-rate share of those dollars based on Medicaid days. This payment will only be made if there are extra unspent funds from the current year. FHCA will be working with AHCA on this in the months ahead and will share more information if extra funding becomes available.
EMERGENCY PREPAREDNESS
Emergency
preparedness became a key priority for lawmakers after Hurricane Irma
pounded the state in September. Shortly thereafter, House Speaker
Richard Corcoran (R-Land O’Lakes) appointed a House Select Committee on
Hurricane Response and Preparedness to develop recommendations on how
the state could better prepare for natural disasters.
In January, the Agency for Health Care Administration and Department of Elder Affairs filed modified Emergency
Environmental Control Rules requiring nursing centers (Rule 59A-4.1265)
and assisted living facilities (Rule 58-5.036) to maintain generators
and adequate fuel supply, and those rules needed legislative approval to
take effect.
Additionally,
the 2018 legislative session saw over 22 proposals filed to address
disaster readiness in nursing centers, assisted living facilities (ALFs)
and other health care settings.
FHCA
was actively engaged with lawmakers throughout session, testifying
before committees and holding meetings to recommend changes to the
Emergency Environmental Control Rules, discuss funding considerations
and offer solutions for strengthening emergency procedures to keep
residents safe.
The
House Select Committee’s final recommendations that impacted health
care facilities included sales tax exemptions for equipment which
utilize natural gas, petroleum or diesel fuel; a requirement that
nursing centers and ALFs provide adequate emergency power during power
outages; and the creation of an at-risk registry to assist in the
evacuation of vulnerable individuals.
Several legislative proposals developed from these recommendations successfully advanced out of the 2018 Legislature.
The tax package passing out of the Legislature [HB 7087
by the House Ways and Means Committee and Rep. Paul Renner (R-Palm
Coast)/Sen. Kathleen Passidomo (R-Naples)] will give nursing centers and
ALFs a sales tax break of up to $15,000 for the purchase of any
equipment to generate emergency energy.
In the final days of session, the Legislature also passed HB 7099, the nursing center generator rule ratification (Rule), and SB 7028,
the assisted living facility generator rule ratification. The Rules
were modifications to the Governor’s Emergency Power Plan Rules
initially released in September and required legislative approval. HB 7099 ratifies Rule 59A-4.1265,
"Emergency Environmental Control for Nursing Homes, which requires
nursing centers to maintain generators and adequate fuel, while SB 7028 ratifies Rule 58A-5.036, “Emergency Environmental Control for Assisted Living Facilities.”
FHCA
appreciates the Governor, the agencies and the Legislature for
listening to our concerns throughout the development of these rules, as
the final language gives providers flexibility in working to meet the
goal to keep residents safe and cool when the electricity goes out.
Once
signed by the Governor, these Rules will become law, and nursing
centers and ALFs must be in compliance no later than June 1, 2018.
LAWSUIT LEGISLATION
Prior to session, FHCA successfully opposed personal injury lawyer supported bills. HB 655 / SB 898 would have created multiple new causes of action against nursing centers and given the Long Term Care Ombudsman Program more watchdog authority through an “undercover system," as well as a system for reporting complaints. These bills, which were never heard in committee, also called for minimum liability insurance and increased civil penalties.
Also failing to advance was HB 1369 by Rep. Amber Mariano (R-Port Richey) and SB 1408
by Sen. David Simmons (R-Longwood), whose bills would have mandated
minimum insurance and revised the punitive damage laws for nursing
centers.
These
bills failed to advance through the Legislature thanks to FHCA members
educating lawmakers about the negative impact they would have and how
funding is better spent on resident care than increased lawsuits.
PATIENT HEALTH, SAFETY AND WELL-BEING
Several bills addressed by the Legislature focused on the care and comfort of residents and improved operations for centers.
Those passing out of the Legislature focused on:
AHCA Regulations
SB 622
by Sen. Denise Grimsley (R-Lake Placid)/Rep. Clay Yarborough
(R-Jacksonville). This legislation makes helpful changes to the nursing
center change of ownership process and streamlines the licensure renewal
process. The bill also eliminates obsolete provisions in statute which
are out of date and no longer necessary.
Protection from Financial Abuses
HB 1059
by Rep. Colleen Burton (R-Lakeland)/Sen. Kathleen Passidomo (R-Naples).
This legislation will allow for a temporary injunction on vulnerable
adults who are considered at-risk for exploitation. FHCA actively
supported this legislation, as it will protect long term care residents
from financial abuses.
Patient and Staff Safety
HB 551
by Rep. Colleen Burton (R-Lakeland)/Sen. Dana Young (R-Tampa). This
legislation exempts from public record a health care facility's building
plans, blue prints, drawings and diagrams that show its internal layout
and structural elements. It will be another important step toward
keeping nursing center residents and staff safe.
Pain Management
HB 21
by Rep. Jim Boyd (R-Bradenton)/Sen. Lizbeth Benacquisto (R-Ft. Myers).
This legislation exempts cancer, palliative care and terminally ill
patients, as well as patients with chronic pain, from the 3- or 7-day
supply limit for Schedule II prescriptions. FHCA worked tirelessly to
ensure these exemptions were included in the final legislation so as not
to affect long term care centers' ability to help their residents
manage their pain.
APRN Compact
HB 1337
by Rep. Cary Pigman (R-Sebring)/Sen. Jeff Brandes (R-St. Petersburg).
This legislation brings Florida closer to meeting the requirements to
join the APRN compact, which allows reciprocity for nurses to practice
in states that are members of that compact. FHCA actively supported this
legislation, which will assist centers with meeting their workforce
needs. This is of particular importance during seasonal months when
additional caregivers are needed to assist with the increased number of
"snowbird" seniors requiring long term and post-acute care.
Legislation which failed to pass focused on:
Increased Notifications
HB 443 by Rep. Emily Slosberg (D-Delray Beach) and SB 830
by Sen. Gary Farmer (D-Ft. Lauderdale). This legislation would have
increased notification requirements by nursing centers and ALFs to the
Long Term Care Ombudsman.
Baker Act
HB 573 by Rep. Kim Daniels (D-Jacksonville) and SB 112
by Sen. Daphne Campbell (D-North Miami Beach). This legislation would
have added ARNPs and PAs to the list of health care professionals who
would be authorized to execute a Baker Act.
Consultant Pharmacists
HB 689 by Rep. Cord Byrd (R-Jacksonville Beach) and SB 914 by
Sen. Rene Garcia (R-Hialeah). This legislation would have created more
access to care by allowing a consultant pharmacist to join a health care
team to order and evaluate laboratory and clinical tests, conduct
patient assessments, and initiate, modify, discontinue and administer
medications if authorized in the supervising physician's protocol.
Telehealth
SB 280 by Sen. Aaron Bean (R-Jacksonville) and HB 793
by Rep. Ralph Massullo, Jr. (R-Beverly Hills). This legislation would
have established standards of care for telehealth providers.
Health Care Disaster Preparedness and Response
HB 7085
by the House Health and Human Services Committee and Rep. Ralph
Massullo, Jr. (R-Beverly Hills). This legislation primarily focused on
special needs shelters but would have also made some statutory changes
related to nursing centers' and ALFs' emergency plans, including posting
a working phone number and general overview of the emergency plan on
AHCA's website.
ASSISTED LIVING FACILITIES
Much
of FHCA’s advocacy work for its assisted living members centered around
emergency preparedness. FHCA played an active role in the discussions
that led to the development of final language for Rule 58A-5.036,
“Emergency Environmental Control for Assisted Living Facilities.” FHCA
offered a number of recommendations related to generator installation,
fuel supply and areas of refuge. The Rule was a modification to the
Governor's Emergency Power Plan Rule in September and required
legislative ratification.
The Legislature passed SB 7028
which ratified the Rule, and upon signature of the Governor, the Rule
becomes law. As such, assisted living facilities (ALFs) will need to be
in compliance by June 1, 2018.
FHCA
lobbied for increased funding for ALFs in the Medicaid budget, but the
Legislature was reluctant to increase the line item. Additionally, a
proposal supported by FHCA to use the Quality of Long-Term Care
Improvement Trust Fund as a resource for grants to ALFs purchasing
generators failed to be included in the final budget.
Additionally, this year's tax package passed [HB 7087
by the House Ways and Means Committee and Rep. Paul Renner (R-Palm
Coast)/Sen. Kathleen Passidomo (R-Naples)] and gives ALFs a sales tax
break of up to $15,000 for the purchase of any equipment to generate
emergency energy.
In
the coming months, FHCA’s Florida Center for Assisted Living Committee
will be working closely with FHCA’s Legislative Committee to meet with
lawmakers on the concept of establishing a Funding Methodology Work
Group as an approach for addressing Florida's assisted living
demographics and challenges. The Work Group would look at policy trends
and make recommendations to state agencies and the Legislature for a
more modernized system of reimbursement.
THANK YOU
FHCA
is extremely grateful to our members for your ongoing support both
before and during session. Your active involvement in the Association
and your support of Our Florida Promise (OFP) and the FHC PAC plays a
critical role in keeping our issues front and center with legislators.
Our
ability to advocate for a Medicaid rate increase, fight back harmful
legislation and pass legislative priorities that focus on the health and
well-being of your residents is a combined result of the strength of
our Government Affairs team, the support from FHCA’s Board of Directors,
Legislative Committee and OFP and the extensive reach of our members’
grassroots advocacy.
In
addition, FHCA will be providing more information and resources about
the Nursing Home and ALF Generator Rules and the Medicaid funding
increase that takes effect under the Prospective Payment System. Make
plans to attend our upcoming Quality Symposium April 4-5 at the Hilton Orlando for special sessions on these topics, as well as our Annual Conference in July.
Be
on the lookout for more information about the Governor's action on the
budget and other legislation in the weeks ahead. On behalf of the entire
team at Florida Health Care Association, thank you again for your
continued support and allowing us to represent you and the important
work you do.
