Sunday, March 11, 2018

2018 Legislative Wrap Up

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.


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. 
In addition to the nursing center funding increase, the final FY 2018-2019 budget also includes funding for an additional 475 PACE slots: 100 in Miami-Dade County, 100 in Lee County, 100 in Collier County, 75 slots in Martin County and 100 slots for the combined program in Baker, Clay, Duval, Nassau and St. Johns Counties. Several home and community-based (HCBS) programs also saw additional funding for waiting list slots.

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 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.


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.

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.
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.

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.

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.
FHCA wants to remind you of the importance of continuing that grassroots throughout the year. With lawmakers returning to their districts, we want to encourage you to invite them into your center to highlight the care you provide to Florida's frailest elders. In the coming weeks, we will be compiling the 2018 Legislative Scorecard which is a valuable tool for measuring lawmakers’ support of our issues.
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.

Friday, June 16, 2017

FHCA Applauds Governor Scott for Signing Prospective Payment System into Law

Today, Governor Scott signed SB 2514 which includes a Prospective Payment System (PPS) for nursing center reimbursement. The PPS plan, approved by the 2017 Legislature and advocated for by Florida Health Care Association and its more than 550 nursing center members, improves the current, cost-based nursing center reimbursement system by increasing accountability and enhancing return on the state’s investment in nursing center care by ensuring that money is spent on direct care and quality improvements.
"Florida is a national leader in providing long term care services and supports to its senior population, and we appreciate Governor Scott for recognizing that a stronger reimbursement system is best for everyone involved. The Prospective Payment System will put the focus on quality care and quality of life for Florida's nursing center residents, and, for the first time in Florida's Medicaid history, will link nursing center reimbursement to quality outcomes. On behalf of the thousands of long term caregivers working in our member centers, we commend Governor Scott for supporting the PPS so they can achieve their goals of providing exceptional care and services to our state’s seniors and people with disabilities,” said Emmett Reed, FHCA Executive Director.

Monday, May 8, 2017

FHCA 2017 Legislative Wrap Up Report

The Legislature officially adjourned today, May 8, to pass the final $83 billion budget for the 2017-18 state fiscal year. The three-day 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 May 5. 

The 2017 legislative session was one of the most challenging in history for Florida Health Care Association. Much of the work started well before the session began in March, with workshops held late last year focused on the Medicaid managed care program. By February, legislation that eliminated nursing center and hospice Certificate of Need was filed. After many months providing input on the Agency for Health Care Administration’s development of a Prospective Payment System, a flawed PPS model delivered by the AHCA consultant (Navigant) put the Association into overdrive to ensure the quality components and protections for providers were captured in the final PPS plan. All that was compounded by the threat of negotiating rates with managed care organizations and small group of outliers in the profession delivering a false narrative to lawmakers and the media.

Despite those significant challenges, FHCA not only succeeded on almost all our priorities, but I believe we got better. We unified, we strengthened our lobbying efforts, stepped up our traditional and social media activity and increased our grassroots advocacy initiatives. We became part of the solution at the Capitol by giving legislators meaningful recommendations from the experts – our members – who will now have the ability to take quality care to a whole new level.

Our ability to bring consensus to the profession resulted in the passage of a Prospective Payment System that ties nursing center reimbursement to quality advancements and gives providers much-needed protections to adapt to the new payment structure.

Our effective messaging about the need for managed growth ensured that nursing centers’ and hospices’ Certificate of Need remains intact.

Our ability to fight back hard ensured managed care companies will not be the driver in setting your Medicaid rates. In fact, because of FHCA’s effective advocacy, members will see their rates increase approximately $2.75 per patient day when reimbursement rates are set September 1, 2017.

FHCA also supported preserving the nursing center personal needs allowance, which will remain intact at $105 per month. 

Earlier today, Florida Politics touted FHCA as one of the winners emerging from the 2017 legislative session, and I cannot agree more.

The reality is, however, that we did not accomplish these legislative successes alone. Our ability to effectively advocate for so many complex issues this session is a combined result of the strength of our Government Affairs team, the support from our FHCA and Our Florida Promise leaders, the active involvement and expertise of our Legislative and Reimbursement Committee members, and the extensive reach of our members’ grassroots advocacy.  

In my more than 20 years in association management, I have never experienced a more challenging session. And in my eight years as your Executive Director, I have never been more proud of my FHCA team and the membership for the countless hours that were put in to advance these legislative priorities and get our messages across.

Once again we had a record attendance of more than 500 participants in our Lobby Wednesdays, including many of our business partners who also joined us in our efforts. Thank you to our Lobby Wednesday sponsors - Bouchard Insurance, who also sponsored the Provider Program, Health Care Professional Consulting Services, Inc. and Medline Industries, Inc. for giving this grassroots initiative an even greater presence.

FHCA is proud to represent you at Florida’s Capitol and in everything you do to care for our state’s frailest elders. Together we worked hard, remained united and never gave up throughout the process. And as a result, we saw legislative outcomes that keep the focus on quality care.


Governor Rick Scott released his initial budget in January, funding the estimated fiscal year 2017-2018 expenditures for nursing centers without an inflationary increase due to the required rate freeze stated in s. 409.908, Florida Statutes (F.S). The Governor also proposed fully funding the Nursing Facility Quality Assessment (NFQA), which would ensure a “buyback” of over $663 million in Medicaid rate reductions.  
The initial budgets released by the House and Senate mirrored the Governor’s proposed budget for nursing center funding.

The final budget (SB 2500) provides $4.4 billion for Long Term Care, including fee-for-service nursing center care paid by the Medicaid contractor and Managed Long Term Care paid by managed care plans. The NFQA is increased by over $41 million compared to fiscal year 2016-2017. The per-day assessment rate would increase to approximately $25.26 per non-Medicare patient day ($4.55 per non-Medicare patient day for high volume Medicaid facilities), which provides for rate “buyback” of an additional $33.7 million compared to the current year.

The result of the additional funding and changes to the Federal Medical Assistance Percentage (FMAP) leads to increased Medicaid rates for nursing centers of approximately $2.75 per patient day when rates are set September 1, 2017.  

When initially proposed, the House budget reduced the resident personal needs allowance from $105 per month to $70 per month. The Senate budget, however, did not include this reduction. During budget negotiations, Senate President Joe Negron (R-Palm City), a long-time champion for nursing centers and the residents under their care, stood firm to ensure this funding was preserved. As a result, the personal needs allowance will remain at $105 per month for fiscal year 2017-2018.  

It’s important to note that while nursing centers were not subject to any funding cuts, other providers saw large reductions to their funding. Hospitals, for example, face a proposed cut of $521 million beginning July 1.  


SB 2514 implements the Nursing Home Prospective Payment System (PPS). The PPS Plan places in statute the Senate PPS model with its quality components and transition period, with an implementation date of October 1, 2018.

In 2016, the Legislature provided funding to the Agency for Health Care Administration to work with an independent contractor (Navigant) to develop a Prospective Payment System (PPS) for Medicaid nursing center rates. Over the past year, FHCA members and staff invested a significant amount of time and expertise to support AHCA and Navigant with developing a system that rewards centers for providing high quality care and making the much needed investments in updating and upgrading their centers.

While the public meetings brought together stakeholders for discussion over what was needed in a PPS, FHCA made it clear in public testimony that the Navigant model did not represent the best way to implement PPS policy for nursing center reimbursement. It was a starting point from which FHCA recommended significant changes.

Unfortunately, the final report that was presented to the Legislature contained a series of flaws and raised serious concerns among legislators. FHCA brought together members of the Association who were negatively affected by the Navigant PPS model to further develop recommended changes and gain consensus before presenting it to the Legislature. Upon approval, FHCA presented these recommendations to Senator Anitere Flores (R-Miami) and Senate Health Care staff to support their work to improve AHCA’s PPS model. Ultimately, the Florida Senate included a number of FHCA’s recommendations to develop an improved model that was passed as part of the Senate budget.

To coincide with FHCA's PPS lobbying efforts, the Association launched a social media campaign and engaged members to ensure their voices were heard. The campaign focused on the facts about PPS to emphasize how PPS puts the focus on rewarding centers for quality advancements. Digital advertising, guest editorials in local newspapers, Facebook and Twitter messages, videos and infographics, a press conference with over 75 Lobby Wednesday participants, Facebook Live events, Letters to the Editor from a number of center administrators across the state, thousands of emails and legislative district office visits with residents and staff were all part of the campaign.

While the House did not include the PPS language in their budget, Senate and House leaders were able to work out a compromise during budget negotiations to include the Senate PPS Plan with the majority of FHCA’s recommendations into the final budget. The Legislature did agree on one-year delay, which means the new reimbursement system will take effect October 1, 2018.

The PPS Plan includes a multi-year transition to ensure centers have time to adapt, and, for the first time in Florida Medicaid history, will tie payments to health quality outcomes. For more information about the components of the PPS Plan, click here.

FHCA was successful in preserving nursing center and hospice Certificate of Need (CON), despite a philosophical belief by many legislators that a more “free-market approach” is better for our state’s health care system.

HB 7 by Rep. Alex Miller (R-Sarasota) and SB 676 by Sen. Rob Bradley (R-Orange Park) would have eliminated the Certificate of Need regulatory process for all health care providers, including hospitals, nursing centers and hospices; however, these bills failed to pass.

FHCA led an effective lobbying effort and grassroots campaign that included hundreds of members making this a key discussion point during their Lobby Wednesday visits. Several FHCA members also traveled to Tallahassee to testify in committee and nearly 2,000 emails were sent to legislators to urge them to protect nursing center CON. FHCA also used social media to raise awareness to this issue with a series of targeted messages on Facebook and Twitter.

In the end, Rep. Miller heard members’ concerns, and as a result, offered an amendment to remove nursing centers and hospices from the bill. Both the amended House bill and the Senate bill died with the scheduled end of the legislative session on Friday, effectively putting this issue to rest for another year.


Improving the managed care system was a top priority for FHCA this session, as well as Senate President Joe Negron (R-Palm City). In the months leading up to the session, Sen. Negron tasked the Senate with studying the Statewide Medicaid Managed Care Program as the state approached the end of its first round of five-year contracts with managed care plans. After much deliberation, several managed care related bills were filed this session.

SB 682 by Sen. Kelli Stargel (R-Lakeland) and HB 1059 by Rep. Alex Miller (R-Sarasota) failed to pass. SB 682 included a provision to exempt long-stay residents from the Medicaid managed care system once it was determined the nursing center is the safest place for them to receive their care. While the House companion bill did not include the long-stay exemption, both bills contained language to ensure providers are paid timely by managed care companies and have access to managed care networks.

FHCA staff and members testified before a number of committees, with an overarching message that the managed care system does not work effectively for long-stay nursing center residents. FHCA also commissioned Moore Stephens Lovelace to assess how the state could save money (approximately $68.2 million) by exempting these residents. Traditional and social media relations and grassroots advocacy through Lobby Wednesday discussions and member email campaigns were part of the strategy to try to advance this legislation.

And while the push to exempt long-stay residents from the managed care system did not resonate with lawmakers this session, FHCA was successful in defeating legislation that called for managed care companies to negotiate providers’ reimbursement rates.

HB 7117 by Rep. Travis Cummings (R-Orange Park) and SB 916 by Sen. Denise Grimsley (R-Lake Placid) failed to pass. You may recall this legislation included language that would have allowed managed care companies to negotiate rates with providers, a provision FHCA was successful in having struck down before the bill saw a final vote. Had this legislation passed, it would have revamped Florida’s Medicaid managed care system and required AHCA to fine managed care plans which fail to pay providers timely - a provision from SB 682 by Sen. Kelli Stargel (R-Lakeland).

Prior to session, FHCA was alerted that certain county property appraisers were contending that assisted living facilities (ALFs) are not health care facilities. As a result, these ALFs were being charged property taxes. FHCA educated the Legislature as to the role assisted living facilities play in the continuum of long term health care and, therefore, should not be levied property taxes.

This year's tax package passed [HB 7109 by Rep. Jim Boyd (R-Bradenton) and Sen. Kelli Stargel (R-Lakeland)] and includes a provision that exempts ALFs from property taxes.


While the Legislature began the session with talk of creating major reforms to Florida’s health care system, many of the issues below were not significant enough to make House and Senate leaders’ "must pass" list. After much attention, issues such as the regulation of medical marijuana, expanding the scope of nonphysician providers, greater roles for ambulatory surgical centers and the creation of recovery care centers, and workers’ compensation all failed in the waning days of the session. A number of bills actively worked by FHCA also fell into this category, as both chambers were unable to come up with a compromise on the proposals they put forth.

Recovery Care Centers
HB 145 by Rep. Paul Renner (R-Palm Coast)/SB 222 by Sen. Greg Steube (R-Sarasota) failed to pass. This legislation would have created a new recovery care center license in Florida and allowed patients to receive services up to 24 hours in an ambulatory surgical center. As part of its lobbying efforts, FHCA worked to ensure these providers remained focused on post-surgical recovery rather than provide rehabilitative care that would typically be delivered in a skilled nursing center.

Agency for Health Care Administration Regulatory Bill
HB 1195 by Rep. Alex Miller (R-Sarasota)/SB 1760 by Sen. Denise Grimsley (R-Lake Placid) failed to pass. To ensure nursing centers were not negatively impacted by this legislation, FHCA collaborated with the Agency for Health Care Administration (AHCA) on several provisions related long term care, with particular focus on language related to background screening, change of ownership and the licensure process.

Employees Working in a Health Care Setting
HB 1207 by Rep. Daisy Baez (D-Coral Gables)/SB 1712 by Sen. Darryl Rouson (D-St. Petersburg) failed to pass. This legislation added employees working in hospitals, specifically physicians, registered nurses, employees, agents or volunteers, to the list of professionals who trigger a reclassification of certain assault and battery offenses when committed while on duty. Although it failed to advance, FHCA was successful in seeing HB 1207 amended to include said professionals who work in nursing centers.

Medical Marijuana
HB 1397 by Rep. Ray Rodrigues (R-Ft. Myers)/SB 406 by Sen. Rob Bradley (R-Orange Park) related to medical marijuana regulations failed to pass. There were several medical marijuana bills filed this session, each of which came with contrasting approaches. FHCA’s priority was to protect members in the final outcome by educating legislators and their staff about the conflict nursing centers face between Florida’s constitutional amendment and federal law.

Workers' Compensation
HB 7085 by Rep. Danny Burgess (R-Zephyrhills)/SB 1582 by Sen. Rob Bradley (R-Orange Park) failed to pass. Florida lawmakers sought to reform the state’s workers compensation system after a 2016 Florida Supreme Court ruling led to a 14.5% increase in workers’ compensation insurance rates. While both House and Senate each passed their respective versions of the bill, they were unable to agree on attorneys fee caps and reimbursement cuts to hospitals that provide outpatient treatment to injured workers.  


Now that legislators are returning to their districts, FHCA wants to encourage you to invite them into your center so we can continue educating them about what’s important to the long term care profession and the residents cared for every day. In the coming weeks, we will be compiling the 2017 Legislative Scorecard. This is an effective grassroots advocacy tool that measures lawmakers’ support of our issues and offers more information about the outcomes from session.

In addition, FHCA will be providing more information and resources to members about the Prospective Payment System in the coming months, including an educational session at Annual Conference. This and other opportunities will be designed to help providers better understand the quality components and how to plan and adapt to the new payment structure.

Be on the lookout for more information about the Governor's action on the budget, as well as how to prepare your team for PPS. On behalf of the entire team at Florida Health Care Association, thank you again for the ongoing encouragement, support and resources that allow us to advocate on your behalf.

*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 above.