CNN Lou Dobbs Tonight Addresses Nursing Home Funding Cuts

As a result of ongoing media efforts relative to chronic Medicaid underfunding of nursing home care, the current economic crisis facing states, and the skilled nursing facility Medicare cuts that went into effect on October 1 due to the implementation of the Centers for Medicare & Medicaid Services “forecast error,” the Associated Press (AP) ran a story on October 5 chronicling this issue. On October 13th, CNN and Lou Dobb’s Tonight also produced a segment, during which a reporter went on-site at the West Hartford Health and Rehab Center in West Hartford, CT, to film the care provided in a typical skilled nursing facility and interview the administrator.

American Health Care Association President and CEO Bruce Yarwood was also interviewed, noting that Medicaid has chronically underfunded the care of nursing home care and the disparity between the cost to provide care and reimbursement levels continues to increase over time. In 2008, the national average hourly Medicaid reimbursement for nursing home care was only $6.70 and hour. Yarwood went on to say that most every state is facing a budgetary crisis as they grapple with the reality that demand and need for Medicaid financed care is up, while funding levels for the program are limited or are in jeopardy.

On October 1, an administrative cut in Medicare funding for skilled nursing care went into effect – eliminating an estimated $1.05 billion in FY 2010 alone, or as much as $16 billion over the next ten years. The Medicare cuts, coupled with Medicaid underfunding and state budget crisis, will result in job losses and will jeopardize the recent quality improvements seen in our nation’s skilled nursing facilities.

Long term care facilities are facing even more funding uncertainty, as temporary increases in Medicaid funding that came from the American Recovery & Reinvestment Act (ARRA) stimulus package will expire on December 31, 2010. All of these funding cuts and underfunding come at a time when the long term care sector must be preparing to face an upswell of individuals requiring both short-stay rehabilitative care and long stay 24-hour nursing care and support.

Please help Save Our Seniors. Contact your Members of Congress by phone or e-mail and urge them to oppose the nursing home funding cuts contained in health care reform.

Ask Congress to Stop Proposals that Further Cut Nursing Home Care

FHCA joins the American Health Care Association in its support of health care reform. Yet, proposals in Congress would cut Medicare funding for residents in nursing homes nationwide by more than $32 billion. These cuts add to $12 billion in cuts imposed when the Administration finalized a rule affecting nursing home care on July 31, 2009. Together, cuts of this magnitude are simply unsustainable.

Since labor represents 70% of nursing home operating costs, we worry that such deep cuts would affect jobs - forcing layoffs, lowering salaries, or reducing benefits - and ultimately, hurting residents' quality of care. Congress must stop proposals that further cut nursing home care and reconsider how the existing $12 bllion in cuts, combinded with the state Medicaid funding shortfall that will occur when federal stimulus dollars run out, will negatively impact seniors' care.

FHCA, together with the American Health Care Association, are calling on Congress to ensure that total funding for nursing home care remains adequate to preserve quality care for America's seniors and protects caregiver jobs. Please join us in this advocacy campaign by clicking on this link for resource materials you can use to better educate Congress about these cuts as we campaign to Save our Seniors today.

How You Can Help:

• Call or e-mail your U.S. Senator and Representative today!
• Attend a Town Hall Meeting or set up a meeting in your local district with your U.S. Senator, Representative or a member of their staff.
• Invite your U.S. Senator or Representative into your facility.

Massive Federal Medicare Cuts Will Hurt Nursing Home Residents, Cost Jobs

The Executive Director of the Florida Health Care Association (FHCA) warned that new federal Medicare cuts of up to $16 billion resulting from Friday’s announcement by the Obama Administration that it has put into effect a new Medicare regulation will significantly endanger Florida nursing home residents’ care and jeopardize the state’s already fragile economy and caregiver jobs base.

“We intend to make certain the interests of nursing home residents remain a priority for lawmakers as they pursue health care reform in Washington, and will make sure they understand that the Medicare funding cuts on top of the looming Medicaid funding crisis plaguing Florida’s seniors and providers after stimulus dollars are expended is unsustainable,” Emmett Reed, Executive Director of FHCA said.

In the year 2010 alone, Florida’s Medicare cuts amount to $78.4 million – the 2nd highest level of cuts in the nation. The estimated economic impact on Florida in the year ahead, according to an analysis from the American Health Care Association (AHCA) and the Alliance for Quality Nursing Home Care, will be a reduction of $132.2 million in business activity, a reduction of $65.9 million in labor income, and a loss of 1,960 jobs.

Continued Reed: “Having now just suffered a massive Medicare funding cut of up to $16 billion – distinct and separate from the reductions our sector has willingly and cooperatively agreed to shoulder as part of achieving broader reform – we are alarmed the sheer size of the cumulative cuts we ultimately suffer will be especially damaging to seniors in states like Florida, where our Medicaid program is already underfunded*. Medicare and Medicaid funding are inextricably linked, and the combination of cuts to both programs squeezes our local facilities in a manner harmful to Medicare beneficiaries’ care needs, detrimental to our state’s local economy, and injurious to our caregiver jobs base.”

Reed noted that Florida nursing homes are seeing an increasingly diverse patient base, and providing a greater variety of acute care, rehabilitative and convalescent services that cannot be delivered elsewhere – care services which are now in jeopardy due to the sheer size and scope of the Medicare funding cuts. These massive funding cuts, Reed said, will undermine facilities’ ability to effectively treat this more medically complex patient population, and also put the jobs of the direct care workforce they depend upon in substantial danger.

“Achieving a sweeping health care reform bill we can all be proud of, and which will improve the health of every Florida resident is a necessity, not an option,” Reed continued. Yet, protecting vulnerable seniors in the process must always remain a key priority from which we must not deviate.”

During the upcoming August recess, Reed said, the long-term care community will ask federal lawmakers to keep the interests of nursing home residents and those who care for them foremost in their minds. “We intend to explain in a tangible, informative manner why it is essential for Congress, upon its return to Washington in September, to recalibrate its thinking on health care reform and scale back these enormous Medicare cuts.”

*An Eljay, LLC analysis of the nation’s Medicaid program released in October by the American Health Care Association (AHCA) projects that Medicaid underfunded the actual cost of providing quality long term care in 2008 by $188.5 million annually in Florida, and that Florida seniors rank 10th in terms of cumulative underfunding of nursing facility care.

Health Care Reform Bill to Slash at Least $44 Billion in SNF Medicare Payments

This week, FHCA Executive Director Emmett Reed traveled to Washington, DC, to meet with American Health Care Association lobbyists and several of Florida Congressmen and their staff. Health care reform is moving swiftly in Washington and unfortunately, the legislation as it is currently drafted, is extremely harmful to long term care providers and the residents you serve. Yesterday, HR 3200, America's Affordable Health Choices Act of 2009, was introduced in the US House of Representatives. The bill contains detrimental cuts to Medicare payments for Skilled Nursing Facilities which amount to at least $44.9 billion in cuts for Medicare Payments to SNFs alone. This staggering number doesn't account for the $16 billion in regulatory cuts being proposed by the Centers for Medicare and Medicaid Services (CMS) by August 1st. This bill is on a fast track for passage in the House of Representatives.

The moment to take action is NOW. FHCA is joining the American Health Care Association in asking you to you weigh in with your U.S. Representative and let him/her know that cuts of this magnitude are simply unsustainable. Tell your Representative that cuts to Medicare will have a negative impact on nursing homes and will create a ripple effect - putting at risk the quality of care to our state's frail elders and people with disabilities and the loss of tens of thousands of jobs for long term care providers across the country.

We must put a stop to these egregious cuts before it's too late. Congress has made health care reform a priority this year and intends to pass a bill as early as August. Your voice needs to be heard on this vital issue. Click here to take action today by sending a letter to your U.S. House Representative and telling them to OPPOSE Medicare payment cuts to SNFs contained within HR 3200, America's Affordable Health Choices Act of 2009.

Meeting Legislative Candidates

It's hard to believe that legislative candidates for the 2010 fall election are already out in the community meeting voters and raising money for campaigns. But regardless of what you might say about how early it seems, FHCA has been right in the thick of it, educating some of these early birds on our important long term care issues.

On Wednesday, June 24, Senator Jack Latvala, who is running for Senate District 16 (he previously represented a nearby area) visited Palm Garden of Clearwater and Administrator Roy Meredith and his staff provided a tour followed by sandwiches and sweets. Great job!

That evening we headed to Bradenton to the home of Senator Mike Bennett (R-21), where we joined FHCA Executive Director Emmett Reed and FHCA Vice President Nina Willingham at a fundraiser for Greg Steube (R), candidate for House District 67. Warm breezes off the Gulf and good food and drink enabled everyone to relax and meet the candidate, who is an Iraq war veteran and the son of the local sheriff. We look forward to having Greg visit some local nursing homes in the near future.

We encourage our FHCA members to invite their local legislators and 2010 candidates into your building to help educate them about the valuable work you do in caring for Florida's nursing home residents. First-hand visits are a great way to help them learn more about our long term care issues and help your residents and staff meet the lawmakers who impact their lives. You can visit the Members Only Legislative Section on the FHCA Web site for tips on how to conduct a successful legislative visit, and be sure to e-mail me an update and photos so we can share it with the rest of the membership.

FHCA Testifies Before US Aging Committee, Urges Importance of Coordination Between Policymakers & Long Term Care Providers In Planning for Disasters

On Wednesday, the Florida Health Care Association’s (FHCA) Senior Vice President of Policy and lead emergency preparedness representative, LuMarie Polivka-West, testified before Congress, focusing on the importance of a coordinated effort between long term care facilities and the government in all aspects of disaster planning and preparedness [to view the complete testimony, click here].

“The Florida Health Care Association has been taking the lead in Florida in ensuring that our state’s frail elders and citizens with disabilities residing in nursing homes and assisted living facilities are able to retain access to the long term care and services essential to their health and well being during a disaster,” stated J. Emmett Reed, FHCA Executive Director. “We encourage Congress to take swift action to ensure that all care providers – regardless of tax status – can access federal assistance for disaster relief efforts.”

In her testimony before the Senate Special Committee on Aging, Polivka- West discussed complications that occurred during the 2005 hurricane season, stating, “As decisions were being made regarding evacuations, many nursing home administrators did not have the same knowledge or guidance about when and if they should evacuate as hospitals did. Following several hurricanes during that season, utility services did not understand the special needs of the frail elderly and those with disabilities in nursing homes and assisted living communities, leaving them without electricity and telephone services.”

As the Senior Vice President with the Florida Health Care Association (FHCA) and Principal Investigator of the John A. Hartford Foundation Emergency Preparedness grant, Polivka-West discussed the steps that need to be taken by our nation’s long term care facilities and policymakers to develop appropriate disaster planning. These steps include creating a disaster planning guide and software that facilities can refer to, including disaster preparation training exercises in nursing home staff program, and assembling annual hurricane summits.

Polivka-West addressed the importance of keeping facilities informed and supplying them with the tools to be prepared in any given emergency situation. She stressed that forming a constructive dialogue with legislation is crucial to creating a well-executed disaster plan. “Due to the very vulnerable and complex population that we serve it is essential that we work together with policy makers to better prepare ourselves for any disaster,” stated Ms. Polivka-West.

“The road ahead is no doubt challenging,” concluded Polivka-West. “But the important task before us is to objectively examine how local, state, and federal governments – working with transportation, the health care spectrum and business groups – can better prepare for and coordinate disaster recovery efforts for our most vulnerable citizens nationwide.”

FHCA partners with its national affiliate, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), to make available emergency preparedness resources and information to other long term care facilities across the country. Polivka-West serves as a member of the AHCA/NCAL Disaster Preparedness Committee. FHCA has worked in concert with AHCA/NCAL in coordinating a number of national summits, including the most recent one in December 2008 which brought together state and federal partners in long term care, transportation and emergency management to examine the availability of and access to transportation resources for long term care providers during emergency situations.

2009 Legislative Session Outcomes for Nursing Homes

When legislators cast the final vote on Friday, May 8, nursing homes saw a three-percent cut to their Medicaid rate; however, the Nursing Home Quality Assessment Program will be adjusted to for providers to "offset" the cut through an expanded assessment, thus allowing the state to draw down additional federal dollars to fund nursing home care.

Additionally, there will be no permanent elimination of the annual price level increase in the nursing home budget. Facilities’ financial stability will be preserved, as well as their ability to effectively recruit and retain qualified staff and cover their increasing costs of fuel, utilities and property/casualty insurance. Legislators also agreed to allow a one-year waiver of the lease bond requirements, which takes effect July 1, 2009.

Also taking effect July 1st is the restoration of the 2.9 CNA staffing level contained in the statute. The provision allowing nursing homes to “buy back” their rate cuts will ensure the funding is available to pay for the staffing that is resulting in dramatic improvements to nursing home quality care.

The collective efforts of FHCA members, staff and lobby team resulted in this year's successful outcomes, at a time when many other areas saw significant funding cuts. The impact of the hundreds of nursing home owners, administrators, caregivers and family members descending on the Capitol during Lobby Wednesdays, as well as the thousands of e-mails sent to legislators urging them to protect funding for nursing home residents did not go unnoticed. FHCA is thankful to all who helped make a difference during the 2009 session to preserve quality care for our state’s frail elders.

Session Extended for One Week

Today we learned the session has been extended for one week, through May 8, to deal with budget issues only. House Speaker Larry Cretul and Senate President Jeff Atwater announced earlier that the framework for the budget has been worked out, which means conference committees can begin meeting this afternoon, with discussions expected to continue through Friday. The schedule has budget chairs meeting through the weekend, with the budget printing on Monday and being submitted to legislators by Tuesday. After the required 72-hour cooling-off period, a final vote on an agreed-upon budget is expected by next Friday, May 8.

As the End Draws Near...Or Does It?

As we plan for what we hope will be the last week of the 2009 legislative session, we are all waiting to see whether or not the budget is finished by Tuesday. If not, legislators will have to either extend the session, or go home and come back, before the June 20, 2009 expiration of the current budget. Unfortunately, taxpayers pay the price if session is extended or a special session is convened at a cost of $40,000 per day.

Meanwhile, a limited number bills are moving in either chamber. As we've been reporting, a health care train that contains the Agency for Health Care Administration's regulatory bill along with a Medicaid fraud bill now includes language on a new way to provide home care through the state's medical schools. Could this be another attempt at Medicaid reform? Last week, the nursing home therapeutic formulary bill we've been monitoring was amended to include so many requirements that it has been removed from the pharmacy bill. In other news, the controversial election bills may be dead for the time being, but we've seen oil drilling pop up as a last minute issue, so it will be interesting to watch that debate.

It seems as if the drive to reduce regulation and streamline governmental operations this session has lost its momentum. One wonders if the overriding pressure from the state budget is causing this low number of bills to pass this session. In any event, FHCA will continue tracking those health care bills on which we've been reporting in these last nine weeks, as well as keeping an eye on whatever outcome results as the clock ticks away on lawmakers' timetable to pass a budget in the final days.

Midweek Update

As we reach the last 10 days of the 2009 session (we hope!) we are seeing the creation of some health care trains, a concept that has been somewhat obsolete for a few years but is now coming back. This typically happens when bills are stuck in committees and legislators, worried they will run out of time before the end of the session, will add on an amendment to a bill that appears to be moving through the process. On Monday, Rep. Homan's bill, HB 7131, which deals with medical encounter data, was amended to include the text from HB 651 by Rep. Hudson, which is the Agency for Health Care Administration's deregulation bill, and SB 1986 by Senator Gaetz, which is the Medicaid fraud bill. There is no Senate companion to HB 7131, which is a requirement for a bill to be passed, so we'll be watching the bill carefully to see how things will progress.


The nursing home therapeutic formulary bill, SB 1868, will be debated on the Senate floor on Thursday. FHCA is continuing its communication with all Senators to help them understand how important this issue is to long term care providers.



FHCA also continues to work on an amendment to ensure that nursing home residents have access to voting at the polls. As we mentioned previously, an elections bill has, in fact, been passed by the Senate, SB 956, and by the House, HB 7149, but will need much work if it is going to pass the full bodies on the floor.

Citizen Groups Urge Legislative Leaders to Halt Voter Suppression Bills

On Monday, FHCA attended a press conference during which numerous nonpartisan public interest organizations called upon Florida Speaker of the House Larry Cretul and Senate President Jeff Atwater to prevent two election bills from reaching the floor of the state legislature’s chambers. The groups stated the legislation (SB 956/HB 7149) passed despite the lack of opportunity for public input and also objected to the bills’ content.

Among the public interest groups calling for defeat of the bill during Monday’s press conference were the League of Women Voters, AARP, AFL-CIO, NAACP, Advocacy Center for Persons with Disabilities and Miami-Dade Election Reform Coalition. Joining them were more than a dozen Democratic legislators who cited a critical New York Times editorial titled "Suppressing the Vote in Florida."

FHCA is particularly concerned about the proposed changes to Florida’s voting and elections laws outlined in SB 956, which further limits acceptable IDs for voter registration and identification at the polls. Retirement center identification would no longer be valid with this bill, which is likely to disenfranchise many elderly voters, including those in nursing homes, who no longer have a driver’s license. Additionally, the bill eliminates the only free forms of ID that are currently valid and proposes no acceptable alternatives. Several FHCA member nursing homes currently serve as election polling places, and the limitations that SB 956 imposes on acceptable IDs would prohibit facility residents from the ability to exercise their right to vote in person.

Nursing Home Budget Update

On Thursday, the House and Senate passed their respective budgets, setting up conference negotiations to begin on Monday. The nursing home budget language remains unchanged, with a 3 percent rate reduction in the Senate ($81 million) and a 2.5 percent rate reduction in the House ($69 million).

The House version contains language that continues to prohibit the Agency for Health Care Administration (AHCA) from citing facilities for failure to comply with the 2.9 CNA staffing level as long as the facility remains above the 2.6 CNA staffing level through June 2010.

The staffing issue generated some debate on the House floor, as Reps. Ocscar Braynon (D-109) and Yolly Roberson (D-104) discussed how the 2.9 staffing has greatly improved care in Florida nursing homes. Chairman Kevin Ambler (R-47) responded that nursing homes funding is being cut because providers were able to buy back previous rate cuts from January 1, 2008 and January 1, 2009 with the Quality Assessment Program that passed during the special session earlier this year. To help ameliorate the current funding cut proposed, he stated, the House extended the 2.6 staffing for another year. He argued that between a recent AHCA staffing report showing quality of care was very good under the 2.6 staffing and the flexibility this gives nursing homes, the extended staffing moratorium should not have any impact on quality of care. Reps. Braynon and Roberson pressed Chairman Ambler that, if the money could be found for nursing homes, the 2.9 staffing should be restored. Ambler responded that if any additional money is put into the health care line item during the budget conference, the restoration of nursing home funding and the staffing level will be his first priority.

Rep. Braynon offered an amendment that, if the tobacco tax passed through the legislature, then the 2.9 CNA staffing level for nursing homes is restored. Unfortunately, the amendment did not directly link any revenues from tobacco money to a nursing home rate restoration, so after a positive discussion with Chairman Ambler on the House floor, he withdrew his amendment.

FHCA's position continues to be one of supporting the higher staffing ratio of 2.9 CNA hours if the legislature provides the appropriate funding. We believe that funding and staffing must be aligned. In the meantime, we will continue monitoring the budget process once the conference begins on Monday and keep urging legislators to reconsider these funding cuts to nursing home care for our most frail elders.

And The Week Goes On

As week seven of the 2009 legislative nears a close, a lot has happened. After a stormy beginning, the sun emerged in Tallahassee, which was wonderful for the 50+ FHCA members in town for our last Lobby Wednesday. We welcomed members from Opis Management and Clear Choice Health Care, as well as several of FHCA's Florida Leaders, who joined us for an early morning at the FHCA headquarters in anticipation of a busy day ahead.

It was a good day to be at the Capitol, as there were several health care committees meeting. Most relevant was the discussion on SB 1868, which creates a formulary for nursing homes similar to that in place for hospitals. This is an important issue for FHCA, and during the meeting Dr. Kaplan, a medical director who currently works for Opis, testified in support of the bill. He asked all the long term care providers in the room to stand, and it was an impressive sight. Be sure to check out this week's Provider Program online video update to see more.


HB 1209 and SB 2284, which will give nurses in Florida the opportunity to voluntarily contribute toward the Florida Center for Nursing, are moving in both the House and Senate.

The Agency for Health Care Administration has been working to keep its deregulation bills, HB 651 and its companion, SB 2286, moving in both chambers. In fact, these bills appear to be this year's health care train as there are many other provisions being added on in the form of amendments. These bills contain several deregulation provisions for nursing homes, and we will be pleased to see the final version signed by the Governor.

The Senate Judiciary Committee passed a version of the workers' compensation bill (SB 2072); however, it does not match the version passed by the full House (HB 903), so these differences will have to be resolved before it can go to the Governor for signature.

SB 2004 also passed through the Senate Criminal Justice Committee this week. This is the red-light bill, sponsored by Sen. Thad Altman (R-24), which uses a portion of the motorist fines to go toward creating an add-on for qualified nursing homes serving residents with brain and spinal-cord injuries.

FHCA is continuing to monitor the budget which, after today, will head to conference for resolution. Hopefully agreement between both chambers will be reached so the session can end on time.

Amendments Fly on a Stormy Monday

As FHCA staff headed back to the office after a day at the Capitol, the dark clouds began swirling around us. A tornado warning has been issued for the City of Tallahassee, which resulted in us picking up our pace and thankfully making it inside before the rain and hail arrived.

Things were a bit stormy inside the Capitol, as well, as the amendments started flying for a health care bill we've been tracking. HB 651, sponsored by Rep. Matt Hudson (R-101), is the Agency for Health Care Administration's bill which contains several "deregulation" provisions. It appears to be the perfect "health care vehicle" to move its way through session, and while some of the amendments stayed and some did not, in the end it is still a bill supported by FHCA. The next stop the bill will make is the House floor, so there appears to be a silver lining on the horizon. The Senate companion, SB 2286 sponsored by Sen. Andy Gardiner (R-9), is currently in the Senate Judiciary Committee.

Most of the House Health Care Services Appropriations Committee was taken up by HB 433, sponsored by Rep. Ken Roberson (R-71). FHCA supports this bill, which implements a "formulary" for nursing homes similar to the one that has been in use by hospitals for nearly 25 years. The debate primarily centered around whether the physician was notified prior to the dispensing of the substituted drug (what we have now) or simply notified (the way a formulary system works). A hand-written amendment, filed during the committee meeting by Rep. "Doc" Renuart (R-18), added the "prior to dispensing" language, which is not in the companion Senate bill (SB 1868) also set to be heard later this week. This issue is far from over.

For FHCA, it will be a busy week as we welcome our members to town for our last Lobby Wednesday. The House and Senate, for their part, will spend lots of time in Session, and anything can happen when legislators are on the floor. FHCA will continue tracking these bills, as well as our important reimbursement issue, and will continue keeping members up-to-date as things progress.

A Holiday Break

The halls of the Capitol are quiet today as House and Senate members left Tallahassee late yesterday for the Easter and Passover holidays. Many were concerned about possible flooding along I-10, however that did not stop lengthy budget meetings that went late into the evening.

In the end, budget bills were positioned for a floor debate next week. Next week is back to "business as usual," as policy committees will meet to move several important regulatory bills. Included is HB 651 by Rep. Matt Hudson (R-101), and the companion, SB 2286 by Senator Andy Gardiner (R-9), which are the deregulation bills put forth by the Agency for Health Care Administration. In addition, FHCA staff and lobbyists continue to work on other priorities of the Legislative Committee, including reimbursement, resident voting, ombudsman issues, duplicative inspections and reports and guardianship fees.

FHCA's last Lobby Wednesday will be on April 15th, and a large crowd is expected. Participation at these events has far exceeded last year's numbers, and FHCA appreciates everyone who takes the time to come to Tallahassee and help advocate for our critical long term care issues.

House Budget Starts to Take Shape

The House Appropriations Council on General Government and Health Care approved its half of the state's budget today, which includes health care funding. During the meeting, Rep. Carl Domino (R-83) stated that the Healthy Seniors budget contains only minor cuts in programs for seniors. Rep. Jimmy Patronis (R-6) reported that the Medicaid budget is $18.1 billion, with $3.5 billion coming from the state's general revenue fund. The federal stimulus money allowed the state to reduce its funding by 19.1 percent. The budget included no cut in rates for hospitals or most Medicaid providers. Rep. Kevin Ambler (R-47) stated that nursing homes have a 2.5 percent cut due to an increase in the Nursing Home Diversion Program.

In discussing the Budget Implementing bill, Rep. Oscar Braynon (D-103) offered an amendment to strike language which extends the moratorium for another year on nursing home staffing above 2.6 CNA hours. He, as well as Rep. Yolly Roberson (D-104), called for higher staffing and the funds to pay for it. Rep. Ambler provided an extensive defense of the 2.6 hour staffing, including findings from a recently released Agency for Health Care Administration report, as well as the current budget situation. Rep. Braynon withdrew the amendment and asked that everyone continue to look at this issue.

In the end, the Council approved both the budget and the budget implementing bill along party lines. FHCA will continue to monitor the proposed cuts to nursing homes, urging legislators of the negative effect these cuts would have on nursing home quality care for residents.

Press Event Brings Together Elder Care Advocates to Oppose Nursing Home Funding Cuts

Today, as legislators considered millions in funding cuts to nursing home care, Senator Nan Rich (D-Weston) and Rep. Mark Pafford (D-West Palm Beach) joined Florida Health Care Association (FHCA) Chair Deborah Franklin, Leslie Spencer of AARP, Cloreta Morgan of SEIU and other elder care advocates to urge legislators to use federal stimulus dollars as they were intended – for health and human services – and not cut funds for nursing home care. Currently, the Senate had proposed $81 million and the House $69 million in funding cuts to the Medicaid program, while taking over $780 million of federal stimulus dollars designated for health care and redirecting them into other areas.

“Nursing homes cannot be treated as just another line item in the state budget,” said Deborah Franklin, FHCA Chair. “Washington has provided the much-needed relief…we cannot allow these millions of dollars in cuts to nursing home care.”

Franklin noted during today's event that the solution for funding nursing home care passed in the January 2009 special session with the Quality Assessment Program. Providers began self-imposing a 5.5 percent assessment on April 1, 2009 to allow the state to draw down more than $390 million in federal money. This is in addition to the $4.2 billion that Florida Medicaid will receive in federal stimulus dollars over the next 27 months.

Florida legislators have no reason to impose these cuts when the funding is available through the federal stimulus package. They are simply unnecessary and unacceptable and threaten to undo relief from the Quality Assessment Program, as well, which has barely begun to take affect,” Franklin said.

“We have witnessed a dramatic improvement in nursing home care, and that's a credit to the hard work of the nurses and CNAs who do health care's toughest job,” said Senator Nan Rich. “Our state is in a fiscal crisis that is soon to turn into a moral crisis if we continue cutting critical services for our most vulnerable citizens.”

Rich and Franklin both noted that the elder care reform (SB 1202) that passed in 2001 that required increased minimum staffing standards has resulted in dramatic improvements to nursing home quality. Florida hired over 12,000 nurses and CNA positions over the past eight years, and today has among the highest ratio of staff-to-resident care in the nation. Maintaining steady quality improvements for resident care is a goal strongly supported by elder care advocates including AARP, Florida Association of Homes and Services for the Aging, Florida Catholic Conference, Florida CHAIN and the Service Employees International Union, among others.

The Second Half

As the last half of the 2009 legislative session begins on a humid Monday morning, all eyes are on the state budget. Many committee meetings are packed into this shortened work week (which will last only 2.5 days), and while regulatory and policy issues are important, no one can escape the ever presence of the budget. There is much concern by everyone regarding the state's use of federal stimulus dollars, decisions to cut provider rates and the growing rift between legislative members in the two chambers over just who makes the final decisions.

Let it be said that this short week may be more exciting than week's past. We're jumpstarting this Monday with a press conference today at 12:15 p.m. on the 4th Floor of the Senate Rotunda to address our concerns with these provider cuts when money is available through the stimulus package. FHCA will be joined by Senator Nan Rich (D-Weston), Leslie Spencer of AARP and Cloreta Morgan of SEIU. Watch for our next update with more on this event, and the resulting discussions that surround the state budget.

Weathering the Storm

As Tallahassee continues to receive unending rain, our dedicated FHCA members braved the weather and made their way up to the Capitol for their legislative visits. The weather may have dampened some of the Dade Day activities, but with a captive audience in the Capitol, our members were able to see many more of their legislators.

This is very important, as we are in the midst of serious budget problems and need everyone's support to help educate legislators to the extent of the problem. The proposed nursing home funding cuts - $81 million in the Senate and $69 million in the House - could threaten quality care and quality of life for our state's frail elders. These cuts are unacceptable, particularly when money is available from the federal stimulus package, yet lawmakers are moving over $780 million of stimulus dollars out of health and human services and into other areas. FHCA members, family members of residents and long term care staff are encouraged to contact their legislators and urge them to oppose these funding cuts and use the stimulus dollars as they were intended - to fund the Medicaid program. You can click here, or use the Take Action link to the right under the FHCA Online Resources section to send this important message to your legislators.

The state budget is often one of the last bills to get worked out during the session, so we know there is a process ahead, With the magnitude of the funding cuts, however, we cannot afford to wait or let up on our elected officials.

Next Monday, April 6th, FHCA will host a press conference with Senator Nan Rich and other elder care advocates to oppose these cuts and raise awareness about using the stimulus as it was intended. If you're in town, please stop by the 4th floor Senate Rotunda at 12:15 p.m. to show your support. In the meantime, stay tuned for more on this important issue next week.

Week 5 Brings a Standstill

As this week begins, the legislative outlook for regulatory reductions looks like it may be coming to a standstill. Although SB 1562 had its first hearing and passed favorably through that committee, the companion, HB 1397, did not get a hearing before the House committees stopped meeting. This means the bill is probably dead for the 2009 session, which is discouraging news for the many FHCA members who have been working hard on eliminating duplicative inspections.

FHCA doesn't stop working on its legislative priorities until the session comes to a close, so be sure to check back for updates soon.

Amendment to Nursing Programs Bill Has Positive Results

Representative Denise Grimsley (R-77) unveiled her strike all amendment to HB1209, related Nursing Programs, during yesterday’s State & Community Colleges & Workforce Policy Committee meeting. This is the companion bill to SB 2284, sponsored by Sen. Mike Haridopolos (R-26), that we mentioned last week. Clearly the Representative has been working hard with the nursing organizations and schools, because everyone seemed happy about the amendment to the bill. The amendment would maintain the Board of Nursing’s role in approving nursing programs while removing their subjectivity and rule-writing authority. The amendment also allows for an increase in the teacher-to-student clinical ratio from 1:12 to 1:18 in some cases. The bill, as amended, was passed unanimously, and we congratulate Rep. Grimsley for her leadership.

Health Care Wednesday

Wednesdays are always busy health care days in the Capitol, but as nearly 100 FHCA members descended upon the halls, it soon became apparent that their presence was not one to miss. The Lobby Wednesday group this week included representatives from Districts 4, 5 and 11, FADONA, Sea Crest Healthcare Management, as well as PPS Results Group, an FHCA associate member.

Legislators did not let them down as the Senate Health Care Regulation Committee kicked off the morning hearing SB 1562 by Senator Mike Bennett. As expected, the Long Term Care Ombudsman spoke against the bill, stating the health care of residents is up to the Ombudsman and that the Ombudsman program has changed the persona of nursing homes due to the care that these volunteers provide to residents. FHCA Chair Deborah Franklin followed with passionate testimony about her 25+ years in long term care and the focus she and her fellow providers in the audience have on quality of care and quality of life for residents. She took time to thank the Ombudsman volunteers who do spend time in facilities advocating on behalf of residents, but noted that the administrative assessment has evolved to duplicate the inspection AHCA is already conducting on facilities through its certified team of nurses, dieticians, life safety experts, etc.

The passage of 1562 will help the Ombudsman refocus their role back on resident advocacy and provide them more time to spend in the facilities, speaking with residents, family and staff about the important role they play in resolving resident complaints. FHCA is thankful to Senator Bennett for the great job he did in responding to this issue and correcting the record, and the bill passed favorably out of the committee, 7-1.

Later in the day HB 433 passed the House Health Care Services Policy Committee, with only seconds to spare at the end of the meeting. This bill creates a "therapeutic formulary" for nursing homes, similar to that used in hospitals. The House Health Care Regulation Committee also approved HB 1097, which begins the implementation of electronic records in Florida.

The Shady Ladies Are Back!

On Monday, six family members from Shady Rest Nursing Home in Ft. Myers arrived in Tallahassee to spend three days visiting legislators in support of long term care and FHCA's 2009 legislative priorities. FHCA members might remember these folks from the 2007 Annual Conference when they supported their administrator, Wes Edwards, as he received the Arthur Harris Government Services Award. Unfortunately Wes was unable to join them for this visit, but these folks have had a successful trip to Tallahassee, busily working the halls of the Capitol and making lots of visits to their legislators. Their stories are amazing, and I enjoyed speaking with them Monday evening when they stopped by the FHCA headquarters for a legislative briefing. This year the group includes two men, so we might have to coin a new name for them. Regardless, their impact on legislators cannot be minimized. What a great idea-thanks to Shady Rest.

Too Long Tuesday

FHCA staff and lobby team members have spent the day meeting with the Agency for Health Care Administration, AARP, trial attorneys, Senators and their staff to provide more information about SB 1562 before it comes up in the Senate Health Regulation Committee meeting at 10:15 a.m. on Wednesday. Postponed after last week, we expect it will be heard tomorrow despite the crowded agenda. Many FHCA members are in town this week, along with FHCA Chair Deborah Franklin, who will testify in support of the bill. Watch for more details soon.

Budget Woes Could Have Drastic Effects on Resident Care

Late last Friday (Friday the 13th), the Office of Economic & Demographic Research released the results of the General Revenue Estimating Conference held that day, lowering the expected General Revenue projections again. Projected General Revenue collections for the current Fiscal Year 2008-09 were $1.1 billion below the amounts used for the January Special Session, and projected General Revenue collections for Fiscal Year 2009-10 were reduced by an additional $2.3 billion. So, for Fiscal Year 2009-10, Florida is expected to have slightly less than $20 billion in General Revenue to spend. This amount compares to $27.1 billion available for the Fiscal Year 2005-06 budget period.

What this means is that after the funding of the minimal “must funds,” such as Medicaid workload and maintenance of effort, education, and prisons, the projected deficit for Fiscal Year 2009-10 is approximately $6.1 billion without consideration of Federal Stimulus funds. After application of the Federal Stimulus funds available to the state of Florida, the deficit is reduced to $3.1 billion. Given Florida’s constitutional mandate to have a balanced budget, the legislature will be charged with finding an additional $3.1 billion in additional cuts or revenue enhancements.

As a result, today the Senate Health and Human Services Appropriations Committee required each of the agencies for which they have jurisdiction to present options to achieve a 10% budget savings. Foremost among the options presented by the Agency for Health Care Administration was a proposal to reduce nursing home Medicaid rates by 12.1 percent, which equates to $357 million ($115.5 General Revenue) in reduced funding. This would equal approximately $22.75 per Medicaid patient day.

AHCA also included options to expand the Capitated Nursing Home Diversion Program by another 1,000 slots, saving $14 million ($4.5 million General Revenue), and the elimination of adult Dental, Visual and Hearing Services, saving $30 million ($9.6 million General Revenue).

Clearly draconian cuts of the nature being discussed would be totally devastating to our profession. Now is the time for FHCA members to let legislators know how difficult it is to survive the March Medicaid rate reductions of an average of $14.77 and what a cut of $22.75 per Medicaid patient day would do to your ability to care for Florida’s frail and elderly residents.

Of note, the proposed cuts would threaten the employment of over 10,000 nursing home workers and exceeds the entire amount of funding provided under the provisions of SB 1202, which increased Certified Nursing Assistant staffing from a regulatory requirement of 1.7 hours per patient per day to 2.9 hours per patient per day. How can providers be expected to maintain the quality of care improvements that have been made with such a loss in funding???

Debate on Nursing Programs

In yesterday's meeting of the Senate Committee on Health Regulation, attendees were not lacking for an exciting give-and-take over SB 2284, related to nursing programs. SB 2284, which is sponsored by Sen. Mike Haridopolos (R-26), repeals the authority of the Board of Nursing to approve programs for the education of nurses. While the nursing curriculum design would still be determined by the Board of Nursing, the school licensure process would be moved to the Department of Education or the Commission for Independent Education. People in support of the bill asserted it was needed since current Board of Nursing policies and actions create unnecessary barriers to expanding nurse education. Opponents of the bill declared that removing the approval authority from the Board of Nursing could result in inadequately trained nurses. The contentious issue seemed to break down along the lines of schools which support the bill and nurse organizations who are against the bill. In the end, the bill passed with a 5-3 vote.

Wednesday's Hot News

Well, it is Wednesday again. After a busy Tuesday preparing material for our largest group in town for Lobby Wednesday so far, FHCA staff kicked off the activities with a Lobby Tuesday briefing for nearly 70 members from Cypress Health Care Management and Gulf Coast Health Care. On Wednesday, representatives from FHCA's District 12 in Pensacola and District 13 in Ft. Pierce, as well as Good Samaritan Society, also took part in legislative visits at the Capitol. All total nearly 150 nursing home owners, administrators, nursing staff, social workers and other caregivers took part in the day's activities. Wherever I went throughout the Capitol today, I saw FHCA members. Many of them thanked me for the great orientation provided by FHCA staff, stating how comfortable they felt visiting their legislators. So as you can see, anyone can do it!

On the calendar for today was SB 1562, sponsored by Senator Bennett, which reduces many duplicative regulatory activities. Time ran out before that bill or SB 2286, which is the Agency for Health Care Administration's deregulation bill sponsored by Senator Gardiner, could be heard. We can only hope they are on the agenda for March 25th.

On the House side today, the House Health Care Regulation Committee passed HB 651, sponsored by Representative Matt Hudson, which is the companion AHCA deregulation bill. FHCA supports this bill which eliminates unnecessary paperwork and gives nursing home staff more time to focus on resident care. I testified on behalf of FHCA members noting that, while we supported the bill, we were concerned about the elimination of the Quality Monitors and would hope they could be retained to focus on problem facilities. The Committee also passed HB 433, sponsored by Representative Roberson, which creates a formulary system for nursing homes similar to the one presently used by hospitals.

So, it was a good day for FHCA, and along with so many great members in town and the sun shining upon us, we continue to work on behalf of long term care providers tomorrow and every day thereafter.

Week 3 Kick Off

Is it really only week three? This week will be one of FHCA's busiest, with more than 100 members from nursing homes across the state expected to descend upon the Capitol for our Lobby Wednesday. In addition to watching the budget-which is not looking good-there are two important regulatory bills which FHCA supports that will be addressed during the same committee meeting on Wednesday.


There has been lots of press surrounding SB 1562, sponsored by Senator Mike Bennett, which eliminates several duplicative surveys and procedures. The bill will be amended on Wednesday to fix several problems created during the bill drafting process. One of the most important issues in the bill for long term care providers is the removal of the administrative assessment by the Long Term Care Ombudsman. The elimination of the assessment does not, however, prevent the Ombudsman from continuing to do his or her most important job, which is to advocate for residents at any time needed.


Keep watching FHCA's legislative blog for updates during the week, and be sure to tell your friends to sign up to follow.

Another Week Draws to a Close...

In typical fashion, the legislature is ending week two with appropriations meetings both on Thursday and Friday. Most committees are still in review mode, looking at the Governor's proposed budget, as well as dissecting the budgets for the state agencies under their review. One rumor that is still active is the merger of the Agency for Health Care Administration and the Department of Health. We'll continue to watch this issue to see how it unfolds.

The Senate Health and Human Services Appropriations Committee held a ½ day meeting today on numerous health care programs under its jurisdiction. The audience, numb by endless presentations from Agency staff, perked up when Senator Peaden concluded the meeting by directing all health agencies to submit a plan to the committee for its next Thursday meeting that will reduce their next year budget by 10%.

Wild Wednesday!

Along with our Lobby Wednesday participation from Life Care Centers of America and the FHC Activity Coordinators Association, as well as the activities related to Ambassadors for Aging Day, FHCA staff and lobbyists tracked a number of bills. These bills related to reorganizing the Department of Children and Families (SB 1986), finalizing the Silver Alert Grant Program (SB 1330) and Electronic Health Records (SB 162). The last bill is one we are very excited about, as we know many of our members are moving into the electronic age.

Wednesday was also Catholic Days and the traditional Red Mass was held last night. This mass is for legislators to ask for guidance during the legislative session ahead.

Finally, I was excited to see a group from Emerald Shores in special t-shirts and enjoying the singing and dancing taking place in the Capitol Courtyard. This facility is one of our FHCA members and had come to town with residents and staff to enjoy Ambassadors for Aging Day. Thanks to them for making the trip and being part of all the excitement at the Capitol.

Ambassadors for Aging Day

Today, FHCA met with hundreds of Florida seniors who passed through the halls of the Capitol for Ambassadors for Aging Day. The event was a great opportunity for elders and elder advocates throughout Florida to showcase the special contributions of older adults to legislators. FHCA helped to sponsor the event, which included health screenings, exercise demonstrations, a number of elder-related exhibitors, performing artists, music and entertainment. Several FHCA members from Life Care Centers of America and the Florida Health Care Activity Coordinators Association, who were in town for the Association's Lobby Wednesday activities, stopped by the booth and helped us promote the important role of long term care providers in our state.

On the Agenda for Day 2, Week 2

During today's committee meetings, FHCA staff monitored several bills of interest to nursing home members, including the major Workers' Compensation bill, HB 903, which was discussed but retained by the House Insurance Committee. As such, it will have to be heard again if it is going to move.


Health care issues on the agenda today included HB 753, which urges Congress to continue funding of the Silver Alert program, HB 767, which allows for the combination of mental health services and substance abuse services at one time, and HB 109, which allows certain medical professionals to violate confidentiality if necessary for someone's safety.


FHCA will be tracking the progress of these bills throughout the legislative session, and as always, long term care providers can stay up-to-date on the Members Only Legislative Section of the FHCA Web site.

Day 1, Week 2: What's On Tap

The weather in Tallahassee took an upward turn and so did the heat in the Capitol. This is the week when suddenly everyone realizes that it's time to get their bills moving or their amendments filed, and as a result the pace quickens. Activities at the Capitol today included the "Officer Down" memorial, which moved everyone on the outside plaza, and the farmworkers also gathered in the halls promoting their issues. Also on tap this week is Catholic Days, with the traditional Red Mass being held so legislators can pray for spiritual guidance through the upcoming session.

Wednesday is Ambassadors for Aging Day, and FHCA will be one of the many organizations promoting services for Florida's seniors. That same day, FHCA will have a dedicated group of members in town for our Lobby Wednesday activities, where they'll have an opportunity to meet with legislators and talk about our important long term care issues. Stay tuned for more information as we continue to track the issues that impact long term care providers, including the beginning of budget negotiations, ongoing negotiation of our legal reform bills and fine tuning of the regulatory reduction bill. You can stay up-to-date on these and other critical issues that impact long term care on the Members Only Legislative section of FHCA's Web site.

On Wednesday, FHCA Executive Director Emmett Reed joined representatives from AARP, the Florida Association of Homes and Services for the Aging, the Florida Council on Aging, Children's Home Society, Florida Coalition for Children and other organizations to urge lawmakers to enact long-term solutions to put the state back on track for a bright future. The press conference was organized by Florida's People, Florida's Promise, a coalition of more than a dozen organizations who speak on behalf of millions of Floridians representing all ages, incomes and conditions.

Leaders of the groups noted that even though recent federal aid will help ease the state’s immediate budget crisis, Florida needs lasting revenue solutions that will bolster the state’s economy and make the state an attractive place to live. Three possible revenue solutions for lawmakers to consider include an increase in the state cigarette tax, a review of state sales tax exemptions periodically and the collection of state sales tax on purchases made via the Internet, catalog sales or telephone hotlines. Continued cuts to critical health and human service needs could hurt Florida’s families, businesses and its ability to recover from the economic downturn.

As the First Week Ends...

As we look at the calendar for the end of the first week, the Legislature will be spending today and part of Friday listening to presentations by the Governor's staff on his recommended budget. You may recall that the Governor's budget is one part of the three-legged stool. There is also a House and Senate budget coming, which should all be reconciled by the end of the session.
In addition, the House continues its discussion on the elimination of some sales tax exemptions, which has been an ongoing issue that is still not settled. For example, if you buy a U.S. flag, pole and hardware, the entire purchase is tax exempt. If you buy the flag in the morning and go back later for the pole and hardware; however, the flag is tax exempt but the hardware purchase is taxed.

Stimulus Dollars Bring Good News

Yesterday, the House Appropriations Committee on General Government and Health Care heard testimony from Dyke Snipes, Medicaid Director for the Agency for Health Care Administration on the enhanced Medicaid Federal match (FMAP) contained in the Economic Stimulus Law recently passed by Congress. Dyke provided the criteria Florida must meet to qualify for the enhanced match, which would result in the state's FMAP increasing from 55.4% to 67.64%. In the 2008-09 Fiscal Year, this increase would provide Florida with an additional $953 million, or $661 million in excess funds after fully funding Medicaid, including caseload increases.

Dyke stated this $661 million can be freed up for any other purpose by the Legislature except placement in reserve or rainy day funds. This initiated a number of questions from legislators, such as whether funds can be used to increase reimbursement rates or if it could empty the wait lists for Home and Community Base waiver programs, and "yes" was the answer to all. In 2009-10 FY, the increase will be $1.169 billion or $646 million of additional funds after fully funding Medicaid programs.

This was the first good news for legislators who fear they will have to make massive cuts to health care services.

The other side of the Baker Act

In complete opposition to HB 535, which was passed yesterday by a House committee after much discussion and riddling, the companion Senate bill, SB 456 sponsored by Senator Don Gaetz (R-4), passed its first committee, Senate Children, Families and Elder Affairs, with not a question or comment.

It will be interesting to watch these bills progress, and FHCA members can stay up-to-date through our weekly legislative updates on the FHCA Members Only Legislative Page.

Tallahassee Today

Earlier today Sen. Nan Rich (D-34) was selected to be the leader of the Senate Democrats in 2010, making her the first woman to hold the position of minority leader in Florida. Sen. Rich is recognized for her commitment to children and senior citizens and has always been a strong advocate for FHCA's issues and the long term care residents served by our members. If you're in Sen. Rich's district, be sure to congratulate her and thank her for her continued support of FHCA.

More great news in Tallahassee today. Rumor has it that President Obama is going to announce that Florida's Division of Emergency Management Director, Craig Fugate, is being tapped to head the Federal Emergency Management Administration. Fugate has run the Division since 2001. If confirmed by the U.S. Senate, Fugate would replace acting FEMA director Nancy Ward as head of the agency, which employs 2,600 full-time staff and has more than 4,000 stand-by disaster employees.

This decision reinforces the recognition Florida has received as a result of our success during the 2004 and 2005 Hurricane seasons. FHCA is very excited about this opportunity for Craig.

Dental Health Access

HB 185, sponsored by Rep. Matt Hudson (R-101) regarding access to health care, was heard in the Health Care Regulation Policy Committee yesterday afternoon. The original bill as filed had one provision that established a 10-member Dental Health Access Task Force to make recommendations on the following Medicaid dental related issues: reimbursement; provider enrollment; maximization of dental funding by other states; claims processing; establishing temporary assistance to dental offices in the event of unexpected death of a provider; and creating a process to address patient behavior in dental offices. A strike-all amendment, filed by Rep. Hudson, removing the task force language from the bill was introduced and passed unanimously.

FHCA was supportive of this provision, and we’re not sure why it was removed. We will continue to watch the Senate companion bill, SB 702 sponsored by Sen. Don Gaetz (R-4), to see what happens.

Baker Act

Freshman legislator Rep. Brad Drake (R-5), got his due ribbing when HB 535 was heard at the Health Care Services Policy Committee yesterday afternoon. Supported by FHCA, this bill provides for a memorandum of understanding between law enforcement and receiving facilities, and many committee members had questions regarding some of the terms used in the bill. After a lengthy discussion, the entire committee voted against the bill. Rep. Juan Zapata (R-119) , however, called for reconsideration and, in a second vote, the bill was unanimously passed on to the next committee.

Sexual Predator Checks Are Back

Senator Ronda Storms (R-10) has just filed SB 2634, which includes a provision to require a search of the FDLE Sexual Predator database to be conducted on prospective or newly-admitted nursing home residents. FHCA will be tracking this bill closely and keeping members up-to-date on its progress.

Opening Day

Watch your local public television station today to see the opening festivities of the 2009 Legislative Session at the Florida Capitol. Lots of people, lots of flowers, lots of traffic and lots of pictures abound in Tallahassee, which is tradition. The House and Senate do their formal installation duties this morning, and then the Governor will share his State of the State message later this evening. Committee meetings start this morning, and FHCA will be tracking several bills that impact long term care in Florida. Remember to visit the Members Only Legislative Section of our Web site to stay up-to-date.

FHCA talks long term care with U.S. Senator Bill Nelson

On Friday, February 27, Florida Health Care Association (FHCA) member Lisa McGinley of Brynwood Center in Monticello joined FHCA Executive Director, Emmett Reed, and several FHCA staff members to meet with U.S. Senator Bill Nelson (D-FL) at his Tallahassee office. The meeting provided an excellent opportunity for the Association to discuss the critical federal issues that impact long term care in Florida, including the arbitration, the Employee Free Choice Act (or card check) and the Stafford Act.

The group also provided the Senator with a historical timeline of how nursing home quality has steadily improved in Florida since the passage of landmark elder care reform in 2001, which mandated increasing minimum staffing requirements up to 2.9 CNA hours of care per resident, along with tougher regulation, quality improvement and risk management programs. The recent creation of the Quality Assessment Program during the 2009 Florida legislative special session helped nursing homes avert significant, increased funding cuts by allowing the state to draw down more federal dollars to fund nursing home care.

Discussions with Senator Nelson also surrounded the anticipated influx of federal stimulus dollars through the passage of the American Reinvestment and Recovery Act of 2009 and what that means to long term care providers and the residents they serve in Florida. Mr. Reed, Ms. McGinley and the others shared with Sen. Nelson that the Florida Health Care Association and the members it represents will be urging legislators during the 2009 regular session to preserve Medicaid funding to support the 2.9 hour staffing mandate and ensure facilities have the resources needed to not only continue providing quality care, but also to make much-needed renovations to aging facilities, modernize health care settings through health information technology and meet the growing demands of Florida’s aging baby boomers through a strengthened health care workforce.

Video Cameras in Nursing Homes

Great news kicked off the start of the 2009 Legislative Session. Representative Esteban Bovo (R-110) withdrew HB963, which would have established "granny cams" in Florida's nursing homes. Thanks to the many FHCA members who contacted Rep. Bovo to let him know the serious side effects that such a policy would have had on the privacy of other residents, staff and families.

Duplication, duplication, duplication

Many legislators are interested in helping reduce the duplicative and unnecessary regulations that the public has to deal with every day. To that end, FHCA submitted a list of 9 suggestions to several legislators, and the resulting bill, SB 1562, has already hit the streets. Due to some bill drafting errors, there are still corrections that need to be made, but this bill is a good start to help save the state resources by eliminating duplicative regulations.

FHCA members can stay up-to-date on the progress of this bill and other Association legislative priorities by visiting the FHCA Members-Only Legislative Section.

Nursing Home Residents' Personal Needs Allowance

HB 455 has been filed by Representative Rick Kriseman (D-53) to increase the nursing home resident's Medicaid personal needs allowance from $35 to $70 per month. Senator Dan Gelber (D-35) has filed the companion bill, SB 1632. FHCA is very supportive of these bills, which are back for the second year in a row. They were not successful last year as the funding source proved controversial. We have talked to Rep. Krisemen, and he is very excited to have many members of leadership indicating their support of the bill and the promise to look for some possible funding source.

FHCA members are encouraged to let your legislators know how important these bills are for the residents in your building. Need help finding who represents your district?Visit Online Sunshine to find a list of your Representatives and Senators, as well as their contact information.

Governor Releases Budget as 2009 Legislative Session Gets Set to Begin

Florida's budget challenges continue to be the primary focus of legislators as we prepare to head into the 2009 regular session next week. Last week Governor Charlie Crist released the Governor’s Recommended Budget, which is normally transmitted a month before the session is scheduled to begin. An extension was requested by the Governor’s Office, and granted by House and Senate Leadership, to allow for inclusion of money designated for Florida by the federal stimulus package, which was signed into law by President Obama on February 17, 2009. Florida TaxWatch has released a new analysis of the Governor’s Recommended Budget, which can be found online.

As we prepare for the start of the 2009 regular session, FHCA will continue communicating with legislators about the importance of preserving Medicaid funding to support the 2.9 CNA hours of per patient care. We believe that the increased staffing standards that were mandated in 2001, and the accompanying funding, have greatly improved care for Florida's frail elders and citizens with disabilities in our nursing homes. By preserving the funding, facilities will have the resources they need to do their critically important work, quality care for residents will continue to improve, facilities can make much-needed renovations and our state can meet the growing demands that aging baby boomers will have on long term care through a strengthened health care workforce.

Legislative Update: February 16-20, 2009

This week legislators wrapped up the last of their committee meetings before the start of the regular session on March 3rd. Most of the time was spent on meetings regarding the budget and the federal stimulus package, with a few bills being filed.

The Agency for Health Care Administration (AHCA) gave a presentation to the Senate's Health and Human Services Appropriations Committee on the impact of the federal stimulus package to Florida, which includes the FMAP increase. The Federal Medical Assistance Percentage is used in determining the amount of federal matching funds for the state's expenditures for assistance payments for certain social services, such as Medicaid. Florida is expected to see close to $3.5 billion for health care from the package, with its federal share of the match rising from the current 55% to 68%. The Committee also heard a presentation on Medicaid fraud and abuse, which costs the state significant dollars each year.

The House Health Care Appropriations Committee heard a presentation from AHCA on the Nursing Home Quality Assessment Program, which was created during the special session in January. The Assessment will help draw down additional federal dollars and allowed nursing homes to avert nearly $231 million in cuts to resident care funding. Instead the Assessment will restore the Medicaid funding cuts imposed on nursing homes in January 1, 2008 and January 1, 2009, as well as March 2009. The Assessment will become effective April 1, 2009 and will be calculated annually on a per-resident basis, exclusive of Medicare resident days. AHCA must seek a federal waiver from the Centers for Medicare and Medicaid Services for this to occur and precautions are in place in case that waiver has not been approved.

A number of bills were filed this week that impact long term care providers in Florida. Deregulation, insurance, "therapeutic interchange," personal needs allowance and the use of video surveillance in nursing homes are among the top issues we are tracking. You can read more about these bills and FHCA's position on the issues, as well as other legislative activities happening on behalf of FHCA members by visiting our Members-Only Legislative Section.