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

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

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

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

Years after Katrina, one federal program still misses the mark

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

Legislators convene for special session

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

House releases legislative calendar

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

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

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

House and Senate Leaders Announce Special Session

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

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

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

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

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

2010 General Election Update

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

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

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

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

Promote Voter Turnout; Protect Long Term Care

By Deborah Franklin, FHCA Immediate Past President


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

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

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

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

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

House Passes FMAP Extension - Long Term Care Community Applauds

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

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

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

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

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

U.S. Senate Approves FMAP Extension

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

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

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

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

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

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

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

Driving for Quality Care

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

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

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

FHCA Praises Governor Crist for Vetoing Nursing Home Funding Cuts

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FHCA 2010 Legislative Wrap-up

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

Protecting Nursing Home Funding

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

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

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

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

Streamlining the Regulatory Process

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

Managed Care

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

Strengthening Resident Protections

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

Preventing Harmful Legislation

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

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

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

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

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

Other Tracked Bills

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

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

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

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

Provider Program Legislative Scorecard

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

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

Thank You

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

Crist budget veto?

As reported by Gary Fineout, The Current

Speculation mounts that Crist could veto budget

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

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

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

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

Read more

The Drama Continues

As Reported by Gary Fineout for The Current

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

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

Deregulation Bill Dilemma

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

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

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

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

Sponsors say Fla. Medicaid overhaul dead for 2010

The Associated Press

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

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

Regulatory bills update

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

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

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

By Peggy Rigsby, FHCA Director of Government Services

Urge Legislators to Prevent Funding Cuts to Nursing Home Care

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

Help e-mail these important messages to your legislators:

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

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

Letters: Nursing-home bills would help sickest residents

Letters: Nursing-home bills would help sickest residents

Posted using ShareThis

Arbitration bill withdrawn

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

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

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

FHCA analysis of House Medicaid reform proposal

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

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

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

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

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

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

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

Budget cuts threaten nursing homes and elder care

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

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

Read more: Budget cuts threaten nursing homes and elder care

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

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

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

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

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

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

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

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

By John Kennedy
The News Service of Florida

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

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

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

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

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

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

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

FHCA members speaks out on Medicaid funding cuts

Freddie Franklin : Nursing home residents deserve dignity, funding - http://tinyurl.com/ycrlt67

Budget update

On Tuesday, the Full Appropriations Council on Education & Economic Development took up the budget. As we told you last week, the House has a proposed $132.4 million (4.6%) reduction to nursing home funding. The Senate Ways and Means Committee took up the budget Thursday, and FHCA staff and lobby team members continued to monitor these discussions. As we've reported, the Senate has proposed a $199.5 million (7%) funding cut to nursing home care. This cut is nearly equivalent the Medicaid funding that is provided annually for the increase in CNA staffing from 2.0 to 2.9, which amounts to $211.8 million. FHCA continues to advocate that these funding cuts would threaten resident quality care and could negatively impact caregiver jobs, since 70 percent of your operating costs go to people - salaries and benefits.

The Senate has developed a contingency budget which considers the $1 billion that would come from the six-month extension of the enhanced FMAP, which we hope will be taken up by the U.S. Congress just after they return from the Easter/Passover break. However, even with the $1 billion in relief from the enhanced FMAP extension factored into their contingency budget, the Senate makes no attempt to restore any of the nursing home funding cuts.

We need your help with urging legislators to do the right thing and use the FMAP money as it was intended - to fund the Medicaid program and alleviate cuts to funding for nursing home resident care. Please join us in taking action and e-mail your legislators today. Ask them to oppose the nursing home funding cuts and use the FMAP money as it was intended. Click here and use our pre-printed message (or customize your own); you'll simply need to enter your zip code to identify legislators in your district. We appreciate your help with this important call to action to protect our state's seniors.

Weekly wrap up

This was a busy week in Tallahassee, with a number of bills FHCA's been watching taken up by committees. On Monday, the Health Care Regulation Committee passed HB 7183 by Rep. Hudson, which reorganizes the Department of Health and removes all inspection duties for facilities such as nursing homes. Today, the bill also passed the House Health Care Appropriations Committee, along with Rep. Hudson's HB 1143, which is the regulatory reduction bill that helps providers reduce or eliminate duplicative inspections in nursing homes by agencies other than AHCA.

Background screening legislation was taken up by the Senate Criminal Justice Committee today. Multiple amendments were added to SB 1520 by Sen. Ronda Storms (R-10) to conform it to the House bill (HB 7069); however, two additional amendments regarding child care centers that were added now result in differences between the House and Senate versions.

Another important bill we're watching which was taken up today by the Senate Judiciary Committee is SB 2034 by Sen. Steve Wise (R-5), which would effectively prohibit the use and enforcement of pre-dispute arbitration agreements in long term care settings by allowing the agreement to be rescinded at any time. FHCA associate member Andrew McCumber testified that arbitration is more efficient, less adversarial and has a reduced time to settlement. The bill passed through committee; however, FHCA will continue to work with lawmakers to educate them about the importance of arbitration clauses in ensuring that scarce Medicaid resources go toward improving resident care rather than paying the escalating costs associated with protracted lawsuits.

The Senate Children, Families and Elder Affairs Committee amended SB 2008 by Sen. Mike Fasano (R-11) to delay the requirement of Automatic External Defibrillators in ALFs until July 1, 2011, giving providers more time to prepare.

FHCA will continue to monitor these bills as they make their way through the process. In the meantime, legislators will take a short respite for the Easter/Passover break, but will resume mid-week to get back to business. Check back next week for an update on what transpires.

Nursing Home Resident Care Faces Hit from Funding Cut ‘Perfect Storm’

Combination of Medicaid Cuts and Medicare Cuts Will Threaten Seniors’ Quality of Care, Caregiver Jobs

The Executive Director of the Florida Health Care Association (FHCA) warned that new federal Medicare cuts to Florida nursing homes amounting to $1.2 billion over 10 years contained in health care reform will threaten quality of care and quality of life for the nearly 71,000 frail elders who rely on their care. Combined with cuts to Medicare-funded nursing home care that went into effect October 1, 2009 - $895.8 million for Florida over the next 10 years - and the Florida Legislature’s proposed annual Medicaid funding cuts - $200 million in the Senate and $133 million in the House – these deep cuts will significantly endanger Florida nursing home residents’ care and jeopardize the state’s already fragile economy and caregiver jobs base.

“Nursing homes and the seniors under their care face an unprecedented ‘perfect storm’ funding threat from combined federal Medicare and state Medicaid cuts to nursing home care,’” said J. Emmett Reed, Executive Director of the Florida Health Care Association, the state’s first and largest advocacy organization for Florida long term care providers. “Legislators must understand that Medicare and Medicaid funding are inextricably linked, and the combination of cuts squeezes local facilities in a way that could harm seniors’ care, impact caregiver jobs and be detrimental to local economies.”

In the year 2010 alone, Florida’s Medicare cuts amount to $78.4 million – the 2nd highest level of cuts in the nation – as a result of federal regulatory cuts that went into effect October 1, 2009. 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. These cuts don’t take into account the $1.2 billion in cuts to Medicare-funded nursing home care that is included in health care reform signed into law today by President Obama.

Approximately 20 percent of nursing home residents rely on Medicare to pay for their nursing home care, while nearly 60 percent of residents rely on Medicaid. Medicare funding is critical to nursing homes because it supplements inadequate Medicaid payments. On average nursing homes lose $9.91 a day, or just over $225,000 a year in caring for Medicaid residents.

Continued Reed: “Having suffered a massive Medicare funding cut this past October of up almost $900 million over the next 10 years – distinct and separate from the reductions our sector has willingly and cooperatively agreed to shoulder as part of achieving broader health care reform – we are alarmed that the sheer size of the cumulative Medicare and Medicaid funding cuts we ultimately suffer will be especially damaging to seniors in Florida, where our Medicaid program is already underfunded.

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 combined Medicaid/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, since nearly 70 percent of nursing home costs go toward people – salaries and benefits of the caregivers and other key staff vital to the quality of care and quality of life for residents.

“Maintaining Medicaid funding for nursing homes has become even more urgent as a result of the Medicare cuts that went into effect in October and those we will experience as a result of health care reform. The combination of cuts will significantly reduce the resources available for nursing home care at a time when residents have more medically-complex needs than ever before and the demand for access to that care continues to grow with our state’s aging baby boomer population,” said Reed.

Staffing language passes House

Yesterday, the House Health Care Appropriations Committee passed language to provide for a combined (nurses and CNAs) weekly average staffing standard of 3.9 hours per resident per day, while retaining daily minimum staffing of 1.0 hours per patient day for licensed nursing and 2.7 hours per patient day for CNAs, which was included in the House Medicaid conforming bill (HB 5301). FHCA's Senior Director of Policy, LuMarie Polivka-West, testified before the committee about nursing homes are caring for residents with a much higher acuity level as a result of Florida doing a good jog of identifying the appropriate placement for those individuals requiring nursing home care (Florida has the second lowest percentage in the country of with its over-65 nursing home population at just 2.1% - compared to the national average of just under 5%). She also noted how the federal government is anticipating an increase in direct care nursing with RUGS IV and the composite 3.9 staffing will allow nursing homes to better accommodate the Medicare changes.

Last week, the Senate Medicaid conforming bill (SB 1464) passed with identical language. If the final legislation passes, the combined 3.9 CNA/direct nursing per patient day will allow additional flexibility in meeting the needs of higher acuity residents with additional licensed nursing staff.

Health care reform

Summary of issues affecting post acute and long term care in the health care legislation: http://ow.ly/1qfy1

Changes to Department of Health Clear Committee

Calling it an "outside the box" approach, during today's House Health Care Regulation Committeee Rep. Matt Hudson explained PCB HCR 10-03, which breaks down the Department of Health and removes all inspection duties for facilities such as nursing homes. After technical amendments were adopted, the partisan debate began. Repeatedly grilled over and over by Democratic members, Rep. Hudson kept his composure and answered directly and clearly. The State's Surgeon General testified first about the reorganization, which is devastating in her mind, and did not acknowlege that the Department could still investigate disease due to wording changes. Other public interests were concerned about other areas, but the bill passed out along party lines.

Committee discussing health care reform and its impact on Florida

As I sit in the House Health Care Regulation Committee meeting this afternoon, it is clear that the federal health care bill which passed yesterday has fueled a volatile debate. Currently, the Committee is discussing HJR 37 by Rep. Plakon to create a constitutional amendment to protect Florida from the federal bill. As citizens, advocates and others stand in line to express their opinions while others shout out from the audience, it is clear that this issue is partisan and not finished yet. What does it mean for us? Follow this bill with us as it may be on your 2010 ballot.

Nursing Home Care Threatened by Medicaid Funding Cuts

New Report Shows Impact of Funding Cuts by County - http://ow.ly/1pu1S

House Health Care Regulation Committee takes up bill to revamp Department of Health

Three weeks down in the 2010 legislative session and usually by now, we are in a routine of what committees are meeting when, allowing us to actually plan some sort of schedule. But in looking at the calendar for the upcoming week, something important for Sunday afternoons, that routine is all shook up.

On Monday, the House Health Care Regulation Committee will discuss a proposed bill to totally revamp the Department of Health. There's lots of reasons, and probably politics behind it, but the important part for nursing homes is that it removes all DOH regulatory and inspection duties from any facility licensed by the Agency for Health Care Administration.

Could this really be happening? Might this legislation pass in 2010? There is lots of duplication between DOH and AHCA in regards to nursing homes, so FHCA will be watching and supporting this bill. Look for more later.

Senators support nursing home staffing

During today's Senate HHS Appropriations Committee meeting, Sen. Joe Negron offered an amendment to include language to provide for a combined (nurses and CNAs) weekly average staffing standard of 3.9 hours per resident per day, while retaining daily minimum staffing of 1.0 hours per patient day for licensed nursing and 2.7 hours per patient day for CNAs in the Senate Medicaid conforming bill (SB 1464). FHCA's Senior Director of Policy, LuMarie Polivka-West, testified before the committee about how the federal government is anticipating an increase in direct care nursing with RUGS IV and the composite 3.9 staffing will allow nursing homes to better accommodate the Medicare changes.

Sens. Don Gaetz and Durrell Peaden spoke in support of the amendment, and voted in its favor along with Sen. Negron and Sen. Mike Haridopolos. As a result, the amendment was adopted. Currently, the House Medicaid conforming bill (HB 5301) includes identical language. If the final legislation passes, the combined 3.9 CNA/direct nursing per patient day will allow additional flexibility in meeting the needs of higher acuity residents with additional licensed nursing staff.

Update on background screenings

During the House session, background screening legislation - HB 7069 by Rep. William Snyder (R-82) - rolled over to a third reading; all eight amendments were adopted with no questions. This includes FHCA's suggested amendment that current employees rescreened under the new law may apply for an exemption - and continue to work - if they have a disqualifying offense that was not a disqualifying offense at the time of the last screening (such offense may now be considered disqualifying as new crimes have been added under SB 1986, for example) and was committed prior to the last screening. Stay tuned for more updates on this important legislation.

House releases health care budget

Reports from the Capitol are out of the initial House Health Care Appropriations budget, which includes a $132.8 million cut to nursing home Medicaid funding (that amounts to approximately 4.6% or $8.50 per patient day). The budget also expands the Nursing Home Quality Assessment Program to the maximum 5.5 percent, and Hospice rates are reduced $11.6 million to reflect nursing home funding cut. There is a funding transfer of $8.5 million from nursing home case growth for the Nursing Home Transition Program (which represents 540 individuals) ; however, there is no expansion of additional slots for the Nursing Home Diversion Program.

The budget release is timely, as over 100 FHCA members representing Cypress Health Care Management, Gulf Coast Health Care, Summit Care, Avante Group and Ponce de Leon are in town this week to urge legislators not to make these devastating cuts which will threaten quality of care and quality of life for our state's most vulnerable citizens.

Please join FHCA in advocating for adequate nursing home funding and contact your legislator to urge them to oppose these funding cuts for our state's frail elders, 60 percent of who rely on Medicaid to cover the costs of their nursing home care. Our 'Greatest Generation' deserves better.

House takes up background screening

The House is in session today and background screening legislation (HB 7069 by Rep. Snyder) is on the agenda. Interesting to note that despite an appropriation attached to this bill, it leaped over that process, heading straight to the House floor. It's obvious this legislation is a priority this year. Stay tuned for an update on today's events.

Senate releases proposed budget

On Thursday, the Senate HHS Appropriations Committee released the initial Chairman's budget, which includes a 7 percent ($199.4 million) cut to nursing home Medicaid funding. The budget does not account for the $1 billion in Medicaid money that will result from the extended Federal Medical Assistance Percentage funding, which was included in legislation that cleared the U.S. Senate earlier this week.

Coverage for adult vision and hearing services were eliminated, managed care was expanded (but does not include long term care), hospice rates were reduced to reflect the cut in nursing home rates ($17.5 million) and the Nursing Home Quality Assessment was expanded to the maximum 5.5 percent. Funding was also shifted for nursing home case loads to more cost-effective home and community-based waiver programs, which is in line with FHCA's position statement to ensure cost-effective delivery of long term care services while preserving Florida’s economy and safeguarding the taxpayers’ interests.

This week the members of Our Florida Promise continued to urge legislators to keep the promise to fund quality nursing home care. On Tuesday, they delivered our blog post about how nursing homes are a critical component to the long term care continuum and must be adequately funded and not undercut by an expansion of less cost-effective programs. This grassroots campaign is making an impact, as the Senate's proposed budget contained funding for those more cost-effective home and community-based waiver programs but no expansion of slots for the Nursing Home Diversion Program.

The House is expected to release its version of the budget next week, and FHCA will keep you informed as soon as this information becomes available. In the meantime, there is talk at the Capitol of possibly using the FMAP dollars to fund other programs rather than alleviate funding cuts to the health and human service budget. Next week, we'll ramp up the message that legislators have no reason to impose these funding cuts when federal money is available. We'll be asking your help to take part in our grassroots campaign to e-mail this message to your local legislators, so stay tuned.

FMAP extension legislation clears U.S. Senate

U.S. Senate's Medicaid funding vote will help Florida balance budget - http://bit.ly/9lsdQb

Another successful Lobby Wednesday

The best part of our Lobby Wednesday is listening to our members’ comments as they return to the office to “debrief” before heading back home. The group yesterday was very excited, as they got to see lots of special demonstrations and displays as part of the Ambassadors for Aging Day. What’s important for our members back home to know is that every time you visit Tallahassee and spend time with your legislator, you are reinforcing our FHCA positions on reimbursement, managed care, duplicative regulation and background screening. If you have not come to Tallahassee yet this year, please consider doing so before the end of the 2010 session. Your residents need you to get involved.

Wow, what a long day...as I sit at my computer and ponder the events of the day, let me share what goes on in Tallahassee on a busy committee day.

Starting at 7:30 a.m., I joined other health care lobbyists to talk about the issues of the day. While there we met Dr. Alice Sterling, a candidate for the Florida House (Rep. Adams seat) and learned how she plans to win her competitive race-she states she has an opponent with support in Tallahassee, but she has local support and is very positive regarding her success. Following a serious discussion regarding SB 752, Medicaid fraud, it was agreed that most health care lobbyists still have concerns about some of the legislation passed last session that no one seems interested in fixing this year. That, unfortunately, has led to some health care professionals losing their professional licenses and their livelihood.

FHCA's de-regulation bill was on the agenda for Health Care Regulation at 9 a.m., so with minutes to spare I arrived at the Capitol and got my committee packet. Of course, the bill was last on the agenda, so at 11:30 a.m., I finally had a chance to check for amendments for the bills I had on the calendar in the afternoon. After a quick lunch that included reviewing my bill for a 2:00 committee meeting, I made it to the Clearinghouse meeting at Noon-an advocacy group for children, people with disabilities and seniors-a great chance to network with others with similar interests.

Just in time, I made it to the Senate documents room to see if there were amendments for my 3:30 bill. What - I exclaimed as the staff told me there were 13 amendments!! All filed within the last two hours. I grabbed the pile of papers and headed to my 2:00 over in the House. The Policy council passed HB 7069 on background screenings and Rep. Snyder agreed to work with us on how to handle current employees who might be affected by the new law.

I headed back to the Senate just in time to review SB 1520 by Senator Storms, the companion to HB 7069, and the 13 amendments. I felt better as I saw that the Senate bill was being conformed to the House bill, but there were three new amendments that now make the two bills different which must be resolved somewhere down the road.

At 6:00 p.m. I headed to the University Club for our Lobby Wednesday briefing with a large group from FHCA's Districts 4 and 5. They were so much fun - eger for information and excited to go to the Capitol...I'm going to be looking for them amidst all the hustle and bustle up there, as it is Ambassadors for Aging Day. I LOVE MY JOB!!

- Peggy Rigsby, FHCA Director of Government Relations

Nursing homes a critical part of the long term care continuum and funding must be protected

With Florida facing an increased demand for Medicaid-funded eldercare services, it is more important than ever for our state’s leaders to recognize the invaluable role nursing homes play in our local communities. This session, with Florida’s economy still facing declining revenues, legislators in Tallahassee will be forced to make tough decisions about how to allocate state funding, including how to secure the future of our state’s Medicaid program.

It is important to recognize that nursing homes are an essential part of our health care system. Caregivers in these settings provide life sustaining care and services for nearly 71,000 of Florida’s most frail and elderly individuals who can no longer care for themselves.

Today, nearly 60 percent of nursing home residents in Florida rely on Medicaid as an important safety net. Without it, these seniors would not have access to appropriate medical care; yet, they face a serious and worsening problem as the future of this vital program appears uncertain.

As discussions ensue over the next 60 days about how to balance the state’s $3 billion budget deficit and how to reform a broken Medicaid system, it is essential that all the facts are considered when evaluating long term care as part of the overall Medicaid program.

Currently, nursing home expenditures account for less than 15 percent of the state’s overall Medicaid budget, which is down from 19 percent in 2004. Additionally, the number of individuals relying on Medicaid to pay for the cost of their nursing home care is declining, with the number of days Medicaid patients spend in facilities dropping from 17.2 million in 2004 to 15.5 million in 2009.

Today’s nursing homes are providing care to more medically-complex populations than we have in the past, including increased levels of short-term patients seeking post-acute care following a hip replacement or stroke. Once rehabilitated, many of these patients return home as active members of their communities.

Much has been written about ways to save the state money by keeping individuals out of nursing homes for as long as possible. It’s important to remember that nursing homes have always supported the full continuum of long term care, which factors in appropriate placement to ensure seniors receive the proper care in the proper settings based upon their medical needs. Florida has always done a good job appropriately placing those who require nursing home care. Florida is the oldest state in the nation; yet, we have the second lowest percentage nationally of over-65 seniors living in nursing homes, at just 2.1 percent. That compares to a national average of just under 5 percent.

Long term care in Florida continues to make measurable improvements in quality care, which we are committed to maintaining and advancing. Regulations established in 2001, including mandated staffing levels, make certain that individuals residing in our state’s nursing homes are properly cared for. Along with that minimum number of hands-on caregivers attending to their needs, risk management programs, charting requirements, physician support and other aspects ensure that quality care. Proposals that suggest moving frail elders to less regulated and less medically-equipped settings is a dangerous proposition for those frail, vulnerable seniors who require 24-hour nursing care.

As millions of baby boomers approach retirement age and begin entering the long term care system, lawmakers must protect much-needed Medicaid funding for our state’s frail elders and the frontline caregivers who care for their needs. We cannot build reforms on the backs of our seniors who rely on us for the quality of care they expect and deserve.

J. Emmett Reed, CAE
FHCA Executive Director

The time to get involved is now

As I sit in the House select committee listening to presentations on long term care, I am surprised at the number of legislators who believe there are people in nursing homes who don't need to be there. So I issue a challenge to FHCA members - get out and educate your legislator about who you care for every day. Do it at home or come to Tallahassee...we need each and every one of you this year.

Bunning finally drops resistance to bill with therapy caps extension, Medicaid assistance - McKnight's Long Term Care News

Bunning finally drops resistance to bill with therapy caps extension, Medicaid assistance - McKnight's Long Term Care News

Unemployment Tax Relief Passes Both Chambers

Today, Florida Legislators unanimously passed HB 7033 which provides Florida employers with immediate relief from unprecedented unemployment compensation tax increases that they were facing this year.

Without this important legislation, most Florida employers would be forced to pay unemployment taxes at levels higher than 1200% over last year’s amounts. Plus, the full payments would have been due April 1, 2010.

Specifically, HB 7033 makes the following key changes to the 2010 tax requirements:

• Reduces the amount of each employee’s wages upon which the employer pays the UC tax – from $8,500 back down to $7,000 for 2010 and 2011.
• Establishes a quarterly payment plan for 2010 and 2011 that lets employers spread out their unemployment compensation payments over the whole year without normal application of penalties or interest.
• Eliminates all elements of the rate calculations in the current law that would otherwise increase the tax for purposes of replenishing the Unemployment Compensation Trust Fund balance for 2010 and 2011.
• Allows unemployed Floridians to receive additional extended unemployment benefits funded by the federal government.

FHCA worked with Associated Industries of Florida, the Florida Chamber and other business groups who made a top priority to have the measure pass on the first day of session.

House passes two-year delay in business tax hike

This morning, Florida lawmakers passed a two-year delay in a massive unemployment compensation tax hike on thousands of businesses brought on by the deepening ranks of unemployed workers. Click here to read more.

Campaign to protect nursing home residents' quality care begins

The 2010 legislative session gets underway today with the House and Senate meeting on the floor this morning for opening day speeches by House Speaker Larry Cretul and Senate President Jeff Atwater. Lawmakers will work toward filling a $3 billion hole in the budget this year, with the health care budget experiencing a $1.8 billion deficit. Hope still remains for a boost in the federal portion of Medicaid through an extension of the enhanced Federal Medical Assistance Percentage (FMAP), and FHCA will be monitoring this issue at the federal level to keep members up-to-date.

Meanwhile, Our Florida Promise, a 501(c)(4) advocacy organization, wants to ensure the funding needed to preserve nursing home residents' quality care is protected. Click here to view the :30 second TV spot that will air in Tallahassee for the next two weeks on behalf of Florida's 71,000 nursing home residents. To sign up to show your support of maintaining adequate funding for nursing home quality care, click here. We'll keep you updated throughout the session on what's at stake.

Senate Dems join call for state Medicaid funding extension - McKnight's Long Term Care News

Senate Dems join call for state Medicaid funding extension - McKnight's Long Term Care News

Gearing up for a tough 2010

Next Tuesday, March 2nd, begins the 2010 legislative session. Lawmakers will return to Tallahassee with a sense of urgency to find ways to plug a $3 billion budget deficit and prepare for the expanding Medicaid rolls resulting from Florida's increasing number of unemployed and uninsured citizens. The health care budget is looking at an unprecedented $1.8 billion deficit.

With the theme at the Capitol being that Medicaid is the biggest cost driver in the budget, legislators are discussing several ideas on how to reform the program. Main ideas include moving all Medicaid recipients into managed care, expanding the current Medicaid Reform pilot to an additional 19 counties, and as presented by Nursing Home Diversion Provider American Eldercare, eliminating Medicaid funding for intermediate care level residents in nursing homes and serving those individuals via the Diversion Program.

As you can see, we have our work cut out for us, which is we need all our FHCA members to participate in our 2010 Lobby Wednesdays. Last week, we spoke with Darrell Jean of Consulate Health Care, who was in town for our first Lobby Wednesday. If you're unsure as to why you should participate or how your voice makes a difference, click here to hear from your fellow FHCA member about what an impact you can make on our lawmakers.

Along with getting involved in this grassroots initiative, we've got members across the state meeting with newspaper editorial boards over the coming weeks to educate the media and ultimately local citizens about why we cannot drain funding from the nursing home line item to pay for other long term care services and emphasize how these suggested budget savings could put residents at risk and eliminate choice for those needing future long term care services.

FHCA has more information about these and all of our 2010 legislative priorities, which you can find on the FHCA Web site. Stay informed and get involved this session, your residents and your profession depends on it.

Watch our Provider Program video update

FHCA will be bringing you live updates from the Capitol this legislative session through our weekly Provider Program. With more than 20 members in town yesterday for our first Lobby Wednesday, we kicked off this season with a great interview with Kristine Schiff of Ponce de Leon, who gave us the associate member's perspective of why it is important to participate in the legislative process. We also heard from Consulate Health Care's Mark Johnson, who shared highlights from his legislative meetings as well as his overall experience. Click here to watch this week's video, and stay tuned for our next series of video updates to begin when session starts March 2nd. If you miss a week, don't worry. You can always find archives of our video updates in the Provider Program section on the right sidebar.

Background Screening Update

Tuesday was an interesting day at the Capitol. It started early with a meeting of the House Criminal and Civil Justice Policy Council, which began at 8 a.m. We arrived bright and early at 7 a.m. in ancipation of giving public testimony on the proposed legislation that modifies background screening laws for a multitude of different entities.


For facilities and licensees regulated by the Agency for Health Care Administration, the bill, PCB 10-04, will require Level 2, fingerprint screenings for all employees who provide personal care or services directly to residents, have access to resident living areas or a resident's funds or personal property, and for all contractors who provide personal care or services directly to residents. All fingerprinting must be done electronically, and all employees who have worked longer than five years will have to have the electronic Level 2 screening. The cost of such a screening is $24 for the state check plus $19.25 for the electronic Level 2. Then, there will be a "vendor" charge for the company that actually rolls the prints and submits them to FDLE.


There's lots of details that have yet to be worked out, so your FHCA staff and lobbyists continue to work diligently with legislators and staff on these details. Since this was the first and perhaps only time public comments were being allowed, I stepped up and provided two comments for consideration: the availability of vendors to provide the screening - are they accessible by public transportation, which many of our caregivers use as their mode of transportation to get to work? Another important point of consideration is the cost of implementing such a system on July 1, 2010, which gives providers little time to detemine how to do the screening, and no system to reimburse the employer.

Joe Langford, president of Edge Information Management and an associate member of FHCA and FHC Service Corp member, also testified during the meeting to ask consideration of third parties to be allowed to act as an agent on behalf of the employer. It is important that the final bill doesn't negatively impact Florida businesses.


You might remember this issue began when several TV and newspaper outlets in south Florida did an investigative series that found employees with criminal records working with vulnerable persons. As a result, the Legislature has picked this up and is running with it. FHCA is in support of background screening legislation, since resident safety is our first priority.

So what happens next? The bill needs to be printed and assigned a number, and it will move onto its next committee of reference. We'll continue to keep you posted on this issue, so be sure to follow us here for more information.

FHCA kicks off Lobby Wednesdays

FHCA members Consulate Health Care, Hathaway Resources and Ponce de Leon were in town today to kick off the Association's 2010 Lobby Wednesdays. More than 20 nursing home administrators and vendors who support our interests traveled to Tallahassee to help us discuss several priorities which FHCA will focus on for the 2010 session. Issues of importance include protecting the funding for nursing home residents' quality care; ensuring a cost effective delivery of long term care services while preserving Florida's economy and safeguarding taxpayers' interests; working with AHCA and Rep. Matt Hudson (R-101) on their regulatory relief bill to help eliminate duplicative requirements for long term care providers; and strengthening resident protections by ensuring background screening legislation does not limit providers' access to a qualified workforce.

FHCA has developed issue papers on each of these priorities, which can be found on our Web site. They address each of our issues:

• Protecting the funding to ensure resident quality care


• Ensuring cost-effective delivery of long term care services


• Preserving state resources by eliminating duplicative requirements and regulations

Also included on the FHCA Web site is the FHCA position regarding background screening legislation.

The next Lobby Wednesday will take place March 10th, and if you haven't participated in Lobby Wednesdays before, don't worry! FHCA can team you up with fellow members to visit your lawmakers in groups. FHCA staff conducts an in-depth briefing to prepare you for communicating our issues effectively during those meetings, and we do our best to make your experience a success. To learn more about how to participate, click here or contact Teresa Hamlin of our staff if you have any questions.