Tell Congress to Oppose Reductions to Nursing Facility Bad Debt Reimbursement

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

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

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

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

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

Governor's Budget Recommendations

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

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

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

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

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

A Pre-Session Message from Emmett Reed

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

Get the Facts on long term care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

J. Emmett Reed, CAE
FHCA Executive Director

New Ad Campaign Urges “Care Not Cuts”

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

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

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

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

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

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

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

We’ve given our fair share, and more.

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

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

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

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

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

CMS Issues Final Rule on Medicare Payments to Skilled Nursing Facilities

Federal Agency Drastically Reduces Skilled Nursing Facility Payments

J. Emmett Reed, Executive Director of Florida Health Care Association (FHCA), issued the following statement in response to the release of the Skilled Nursing Facility Prospective Payment System final rule for FY 2012 by the Centers for Medicare & Medicaid Services (CMS):
 
“In its Final Rule, the Centers for Medicare and Medicaid Services will cause long term care facilities to see a significant reduction in Medicare funding for skilled nursing care of nearly $4 billion beginning October 1, 2011. Facilities in Florida are already experiencing a drastic $187.5 million cut to state Medicaid funding that went into effect July 1. The CMS reductions will threaten our facilities’ ability to continue delivering quality care to Florida’s seniors and puts thousands of long term care jobs at risk, particularly since Medicare funding helps to prop up Medicaid, which has historically underfunded nursing home care. FHCA will continue advocating on behalf of Florida’s long term care facilities in hopes that lawmakers at the state and federal level will see the importance of preserving much-needed funding so seniors can have access to quality long term care both today and in the future.”

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

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

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

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

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

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

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

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

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

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

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


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

Governor vetoes background screening legislation

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

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

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

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

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

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

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

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

Agency hosts public meetings on Medicaid Managed Care

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

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

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

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

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

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

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

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

2011 Legislative Session: Medicaid Reform and Long Term Care

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

• Establishes the statewide, integrated managed care program for all covered Medicaid services, including long term care services.
• AHCA shall begin implementation of the long term care managed care program by July 1, 2012 (required to provide notice of invitations to negotiate), with full implementation in all regions by October 1, 2013.
• Medicaid recipients 65 years of age or older or eligible for Medicaid by reason of a disability and determined by the CARES Program to meet the requirements for nursing facility care are eligible. 
• All Medicaid recipients who are either residing in a nursing facility or enrolled in a Medicaid waiver program on the date long term care managed care plans become available in their region are automatically eligible to participate for up to 12 months without being re-evaluated for their need of nursing facility care.
• Establishes eleven (11) regions with a minimum of two plans for each region.
• Plans must offer network contracts to all nursing homes, hospices and aging network service providers that have previously participated in home and community-based waivers in their region for the initial period between October 1, 2013 and September 30, 2014. Plans may exclude providers after this period for failure to meet quality or performance criteria.
• Nursing homes and hospices that are enrolled Medicaid providers must participate in all eligible plans selected in their region.
• Plans shall monitor quality and performance of each participating provider using measures adopted by and collected by AHCA and any additional measures mutually agreed upon by the provider and the plan. (This provision should prevent duplicative surveys.)
• Plans must pay nursing homes an amount equal to the nursing facility-specific payment rates set by AHCA; however, mutually acceptable higher rates may be negotiated for medically complex care.
• For recipients residing in a nursing facility and receiving hospice services, the plan must pay the hospice provider a per diem rate set by AHCA minus the nursing facility component and shall pay the nursing facility the applicable state rate.
• Plans must ensure that electronic nursing home and hospice claims that contain sufficient information for processing are paid within 10 business days after receipt.
• AHCA must establish nursing facility specific payment rates for each licensed nursing home based on facility costs adjusted for inflation and other factors as authorized in the General Appropriations Act. Payments to long term care managed care plans shall be reconciled to reimburse actual payments to nursing facilities.
• AHCA must establish hospice payment rates and payments to long term care managed care plans shall be reconciled to reimburse actual payments to hospices.
• AHCA shall periodically adjust payment rates to the managed care plans to account for changes in the level of care for each managed care plan and shall make an incentive adjustment to encourage the increased use of home and community-based services. (Specific percentage adjustments are detailed in the bill until such time that no more than 35% of the plan’s enrollees are placed in institutional settings.)
• By August 1, 2011, AHCA must establish the technical advisory workgroup to assist in the development of the long term care managed care program. The workgroup will address the following:
• Method of determining Medicaid eligibility.
• Method for managing Medicare coinsurance crossover claims.
• Uniform requirements for claims submissions and payments, including electronic funds transfers and claims processing.
• Process for enrollment of and payment for individuals pending determination of Medicaid eligibility.
• Continues the Comprehensive Assessment and Review for Long Term Care Services (CARES) program. Allows for the contracting of any function of the CARES program.
• Effective July 1, 2012, AHCA may not impose conditions or sanction on providers for failure to meet CON conditions related to minimum Medicaid occupancy.
• Extends the CON moratorium on nursing home beds.

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

2011 Legislative Session: Budget Wrap Up

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

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

The budget conforming bill (SB 2144) includes language that modifies staffing to lower the combined average weekly nursing and CNA staffing standard from 3.9 to 3.6 hours per patient day. The daily nursing standard of 1.0 hours per patient day remains unchanged, and the daily CNA staffing standard will be reduced from 2.7 to 2.5 hours per patient day.
 
The conforming bill also expands the Quality Assessment to the maximum federal allowance which will increase the total annual assessment from $349 million to $381 million, allowing most of the prior year rate cuts to be bought back.
 
To read more about how long term care fared in the 2011 legislative session, click here to read FHCA's 2011 Legislative Session Wrap-Up Report.

FHCA Provider Program

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

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

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

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

Legislative Alert - Help Advance Nursing Home Tort Reform

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

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

The final countdown - budget and bills update

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

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

What happened last week . . .

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

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

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

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

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

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

FHCA Provider Program - Live from the Capitol 4th Floor

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

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

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

Please take action today:

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

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

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

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

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

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

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

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

FHCA Provider Program - Interview with Rep. Ken Roberson

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

Progress report on regulatory bills

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


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

FHCA Provider Program - Week Six of the 2011 Session

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

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

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

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

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

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

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

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

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

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

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

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

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

FHCA Praises Senate Health Regulation Committee for Advancing Important Tort Reform

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

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

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

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

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

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

Update on workforce-related bills we're tracking

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

FHCA Provider Program - Budget Update and Lobby Wednesday Highlights

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

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

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

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

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

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

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

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

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

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

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

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

FHCA Provider Program - Week Two Update

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

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

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

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

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

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

FHCA Provider Program - Week One of the 2011 Legislative Session

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

Workforce bill passes first committee

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

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

House Medicaid Reform Bill - Long Term Care Analysis

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For more information, follow the series here and at:

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

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

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

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

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

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

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

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

For more information, follow the series here and at:

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

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

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

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

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

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

A recent study by the Florida State University Claude Pepper Data Center presented before the legislative committees charged with architecting Medicaid reform proposals found that the average Medicaid nursing home caseload has decreased from 47,059 in 2001 to 42,661 in 2010. The study raises important considerations related to Medicaid managed long term care, pointing out that the effort to transition nursing home residents back to the community have required assisted living facilities (ALF) to offer a wider range of care. It notes, however, that the “typical” nursing home resident could not receive the appropriate medical care in an assisted living facility (ALF) where nursing services are limited and state and federal oversight of those services is less intense.

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

For more information, follow the series here or at:

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