Legislators Recognize Inspiration for "Lucy's Law" Helping Nursing Center Residents

Rep. Matt Gaetz & Sen. Don Gaetz Present Graceville Resident with Proclamation

A Florida law that tripled the personal needs allowance for nursing center residents across the state is known as “Lucy’s Law.” This week the measure’s namesake received a proclamation from the Florida Legislature, presented by two of the lawmakers who helped enact the change.

Lucy Kennedy, who gave the legislators the idea when she served as Resident Council president at Signature HealthCARE of North Florida in Graceville, received the Senate/House proclamation from Sen. Don Gaetz and Rep. Matt Gaetz. The father-son pair of legislators visited Washington Rehabilitation Center in Chipley, where they met with residents and held a recognition ceremony for Kennedy on December 7.

“We took your idea, and Representative Gaetz convinced all 120 members of the House and I worked on the Senate, and we got the governor to sign it,” Kennedy was told by Sen. Gaetz, who was Senate President at the time the provision was adopted. Reading from the proclamation, he told Kennedy: “Nearly 50,000 Floridians living in nursing homes throughout our state owe (you) a debt of gratitude.”

“I thank you that the Legislature listened,” Kennedy told the lawmakers.
The state budget adopted by the Legislature in 2014 included an increase in the resident personal needs allowance, tripling the allocation from $35 to $105 per month. This increased funding provides greater choices to residents who rely on Medicaid as their long term care safety net, helping them to pay for personal items that improve their quality of life – things such as beauty services, clothing and other personal items.

“I’ve been able to see first-hand how the decisions we make in Tallahassee really impact the quality of care that we’re able to deliver at the bedside,” Rep. Gaetz said during his visit to Washington Rehabilitation Center, which is a member of Florida Health Care Association.

In addition to the brief ceremony for Kennedy, the legislators toured the center and met with numerous residents. “It was so empowering to our residents to be able to be able to meet the legislators who are actually making the decisions on how their lives are affected, what’s impacting their lives,” said Kathy Gallin, FHCA’s Legislative Committee Vice Chair and Director of Legislative Affairs for Signature HealthCARE.

Watch video of the Washington Rehabilitation tour below.

Florida Skilled Nursing Centers Prep for Massive, Unfunded Mandates

New regulations can overwhelm operations, impact residents and patients

Local skilled nursing centers (often referred to as nursing homes) will be scrambling to put in place a massive number of new federal regulations that encompass over 400 pages and will increase operating costs by more $40,000 per facility per year.

“Some skilled nursing care centers will be on life support to survive these intrusive, unfunded mandates that call for new staff positions, dictate how doctors practice, micromanage most interactions with residents and patients and create even more work-stifling paperwork,” said Emmett Reed, Florida Health Care Association (FHCA) Executive Director.

Area nursing centers are participating with FHCA in a campaign to communicate with the federal Centers for Medicare & Medicaid Services (CMS), which oversees nursing centers, to ask for substantive changes to the requirements and relief from the quick imposition of the new regulations.

“How are care centers supposed to pay for these unfunded mandates that total thousands of dollars?” said Reed. “Either the federal government pays or it eases off its current plan and agrees to a reasonable phase-in period that gives states the chance to adjust Medicaid rates to offset the new costs. Sixty percent of nursing center residents in our state depend on Medicaid to pay for their care.”

These large unplanned expenses come at a time when a government study shows area nursing centers already have tight operating margins of less than 2 percent on average. At the same time, an analysis of Medicaid rates in Florida shows that care centers lose an average of $15.46 per Medicaid patient per year.

“Many provisions in the proposed regulations are important,” said Reed. “But if they are not carefully phased in, the regulations will be disruptive to care center operations. The regulations will redirect staff and resources away from personal care for residents to focus more on a paper compliance culture.”

“Skilled nursing care centers are major contributors to local economies,” added Reed. “New requirements often look good on paper, yet only drain scarce funds away from important services and person-centered care objectives, staff job creation, and salaries.

More details on the proposed regulations and key areas of concern are here.

FHCA Special Legislative Session Report

Lawmakers are expected to end the 2015 special legislative session this Friday, June 19. At that point, the mandatory 72-hour "cooling off" period ends and both chambers can vote on the $78.7 billion budget. After the final votes, the budget will then be sent to Governor Rick Scott for review and approval.

The contention among lawmakers heading into the special session took its toll on health care. The debates over Medicaid expansion broke down and not a single health care bill passed out of the special session. Much of the Legislature's focus was on replacing lost dollars for the hospital Low Income Pool program, as well as tax cuts and education.

Medicaid Funding
FHCA is pleased to report that, in the end, funding for nursing center care was preserved. The budget contained no Medicaid funding cuts and all workload and price level (inflation) increases were fully funded.

Unfortunately, there was no new money appropriated for the restoration of prior year skilled nursing center funding reductions. This became an impossible task, given the required funding of over $400 million in state dollars to replace some of the lost federal monies from the Low Income Pool fund. The LIP fund is being reduced from over $2 billion in 2014-2015 to approximately $1 billion in 2015-2016.

Quality Assessment
FHCA’s Government Affairs team was successful in amending the Medicaid conforming bill to change the due date of the Nursing Facility Quality Assessment (NFQA) from the 15th to the 20th day of each month to match the new Medicaid Managed Care payment timeframes.  Originally, the NFQA was due approximately five days after Medicaid paid provider claims. With the implementation of Medicaid Reform, long term care managed care plans are required to pay nursing center claims within 10 days after receipt (which frequently occurs after the 15th of the month). This change should ensure providers have sufficient cash flow to pay the NFQA timely and will help alleviate late payment penalties.

Medicaid Prospective Payment System
FHCA also successfully advocated for the removal of the proposed study to develop a new Medicaid prospective payment system (PPS) for nursing center services. The Governor’s original PPS proposal was designed to reduce the variance in Medicaid payments to different nursing centers for similar residents and to eliminate retrospective rate adjustments. Further, the original House language required that the study develop a transition plan to implement the new PPS in a budget-neutral manor.

FHCA conceptually supports the creation of an appropriately designed PPS methodology that is fully funded, and eliminating the proposed study will ensure our experts on PPS methodologies are an integral part of developing the PPS model. Accordingly, FHCA has created a Medicaid Prospective Payment Workgroup under the FHCA Reimbursement Committee that is charged with creating a proposed payment model and making recommendations to the FHCA Reimbursement Committee, Our Florida Promise Board of Directors and FHCA Board of Directors prior to the next legislative session. This Workgroup is chaired by Doug Burr and Joe Lubarsky, nationally recognized for his payment system design, is serving as consultant.

Veterans' Nursing Homes
The budget conferees ultimately removed language that would have given the Director of the Florida Department of Veteran’s Affairs the authority to contract out the management of the State Veterans’ nursing homes and assisted living facility.  This provision was eliminated for procedural reasons, as legislators decided such a major policy change should be made in statute and not through the budget.  Leadership has offered to work with FHCA next session to pursue a bill. 

Planning Ahead
FHCA will be developing its 2015 Legislative Scorecard in the coming weeks, which is an effective tool to help you better understand how legislators voted on all the issues affecting long term care this session. Additionally, we’ll be highlighting the regular and special legislative sessions during the FHCA Annual Conference on Tuesday, August 4, during the Legislative Update Mega Session. Along with a recap of the budget and the bills that passed, attendees will also learn more about the impact of these legislative changes. Current political leaders and future candidates have also been invited to attend, so make plans to join us.

While the session has finally come to a close, the work is not done. Legislators will now return to their districts, and FHCA wants to encourage its members to invite them into your nursing center so we can continue educating them about what's important to long term care. The 2016 legislative session will begin in January, with committee weeks expected to start in less than three months. FHCA and our advocacy partner, Our Florida Promise, have already begun laying the groundwork for next session. Your support of our advocacy efforts, through legislative tours to your center or meetings with lawmakers in their district, is a critical part of our strategy to keep lawmakers informed about the important work you do in caring for Florida's frail elders.

Governor signs two pro-long term care bills into law

Last week, Governor Scott approved SB 332 by Sen. Denise Grimsley (R-21) relating to vaccines in nursing centers. The law, which becomes effective July 1, 2015, will giving nursing centers flexibility by allowing all new, eligible nursing center admissions to be vaccinated with any pneumococcal vaccination, as long as the vaccine is recommended by the Centers for Disease Control and Prevention.

The Governor also approved SB 7018 by Sen. Eleanor Sobel (D-33), which provides a major rewrite to the State Long Term Care Ombudsman program. The law, which becomes effective July 1, 2015, also improves the Gold Seal process under the Governor's Panel on Excellence in Long-Term Care by clarifying the criteria at the application stage. As we've reported, some Gold Seal applications were denied if a center had an unresolved ombudsman complaint. That subjectivity has been eliminated by changing an "unresolved complaint" to "only complaints which result in a licensure citation."

Govenor Rick Scott Proclaims May 10-16, 2015 National Nursing Home Week

Florida nursing centers “Bring on the Fiesta” during National Nursing Home Week

Just one week after Cinco de Mayo, it’s time for a Fiesta! At skilled nursing centers across Florida, residents and staff are celebrating National Nursing Home Week. Celebrations started this past Sunday on Mother’s Day and will run through May 16. Centers are hosting activities using a theme of “Bring on the Fiesta,” with celebrations focused on “Familia, Vida and Amor” (family, life, love).

National Nursing Home Week is the perfect backdrop for embracing those three core values. Everyone can embody the spirit of “Familia, Vida and Amor” by visiting relatives, spending time with life-long friends and neighbors, and brightening the lives of loved ones (or even strangers) who reside in nearby skilled nursing centers.

The observance is a great opportunity for families, community members, youth and others to support nursing center residents and the dedicated staff who care for them on a daily basis. If you can’t visit in person, it’s still easy to make a phone call or send a greeting card or flowers. This special attention will make someone’s day and help enhance their quality of life.

It will also provide you the opportunity to see the abundance of life, care and compassion and the strong sense of community thriving in our state’s nursing centers. This spirit is leading to improved health outcomes for our state’s seniors, and that benefits everyone. So “Bring on the Fiesta,” and make someone’s day extra-special.

Learn more about Florida skilled nursing centers by visiting our website - ElderCareFlorida.com.

By J. Emmett Reed, CAE 

FHCA 2015 Legislative Wrap Up Report

The 2015 Florida legislative session ended prematurely with the House and Senate at a stalemate over a new state budget and health care programs. After weeks of disagreement over Medicaid expansion and federal funding related to the hospital Low Income Pool program, the House unexpectedly adjourned three days earlier than the scheduled May 1st end to the regular session. The Senate chose to stay through the full 60-day timeframe, passing a limited number of bills on Wednesday before officially adjourning at 11:59 p.m. on May 1.
 

The Florida Constitution mandates that the Legislature must pass a balanced budget before July 1, 2015. Because the House and Senate adjourned without passing a budget, the Legislature will be called into a special session sometime in early-to-mid June to pass the 2015-16 state budget. Either the Governor will call the Legislature back into a special session or Senate President Andy Gardiner (R-13) and House Speaker Steve Crisafulli (R-51) will jointly call legislators back. 
 

The standstill over the state budget did not affect FHCA's ability to pass legislation that will have a positive impact on your operations and care delivery. Your tremendous involvement in our Lobby Wednesdays, combined with the comprehensive pre-session strategy put forth by the FHCA/Our Florida Promise leadership and the effectiveness of our government affairs team, all contributed to successful outcomes for long term care.
 

*Please note that although these legislative measures have been approved by both chambers, the Governor must take action for final approval (sign the bill, allow it to become law without his signature or veto the bill). FHCA will provide updates on the Governor's action and effective dates on the bills we’ve reported on below.

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NOTIFICATION ABOUT HOSPITAL ADMISSION STATUS
HB 309 by Rep. Shawn Harrison (R-63)/Sen. Don Gaetz (R-1)

This priority issue for FHCA will protect seniors from unexpected medical bills. HB 309 requires hospitals, at the time of discharge, to educate the patient or the patient's proxy about the individual's admission status. The information must be documented in the patient's discharge papers and education shall also be provided through brochures, signage or other forms of communication.
 

Medicare will not cover the cost of post-acute rehabilitation care in a skilled nursing center following a qualifying three-day inpatient hospital stay if a beneficiary is classified as outpatient under observation status. Seniors are often unaware the hospital classified them as an outpatient under “observation” until they are discharged and transferred to a skilled nursing center for rehabilitation.
 

While legislation at the federal level would deem time an individual spends under observation status as eligible to count toward satisfying the three-day stay requirement, this notification at the state level will ensure seniors are properly informed and protected from serious financial burdens.

 

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VACCINATION OF NURSING CENTER RESIDENTS
SB 332 by Sen. Denise Grimsley (R-21)/Rep. Mike Miller (R-47)

SB 332 removes a current statutory requirement that skilled nursing centers must vaccinate all eligible new admissions with the pneumococcal polysaccharide vaccination (PPV - a name brand vaccine). It instead allows all new, eligible nursing center admissions to be vaccinated with any pneumococcal vaccination, as long as the vaccine is recommended by the Centers for Disease Control and Prevention.

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STATE OMBUDSMAN PROGRAM

SB 7018 by Sen. Eleanor Sobel (D-33)/Rep. Ken Roberson (R-75)

After several years of failed attempts, Sen. Sobel and Rep. Roberson were successful in passing a major rewrite to Florida's Ombudsman statute. SB 7018 will transfer the Ombudsman Council's responsibilities to state representatives of the Office of the State Long Term Care Ombudsman. The bill revises the operating structure and internal procedures of the State Long-Term Care Ombudsman Program (LTCOP), housed in the Department of Elder Affairs (DOEA), to reflect current practices, maximize operational and program efficiencies and conform to the federal Older Americans Act. The bill also revises the appointment process for three at-large positions to the State Long-Term Care Council, whereby the appointments are no longer made by the Governor but rather the Secretary of DOEA.
 

FHCA worked with Sen. Sobel to amend the bill to improve the Governor's Panel on Excellence for Long-Term Care Gold Seal process by clarifying the criteria in the application process. Previously, some Gold Seal applications were denied if a center had an unresolved ombudsman complaint. The final legislation eliminates subjectivity by changing an "unresolved complaint" to "only complaints which result in a licensure citation."

 

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ASSISTED LIVING FACILITIES
HB 1001 by Rep. Larry Ahern (R-66)/Sen. Eleanor Sobel (D-33)

After more than four years of attempting to reform the state's regulatory system for assisted living facilities, the Florida Legislature passed HB 1001 by Rep. Larry Ahern/Sen. Eleanor Sobel. HB 1001, which contained recommendations from FHCA's Florida Center for Assisted Living (FCAL) Committee members, is an excellent step toward promoting ALF accountability without imposing unnecessary regulatory burdens. At the same time, this important legislation will preserve resident quality care and a level of independence these individuals expect from their ALF home.

Among other provisions, the bill:

• Allows ALF staff to better assist residents with self-administration of medication;
• Requires ALFs to inform new residents, upon admission to the facility, that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right;
• Allows nurses to practice within their full scope of licensure in assisted living facilities with limited nursing specialty licenses (LNS);
• Gives the Agency for Health Care Administration (AHCA) broader authority to issue moratoriums and to revoke licenses in certain circumstances; and
• Requires AHCA to significantly enhance the information available about assisted living facilities to the public.

A more detailed section summary, as well as highlights of the landmark legislation, is available in the ALF Regulatory section of FHCA's website.

FHCA appreciates the important role members of the FCAL and Legislative Committees played over the past four years, reviewing and offering input throughout the process to ensure the final bill would promote ALF accountability and allow greater services for ALF residents without imposing unnecessary regulatory burdens.

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CONTINUING CARE COMMUNITIES
HB 749 by Rep. Charles Van Zant (R-19)/Sen. Thad Altman (R-16)

This legislation revamps the contracts between Continuing Care Communities' (CCC) residents and providers. HB 749 makes several changes to ch. 651, F.S, including changing the name of Continuing Care Retirement Communities (CCRC) to Continuing Care Communities. For specific details on HB 749, contact Carol Berkowitz of our staff.
 

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RIGHT TO TRY
HB 269 by Rep. Ray Pilon (R-72)/Sen. Jeff Brandes (R-22)

The bill creates the "Right to Try Act," which provides a framework in which an eligible patient with a terminal illness would be able to access experimental drugs, biological products and devices from the manufacturer after phase one clinical trials (meaning the FDA may not have approved the drug).

In the early part of session, an amendment was added to the Senate companion bill authorizing Physician Order for Life Sustaining Treatment (POLST) forms in Florida Law. The amendment would have required health professional staff to honor either the Do Not Resuscitate Orders (DNROs) or the POLST document in the same manner. FHCA’s Legislative Committee expressed concern that the amendment as proposed would lead to confusion, especially with the choice of multiple forms. FHCA worked with Sen. Aaron Bean (R-4), who amended the bill to delete the language recognizing the use of the POLST.

The POLST form is currently accepted in more than 20 states, making this issue likely to arise again next session. Going forward, FHCA will work with all parties to ensure that, as POLST is integrated in Florida, it stays consistent with other forms of advance directives.

Read more about POLST in the May issue of FHCA's Pulse newsletter.

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UNFRIENDLY LEGISLATION

Watch List: SB 862 by Sen. Darren Soto (D-14)/HB 1061 by Rep. Dwight Dudley (D-68)

While this bill would have required nursing centers to post Gold Seal designations in public access, it also would have mandated those centers on the AHCA Watch List to post a notice in similar areas and notify designated family members describing deficiencies. FHCA worked with Sen. Soto and Rep. Dudley to help them understand our concerns with this legislation, as we believe the Watch list to be an outdated tool, given the 30-month requirement, and that it is often confusing to consumers since the federal five-star rating scale more accurately reflects a center's quality measures. In the end, the bill failed to be heard by any committee and died at the end of session.

FAILED BILLS

Unfortunately, the meltdown of negotiations and abrupt termination of the regular legislative session resulted in many good bills dying. These included:

• SB 614 by Rep. Denise Grimsley (R-21)/HB 281 by Rep. Cary Pigman (R-55) - Relating to Drug Prescription by Advanced Registered Nurse Practioners and Physician Assistants. This legislation would have expanded ARNP prescription authority to controlled substances and permitted ARNPs in independent practice to treat patients outside the direct supervision of a physician. An amendment to formally exempt nursing centers from the physician reporting requirements in the Controlled Substances Act was proposed by Sen. Rob Bradley (R-7) and Sen. Grimsley (R-21). The bills died, however, preventing the amendment from being offered.
• SB 478 by Sen. Aaron Bean (R-4)/HB 545 by Rep. Travis Cummings (R-18) - Relating to Telemedicine. This legislation would have set up a framework to regulate the providers and the types of conditions under which they could provide telemedicine services in Florida.
• SB 7068 by Sen. Tom Lee (R-24) and the Senate Appropriations Committee/HB 7119 by Rep. Gayle Harrell (R-83) and the House Children, Families and Elder Affairs Subcommittee - Relating to Mental Health and Substance Abuse. This legislation provided for a major modernization of the mental health laws, including the Baker Act. Negotiations over this complex package were abruptly terminated with the premature adjournment of the House.
• SB 1232 by Sen. Wilton Simpson (R-18)/HB 915 by Rep. Dane Eagle (R-77) - Relating to Building Codes. This legislation contained a rewrite of the state's building code and would have modernized assisted living facility (ALF) code. Existing ALFs would have been given allowance to comply with the home environment provisions in the most current edition of the codes, at the option of each facility, notwithstanding the edition of the codes applied at the time of construction.

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THANK YOU

The passage of many pro-long term care bills is attributed to the tremendous work of our members, staff and lobby team. The pre-session work of FHCA and Our Florida Promise leadership, along with the members involved in our Legislative, Reimbursement and FCAL Committees, was tremendous. At the same time, to our members back home who helped educate legislators through pre-session center tours and legislator meetings, we appreciate the support. In the end, this advance work helped House and Senate bill sponsors to develop legislation that was reasonable and able to be supported by a vast majority of lawmakers, Republicans and Democrats alike.

FHCA also wants to thank the nearly 500 members who traveled to Tallahassee to advocate for the issues and tell your stories. Lobby Wednesdays, sponsored by Bouchard Insurance and Cotler Healthcare and Development, is an integral part of our legislative strategy and helps our key messages resonate when legislators prepare to cast their votes. Many of our associate members also joined us in our efforts, speaking side-by-side with facility staff about the important link between Medicaid funding and quality care. Be sure to watch our special edition of the FHCA Provider Program, sponsored by Bouchard Insurance, which features exciting member interviews and highlights this year's Lobby Wednesday visits.

When legislators return to Tallahassee for a special session, you can be assured that FHCA will remain in the midst of budget negotiations to protect the Medicaid funding that is vital to the care you deliver. In particular, we'll continue asking lawmakers to restore the two prior-year rates cuts amounting to $61 million when budget deliberations resume. Additionally, FHCA will work with legislators on how to move forward with the development of a prospective payment system for nursing centers, which is proposed in the House budget.

FHCA is proud to represent our members for the important work you do. On behalf of the entire team at Florida Health Care Association, we want to thank you for the ongoing encouragement, support and resources that allow us to advocate on your behalf.

FHCA Provider Program - 2015 Session Recap

Watch this week's Provider Program video, which features a recap of FHCA's Lobby Wednesdays and the long term care legislation that passed this session.

FHCA Applauds Rep. Ahern/Sen. Sobel and Florida Legislature for passing ALF reform

Today we applaud Representative Larry Ahern and Senator Eleanor Sobel for their tireless dedication to craft responsible legislation that takes important steps toward fixing Florida’s ALF regulatory system. The Florida Legislature today passed House Bill 1001 by Rep. Ahern/Sen. Sobel, which is an excellent step toward promoting ALF accountability without imposing unnecessary regulatory burdens. At the same time, this important legislation will preserve resident quality care and a level of independence these individuals expect from their ALF home.

The passage of HB 1001 is not only important for our state's current and future senior citizens, but also will properly bolster the reputation of the dedicated assisted living professionals and staff who go to work each day with a focus on quality for the residents under their care.

Florida Health Care Association represents a core group of assisted living communities that are extremely proactive when it comes to quality improvement initiatives, and we're grateful to them for their continued advocacy throughout this process.

FHCA Provider Program - April 24, 2015

This week's video provides an update on several FHCA priority bills which have passed out of the Legislature and are on their way to the Governor's desk. We also cover the latest developments on the state budget impasse.

Long Term Care Legislation Heads to Governor's Desk

We're just one week out from what should be the scheduled May 1st end of the 2015 legislative session. If you've been following FHCA's updates or reading the news, however, you know that a resolution on the budget is unlikely. This means the Legislature will either have to extend the regular session or return to Tallahassee for a special session to work out the budget.

Despite the stall in budget negotiations, long term care priorities continue to advance. We're pleased to report that hospital admission status legislation is on its way to the Governor's desk after the Senate passed HB 309 by Rep. Shawn Harrison (R-63)/Sen. Don Gaetz (R-1) today. We're thankful to Rep. Harrison and Sen. Gaetz for taking up this important issue which will help ensure seniors are properly informed and protected from serious financial burdens.

SB 332 by Sen. Denise Grimsley (R-21) is also ready for the Governor's signature. The Legislature passed this long term care-friendly bill, which gives providers flexibility when choosing the pneumococcal vaccine for nursing center residents by eliminating the specific name brand from the regulation.

SB 7018 relating to the State Ombudsman Program has passed out of the House and is also heading to the Governor. This bill revises the operating structure and internal procedures of the State Long-Term Care Ombudsman Program and improves the Governor's Gold Seal process.

FHCA will continue its advocacy on behalf of long term care providers and residents, emphasizing the important connection between adequate Medicaid funding and high-quality care. Stay tuned for more updates on legislative advances and the state budget impasse.

FHCA Provider Program - 2015 Lobby Wednesdays Wrap Up with Caregivers, Family Members Advocating for Long Term Care

This week's Provider Program features members from Opis Senior Services Group, Summit Care and Page Healthcare, who joined us for FHCA's final Lobby Wednesday of the 2015 session. The more than 125 advocates in town for Lobby Wednesday, including frontline caregivers and family members, offered a tremendous opportunity to remind lawmakers to continue protecting vital Medicaid funding for nursing center care.

FHCA Provider Program - Working to Protect Nursing Center Funding

This week's Provider Program highlights activity surrounding the House and Senate budget proposals and its potential impact on the budget conference and sine die. As we've been reporting, there is ongoing debate surrounding Medicaid expansion and the hospital Low Income Pool program.  As lawmakers maintain their differences over whether the state should take federal money to expand the Medicaid program, FHCA is working to protect the Medicaid line item for nursing center care and ensure this critical funding remains intact throughout budget negotiations.

FHCA Provider Program - LTC Priority Bills Continue to Advance

At the halfway mark of the legislative session, FHCA continues to see its priority bills advancing and negative legislation dying. While the budget process is very fluid, there are still no cuts to nursing center funding at this time. The success of the week is due, in part, to the members from across the state joining us for Lobby Wednesday and helping to stand up in favor of the bills we're supporting. Watch this week's Provider Program episode to see what transpired.

FHCA Provider Program - Members Thank Bill Sponsors, Advocate for Medicaid Funding

For the March 27 episode, FHCA highlights members in town for Lobby Wednesday, including FHCA Districts III in Lakeland, IX in Jacksonville and XIII in the Treasure Coast. Genesis Healthcare and Signature HealthCARE members also joined us to advocate for important long term care priorities and thank lawmakers sponsoring hospital admission status legislation (HB 309/SB 768) that will ensure seniors and their families are informed about their access to the Medicare coverage they deserve.

House and Senate Budgets Protect Funding for Nursing Center Care

Late last week, the House Health Care Appropriations Subcommittee and the Senate Appropriations Subcommittee on Health and Human Services each released their Chairman's proposed budgets. FHCA is pleased to report that both budgets hold nursing center care harmless from any funding cuts and add the standard inflationary increase.

Additionally, the House budget included $6.3 million to reduce the Medicaid Long Term Care wait-list and $2.9 million for PACE expansion in Palm Beach County, while the Senate budget included $18.7 million to reduce the Statewide Medicaid Managed Care Long Term Care wait-list.

Further, the Senate budget included $238,563 for the Background Screening Clearinghouse System. The House budget also contained funding of $400,000 to maintain and upgrade the Background Screening Clearinghouse System, $900,000 for the Area Agencies on Aging to assist seniors enrolling in Statewide Medicaid Managed Care and $250,000 for the Agency for Health Care Administration (AHCA) to contract with an independent entity to develop a plan to convert the current nursing center cost-based per diem reimbursement payment process to a prospective payment methodology.

It should be noted that the House and Senate health care budgets differ by just over $5.0 billion, as the Senate has included $2.8 billion in the budget to expand health care coverage under the Affordable Care Act and nearly $2.2 billion for the continuation of the Low Income Pool. The House budget proposal did not include either program.

FHCA Provider Program - LTC Resident Dream Flights and Lobby Wednesday Action

This week's Provider Program features a break from the Capitol to showcase long term care residents taking flight with Ageless Aviation Dreams Foundations. Four residents from Seven Hills and Brynwood Health and Rehabilitation Centers experienced a flight of a lifetime on Tuesday, thanks to FHCA’s sponsorship of the Ageless Aviation Dreams Foundation. Bettie Sharp (79) and Phyllis Elmore (76) of Seven Hills and Leo Kelly (72) and Joseph LaRosa (82) of Brynwood enjoyed a memorable flight on a restored 1940s Boeing Stearman, the same aircraft used to train many military aviators in the late 1930s and early ‘40s. Under a clear blue sky, each resident took off on the Dream Flight, full of life and with smiles on their faces.

You can also catch highlights from the more than 100 members from Gulf Coast Health Care, who were in town for Lobby Wednesday helping to advocate for important long term care priorities.

FHCA Provider Program Week 2 - FHCA Kicks Off Lobby Wednesdays

For this March 13 episode, FHCA kicks off its Lobby Wednesdays with members from Consulate Health Care, Florida Leaders, FHCA's Legislative Committee and FHC Activity Coordinators Association. Also watch progress on several bills we're tracking. Special thanks to our Lobby Wednesday sponsors, Bouchard Insurance and Cotler Healthcare and Development.

FHCA Provider Program - 2015 Legislative Session Underway

FHCA Executive Director Emmett Reed outlines the Association's 2015 legislative priorities and reports on progress of House Bill 309 which requires hospitals to provide consumers with advance notification about their admission status.

Bill requiring hospitals to notify patients about their admission status advances

Today, Florida Health Care Association applauded the House Health Innovation Subcommittee for passing House Bill 309. A key priority for FHCA this session, this legislation requires hospitals to give advance written and verbal notification to patients about their hospital admission status being classified as inpatient or as outpatient under observation and is an important step in raising attention to a complex and critical issue.

"We are grateful to Rep. Shawn Harrison for sponsoring this legislation and to members of the committee for their bipartisan support of this important issue," said Emmett Reed, FHCA Executive Director. "Many of the residents cared for in skilled nursing centers come from the hospital, often needing rehabilitative or restorative care before they are ready to return home. This legislation will ensure they are properly informed and will help protect them from serious financial burdens."

In testimony, Rep. Harrison noted that "this bill is about transparency and protecting our seniors." Organizations standing in support of the bill included the AARP and the Florida Life Care Resident Association (FLiCRA). 

"Rep. Harrison is to be commended for working with hospital and long term care providers, as well as consumers groups, to ensure beneficiaries understand what is happening to them. We look forward to him developing a bill that all can agree are in the best interest of the patient," said Reed.

FHCA Launches ENGAGE Long Term Care Advocacy Website

Florida's 2015 legislative session begins tomorrow, March 3. To help keep long term care advocates informed and engaged throughout the process, Florida Health Care Association has launched the ENGAGE LTC Advocacy website to help monitor legislation and track the issues that impact your center, your residents and your staff.
   
FHCA's ENGAGE LTC Advocacy website provides information about FHCA's 2015 legislative priorities and resources to help with becoming an effective long term care advocate. Learn more about our initiatives to restore Medicaid funding, make improvements to Medicaid managed long term care and protect seniors from unexpected medical bills. Visitors will also find informative issue briefs with helpful talking points to help you communicate key messages.

Visit the site often to follow the bills we're monitoring which have an impact on long term care providers and residents. When we need a call to action, we'll post "Take Action" alerts, which gives advocates an opportunity to have their voice heard. The user-friendly system allows visitors to enter their zip code to identify their state lawmakers and send a message urging them to vote for or against a legislative issue. FHCA's social media feeds, including Facebook posts and Twitter updates, along with a link to this Capitol Connection legislative blog, are also available to help keep advocates informed about our grassroots activity.

Click here to access FHCA's ENGAGE LTC Advocacy website today to become an effective advocate for long term care.

FHCA Sets 2015 Legislative Priorities for Long Term Care

With more than 60 percent of residents in Florida’s skilled nursing centers relying on Medicaid, the Florida Health Care Association (FHCA) has set legislative priorities that focus on restoring Medicaid funding, making improvements to Medicaid managed long term care and protecting seniors from unexpected medical bills.

More than three in five residents of skilled nursing centers depend on Medicaid to cover the cost their long term health care needs, and another 20 percent rely on Medicare funding. Funding cuts in recent years have significantly affected resources to care for this population, and restoring previous cuts will allow for upgrades to physical plants and equipment, according to FHCA Executive Director Emmett Reed.

“As Florida’s skilled nursing centers prepare to meet the needs of aging Baby Boomers, it’s important we modernize our aging buildings, enhance our technologies and continue placing focus on a more person-centered environment,” Reed said. “Adequate funding opens the door to so many necessary options and will enable our centers to continue making strides in quality care.”

Florida’s skilled nursing centers have experienced over $700 million in Medicaid reductions since 2008. Despite some funding recoupments over the last few years, Medicaid still currently underfunds skilled nursing care by $15.46 per person per day. Florida has more than 73,000 residents in skilled nursing centers, and those centers lose an average of about $377,000 per year due to this Medicaid shortfall.

FHCA will ask the Legislature to restore Medicaid funding for nursing center care as a top priority this session.

FHCA is calling for the Legislature to review Florida’s Medicaid Managed Care System. Florida’s nursing center residents are experiencing a lack of coordination of care as a result of having two separate plans – one for long term care and another for their traditional health care needs. “Our hope is the Legislature will review the system to ensure residents who rely on Medicaid are receiving the appropriate access to care,” Reed continued.

FHCA is also supporting SB 768 and HB 309, which aim to educate consumers regarding their hospital admission status. Seniors are often unaware that Medicare will not cover the cost of follow-up rehabilitative care in a skilled nursing center if the hospital classifies them under “observation status” rather than admitting them as in-patient during their stay.

“Many of the residents cared for in skilled nursing centers come from the hospital, often needing rehabilitative or restorative care before they are ready to return home,” said Reed. “This legislation will ensure they are properly informed about their hospital admission status and help protect them from serious financial burdens.”

More information about the Florida Health Care Association and its legislative priorities can be found at http://www.fhca.org/advocacy/ or by contacting FHCA at (850) 224-3907. 

Governor's Budget Preserves Medicaid Funding for Nursing Center Care

Today, Governor Scott released his $77 billion budget for Fiscal Year 2015-16. The Governor provides full funding for nursing center care as projected by the December 12, 2014 Social Services Estimating Conference. The budget also recommends funding to develop a resource utilization groups(RUGs)-based prospective payment system (PPS) for nursing center care. It's important to note that FHCA supports the development of a PPS system; however not necessarily one based on the RUGs methodology which does not take into account Florida's high staffing standards required to meet residents’ care needs.

Florida Health Care Association applauds Governor Scott for preserving vital Medicaid funding for the care of nursing center residents. “We recognize that Florida’s leaders must find ways to fund a wide variety of critically important programs, and we’re thankful the Governor understands the important connection between adequate funding and high-quality care for our state's frailest elders,” said Emmett Reed, Executive Director of FHCA.

The Governor’s budget also recommends $400,000 in funding for the expansion of Florida’s Care Provider Background Screening Clearinghouse. In operation since 2013, the Clearinghouse enables several state agencies to conduct criminal background checks which, according to the Agency for Health Care Administration (AHCA), expedites the hiring process for employers and allows qualified applicants to start work sooner.

As part of AHCA's media statement in relation to the Governor's budget, Marilyn Wood, President of FHCA's advocacy partner Our Florida Promise, noted, “I want to thank Governor Scott for his support of this extremely important resource and for his commitment to ensuring that Florida’s background screening process is both thorough and secure.  Having the ability to use the Background Screening Clearinghouse for nursing home team members has not only saved me money, but also allows me to devote more of my time to what is really important – caring for our residents.”

January 15 at 10:00 a.m. EST is New Date/Time for FHCA's Legislative Priorities Webinar

Due to a scheduling conflict, FHCA has rescheduled the Legislative Priorities Webinar to this Thursday, January 15, from 10:00 a.m. - 11:30 a.m. EST .

 

FHCA members only are invited to join us this Thursday, January 15, to learn more about the Association's 2015 legislative priorities and what providers can expect during the 2015 legislative session. From Medicaid funding and managed care to hospital observation stays and other regulatory issues, this informative webinar will help you prepare to advocate this session for your residents, your staff and the long term care profession.

ON THE AGENDA:

• Receive an update on the state budget and proposed changes to our payment methodology, along with reimbursement strategies as we continue to advocate for restoring Medicaid cuts that have been imposed on centers since 2008.
   
• Hear the focus of FHCA's legislative ask to help improve Medicaid Managed Care operations to ensure providers can preserve their ability to deliver quality resident care.
   
• Learn more about legislative initiatives to address hospital observation stays, pediatric nursing care and other regulatory fixes for skilled nursing centers and ALFs.
   
• Hear how you can become actively involved in FHCA's grassroots initiatives, including our 2015 Lobby Wednesdays.

FHCA appreciates your understanding and flexibility surrounding this necessary rescheduling. We hope you can join us this Thursday, January 15, from 10:00 - 11:30 a.m. EST for this informative event. Gather your staff and listen in from your center, or access the program from the convenience of your office or home.

Click here to register online (FHCA members-only login required). For assistance with your member login codes, contact FHCA.

*Please note, webinars are offered free as an FHCA member benefit; no CEUs will be available.