Legislators Should Act Carefully on Changes Affecting Care Options for Frail Elders

Today FHCA provided legislators with invaluable information and insights to help shape crucial policy discussions affecting the care of Florida’s most frail residents.  In presentations to two House panels, the association detailed why nursing centers should be removed from any repeal of the Certificate of Need process and offered recommendations on the state’s proposal for a Prospective Payment System for nursing center reimbursement.

The Association, representing 82% of Florida nursing centers and the elderly they serve, told House members that both the quality of care for the state’s seniors and the health of the nursing centers that care for them could be significantly impacted by proposals under consideration. The association is advocating for an exemption from any proposal that eliminates the Certificate of Need (CON) process and supports efforts to move to a Prospective Payment System (PPS) for delivery of nursing center care.

“Repealing nursing home Certificate of Need will most certainly result in unmanaged growth, low occupancy rates, inefficiencies in how buildings operate and a reduction in the value of our state’s nursing centers. All of this will greatly impact how quality care is provided to our state’s seniors,” Emmett Reed, FHCA’s executive director, told members of the House Health Innovations Subcommittee.

CON repeal has affected elder care in other states, Reed noted. For example, Texas operates twice as many nursing centers as Florida but is plagued by facilities that have beds that remain empty and deliver a poor quality of care. Indiana was forced to impose a moratorium on building nursing centers due to unmanaged growth 16 years after it repealed it CON process.

FHCA speakers also noted that by promoting an environment in which new nursing centers must lure elders to fill costly beds, repeal of CON for nursing centers would run contrary to Florida’s long-standing commitment to enabling elders to remain in their homes or in community-based care for as long as possible.

“Florida has attained a system that strikes the right balance. Those who can be cared for in a home and community-based setting are receiving it there – and those who come to my nursing center and others around the state do so because that is the only place they can safely receive the more specialized care they need,” said Ari Hollander, CFO of Stirling Long Term Care, which operates three centers in south Florida.

The House Heath Care Appropriations Subcommittee received a report on the Navigant model for a Prospective Payment System for nursing center reimbursement, developed for the Agency for Health Care Administration. FHCA representatives supported the concept of a PPS approach to foster higher quality with reasonable Medicaid reimbursement rates, but offered recommended changes to that approach to avoid placing undue financial burdens on nursing centers as they transition to the new system.

“The current cost-based system is antiquated. It involves multiple audits, with some of those audits looking at books dating back several years and resulting in underpayments with no ability to financially recoup those monies paid out to cover resident care costs. We support a prospective payment system, where we will know the amount of our payment to cover the cost of care – and the state will have budget predictability, as well,” said Andy Weisman, president of NuVision Management which operates six nursing centers in Florida.

James Aschenbeck of Signature HealthCARE, who is chair of FHCA’s Reimbursement Committee, warned that any transition to a PPS system should include a three-year transition period and additional funding to pay for the nursing staff who provide hands-on care. “We believe any reimbursement system must take into consideration the current financial landscape of nursing center care in order to achieve its goals and become the payment norm of the future,” he said.

Jamey Richardson, president of Gulf Coast Health Care which operates 33 nursing centers in Florida, shared how their support of the Navigant model will come at a cost of Medicaid rate reductions amounting to $6.7 million once the PPS is fully implemented. “Despite this short-term revenue loss, we support the Navigant model because it recognizes and rewards both efficiency and high-quality outcomes…and we know we will be able to adjust to remain successful in how we deliver quality care to our residents with the recommendations put forth by Florida Health Care Association.”

More information on how the Certificate of Need issue may affect the care of Floridians in skilled nursing centers can be found at http://cqrcengage.com/ahcafl/CONProcess. To learn more about the Prospective Payment System and FHCA’s recommended changes to the Navigant PPS model, visit http://cqrcengage.com/ahcafl/SupportPPS.

Managed Care Not Best Option for Frail Floridians, Needlessly Costs Taxpayers $68+ Million

Florida’s system of managed care does not work effectively for long-stay nursing center residents who can’t take care of themselves or be safely cared for in the community – and the system is costing taxpayers approximately $68.2 million in unnecessary fees each year, the Florida Health Care Association (FHCA) told a state Senate committee today.

More than 47,000 Floridians live in nursing centers and are enrolled in the long term managed care program. FHCA representatives told senators the program achieves cost savings when residents are either delayed from entering or transitioned out of nursing centers and into lower-cost settings – but those are not options for the many residents who need long term nursing center care lasting more than 60 days.

“Florida has a long-standing commitment to help elders remain in their homes or community settings for as long as possible. But we also must recognize that for more and more of the frailest residents, a nursing center is the best – perhaps only – realistic option,” Bob Asztalos, who manages FHCA's Government Affairs Department, told members of the Senate Appropriations Subcommittee on Health and Human Services.

A series of experts presented testimony during the subcommittee’s discussion of the managed long term care component of the Statewide Medicaid Managed Care system. They detailed how managed care is not an effective approach for many skilled nursing care centers, which care for nearly 73,000 frail elders and individuals with disabilities – most of whom require 24-hour complex medical care and have cognitive impairments, such as Alzheimer’s disease or other dementias.

Asztalos said Florida uses home and community-based care effectively to ensure that seniors receive care in the most appropriate place and the least restrictive setting. Less than 2 percent of Florida seniors over the age of 65 are living in nursing homes, less than half the national average of 5 percent.

The managed care program was designed to reduce the cost of providing health benefits, but FHCA presented several reasons why it is not effective for long-stay residents. Steve Jones, an accountant with the Moore Stephens Lovelace CPA firm that conducted a study of the system, testified that the state could save more than $68 million by exempting long-stay residents from managed care.

Jones noted that the number of enrollees in the program who receive care at nursing centers grew by 2.6 percent in the two years ending in July. He said by eliminating the need to contract with managed care organizations, the program would realize savings by eliminating $36.5 million in administrative fees and another $31.7 million in case management fees – expenditures that are not necessary for residents who remain in long-stay care.

“These numbers will only continue to grow as Baby Boomers age. This is money the state could instead be putting into direct resident care, to improve the lives of those who rely on quality care in the later portion of their lives,” Jones told senators.

By utilizing traditional Medicaid, case management costs would be cut by about 72 percent while administrative costs would be reduced by approximately 54 percent, he said.

The Managed Care system complicates the Medicaid process for long-stay residents who need consistent care. It places a barrier in the efficiency of the health services of these facilities and drives up unnecessary costs.

Patti Spears, administrator at Oakbrook Health and Rehabilitation in the rural Hendry County community of LaBelle, described some of the challenges faced by long term care residents at her skilled nursing center. Because many managed care companies will not authorize services across county lines, seniors who live in LaBelle but are treated at the nearest hospital in Lee County are then required to be placed in a nursing center in that distant county.

“The transition from a hospital to a nursing center is already a difficult experience, for the patient as well as the family members. Imagine the additional burdens of being placed in an environment that is far from home and unfamiliar. Your loved ones now have a 45-minute commute, on a busy interstate, to visit you,” Spears said. “These residents deserve better; this is not quality of life.”

Kristina Robinson, a case manager for Opis Senior Services Group, serves as a liaison between 11 skilled nursing centers and an assisted living facility, and the managed care staff they work with. She told senators that managed care case managers typically direct any issues or concerns back to the nursing staff – something the facilities could do themselves.

“Managed care case managers don’t bring any added service to those residents whose health and care needs prevent them from moving to a setting outside the nursing center. Their medical needs are simply too complex, and typically their families believe they are better served in the nursing center where 24-hour care is provided,” she said. “I believe the managed care system is simply duplicating the services we already have in place.”

For more information about Florida Health Care Association and their legislative initiative to exempt long-stay nursing residents from Florida’s Medicaid Managed Care System, visit http://tinyurl.com/FHCAMgdCare17. A copy of the Moore Stephens Lovelace report can also be found at that location online.

Governor's Budget Preserves Medicaid Funding for Nursing Center Residents

Yesterday, Governor Rick Scott proposed a $83.5 billion state budget for Fiscal Year 2017-18. The Governor’s budget provides full funding for nursing center Medicaid rates as projected by the December 7, 2016 Social Services Estimating Conference. The budget also directs AHCA to implement the Nursing Center Prospective Payment System as recommended by the Agency/Navigant. 

The budget also includes additional funds for AHCA to improve the Background Screening Clearinghouse, which will speed up the hiring process for new employees.

It's important to note that hospitals are subject to over $929 million in cuts to Medicaid rates under the proposed budget as a result of the removal of inflationary adjustments, the elimination of supplemental payments for charity care to not-for-profit hospitals and by allowing Medicaid managed care plans to negotiate lower rates for hospitals.

FHCA Executive Director Emmett Reed thanked Governor Scott for his continued support of quality care and services for Florida's frailest elders. "We appreciate him fully funding Medicaid for nursing center services and for initiating the dialogue on the creation of a Prospective Payment System, said Reed. "In addition, his 'Fighting for Florida’s Future' Budget will help to further streamline the background screening process, allowing qualified employees applying at our centers to enter the long term care workforce faster so they can more quickly begin caring for residents."

On a broader level, the Governor’s budget recommends $618 million in tax cuts, including sales taxes on commercial leases, a sales tax exemption on college textbooks, a 10–day sales tax holiday for school supplies, and a nine-day disaster preparedness sales tax holiday. For details on the Governor’s FY 2017-18 budget, click here.