The Legislature officially adjourned today, May 8, to pass the final $83 billion budget for the 2017-18 state fiscal year. The three-day extension was needed because the budget requires a 72-hour “cooling off” period, and thus a final vote could not be taken on the originally scheduled end date of May 5.
The 2017 legislative session was one of the most challenging in history for Florida Health Care Association. Much of the work started well before the session began in March, with workshops held late last year focused on the Medicaid managed care program. By February, legislation that eliminated nursing center and hospice Certificate of Need was filed. After many months providing input on the Agency for Health Care Administration’s development of a Prospective Payment System, a flawed PPS model delivered by the AHCA consultant (Navigant) put the Association into overdrive to ensure the quality components and protections for providers were captured in the final PPS plan. All that was compounded by the threat of negotiating rates with managed care organizations and small group of outliers in the profession delivering a false narrative to lawmakers and the media.
Despite those significant challenges, FHCA not only succeeded on almost all our priorities, but I believe we got better. We unified, we strengthened our lobbying efforts, stepped up our traditional and social media activity and increased our grassroots advocacy initiatives. We became part of the solution at the Capitol by giving legislators meaningful recommendations from the experts – our members – who will now have the ability to take quality care to a whole new level.
Our ability to bring consensus to the profession resulted in the passage of a Prospective Payment System that ties nursing center reimbursement to quality advancements and gives providers much-needed protections to adapt to the new payment structure.
Our effective messaging about the need for managed growth ensured that nursing centers’ and hospices’ Certificate of Need remains intact.
Our ability to fight back hard ensured managed care companies will not be the driver in setting your Medicaid rates. In fact, because of FHCA’s effective advocacy, members will see their rates increase approximately $2.75 per patient day when reimbursement rates are set September 1, 2017.
FHCA also supported preserving the nursing center personal needs allowance, which will remain intact at $105 per month.
Earlier today, Florida Politics touted FHCA as one of the winners emerging from the 2017 legislative session, and I cannot agree more.
The reality is, however, that we did not accomplish these legislative successes alone. Our ability to effectively advocate for so many complex issues this session is a combined result of the strength of our Government Affairs team, the support from our FHCA and Our Florida Promise leaders, the active involvement and expertise of our Legislative and Reimbursement Committee members, and the extensive reach of our members’ grassroots advocacy.
In my more than 20 years in association management, I have never experienced a more challenging session. And in my eight years as your Executive Director, I have never been more proud of my FHCA team and the membership for the countless hours that were put in to advance these legislative priorities and get our messages across.
Once again we had a record attendance of more than 500 participants in our Lobby Wednesdays, including many of our business partners who also joined us in our efforts. Thank you to our Lobby Wednesday sponsors - Bouchard Insurance, who also sponsored the Provider Program, Health Care Professional Consulting Services, Inc. and Medline Industries, Inc. for giving this grassroots initiative an even greater presence.
FHCA is proud to represent you at Florida’s Capitol and in everything you do to care for our state’s frailest elders. Together we worked hard, remained united and never gave up throughout the process. And as a result, we saw legislative outcomes that keep the focus on quality care.
BUDGET
Governor Rick Scott released his initial budget in January, funding the estimated fiscal year 2017-2018 expenditures for nursing centers without an inflationary increase due to the required rate freeze stated in s. 409.908, Florida Statutes (F.S). The Governor also proposed fully funding the Nursing Facility Quality Assessment (NFQA), which would ensure a “buyback” of over $663 million in Medicaid rate reductions.
The initial budgets released by the House and Senate mirrored the Governor’s proposed budget for nursing center funding.
The final budget (SB 2500) provides $4.4 billion for Long Term Care, including fee-for-service nursing center care paid by the Medicaid contractor and Managed Long Term Care paid by managed care plans. The NFQA is increased by over $41 million compared to fiscal year 2016-2017. The per-day assessment rate would increase to approximately $25.26 per non-Medicare patient day ($4.55 per non-Medicare patient day for high volume Medicaid facilities), which provides for rate “buyback” of an additional $33.7 million compared to the current year.
The result of the additional funding and changes to the Federal Medical Assistance Percentage (FMAP) leads to increased Medicaid rates for nursing centers of approximately $2.75 per patient day when rates are set September 1, 2017.
When initially proposed, the House budget reduced the resident personal needs allowance from $105 per month to $70 per month. The Senate budget, however, did not include this reduction. During budget negotiations, Senate President Joe Negron (R-Palm City), a long-time champion for nursing centers and the residents under their care, stood firm to ensure this funding was preserved. As a result, the personal needs allowance will remain at $105 per month for fiscal year 2017-2018.
It’s important to note that while nursing centers were not subject to any funding cuts, other providers saw large reductions to their funding. Hospitals, for example, face a proposed cut of $521 million beginning July 1.
PROSPECTIVE PAYMENT SYSTEM
SB 2514 implements the Nursing Home Prospective Payment System (PPS). The PPS Plan places in statute the Senate PPS model with its quality components and transition period, with an implementation date of October 1, 2018.
In 2016, the Legislature provided funding to the Agency for Health Care Administration to work with an independent contractor (Navigant) to develop a Prospective Payment System (PPS) for Medicaid nursing center rates. Over the past year, FHCA members and staff invested a significant amount of time and expertise to support AHCA and Navigant with developing a system that rewards centers for providing high quality care and making the much needed investments in updating and upgrading their centers.
While the public meetings brought together stakeholders for discussion over what was needed in a PPS, FHCA made it clear in public testimony that the Navigant model did not represent the best way to implement PPS policy for nursing center reimbursement. It was a starting point from which FHCA recommended significant changes.
Unfortunately, the final report that was presented to the Legislature contained a series of flaws and raised serious concerns among legislators. FHCA brought together members of the Association who were negatively affected by the Navigant PPS model to further develop recommended changes and gain consensus before presenting it to the Legislature. Upon approval, FHCA presented these recommendations to Senator Anitere Flores (R-Miami) and Senate Health Care staff to support their work to improve AHCA’s PPS model. Ultimately, the Florida Senate included a number of FHCA’s recommendations to develop an improved model that was passed as part of the Senate budget.
To coincide with FHCA's PPS lobbying efforts, the Association launched a social media campaign and engaged members to ensure their voices were heard. The campaign focused on the facts about PPS to emphasize how PPS puts the focus on rewarding centers for quality advancements. Digital advertising, guest editorials in local newspapers, Facebook and Twitter messages, videos and infographics, a press conference with over 75 Lobby Wednesday participants, Facebook Live events, Letters to the Editor from a number of center administrators across the state, thousands of emails and legislative district office visits with residents and staff were all part of the campaign.
While the House did not include the PPS language in their budget, Senate and House leaders were able to work out a compromise during budget negotiations to include the Senate PPS Plan with the majority of FHCA’s recommendations into the final budget. The Legislature did agree on one-year delay, which means the new reimbursement system will take effect October 1, 2018.
The PPS Plan includes a multi-year transition to ensure centers have time to adapt, and, for the first time in Florida Medicaid history, will tie payments to health quality outcomes. For more information about the components of the PPS Plan, click here.
CERTIFICATE OF NEED
FHCA was successful in preserving nursing center and hospice Certificate of Need (CON), despite a philosophical belief by many legislators that a more “free-market approach” is better for our state’s health care system.
HB 7 by Rep. Alex Miller (R-Sarasota) and SB 676 by Sen. Rob Bradley (R-Orange Park) would have eliminated the Certificate of Need regulatory process for all health care providers, including hospitals, nursing centers and hospices; however, these bills failed to pass.
FHCA led an effective lobbying effort and grassroots campaign that included hundreds of members making this a key discussion point during their Lobby Wednesday visits. Several FHCA members also traveled to Tallahassee to testify in committee and nearly 2,000 emails were sent to legislators to urge them to protect nursing center CON. FHCA also used social media to raise awareness to this issue with a series of targeted messages on Facebook and Twitter.
In the end, Rep. Miller heard members’ concerns, and as a result, offered an amendment to remove nursing centers and hospices from the bill. Both the amended House bill and the Senate bill died with the scheduled end of the legislative session on Friday, effectively putting this issue to rest for another year.
MANAGED CARE
Improving the managed care system was a top priority for FHCA this session, as well as Senate President Joe Negron (R-Palm City). In the months leading up to the session, Sen. Negron tasked the Senate with studying the Statewide Medicaid Managed Care Program as the state approached the end of its first round of five-year contracts with managed care plans. After much deliberation, several managed care related bills were filed this session.
SB 682 by Sen. Kelli Stargel (R-Lakeland) and HB 1059 by Rep. Alex Miller (R-Sarasota) failed to pass. SB 682 included a provision to exempt long-stay residents from the Medicaid managed care system once it was determined the nursing center is the safest place for them to receive their care. While the House companion bill did not include the long-stay exemption, both bills contained language to ensure providers are paid timely by managed care companies and have access to managed care networks.
FHCA staff and members testified before a number of committees, with an overarching message that the managed care system does not work effectively for long-stay nursing center residents. FHCA also commissioned Moore Stephens Lovelace to assess how the state could save money (approximately $68.2 million) by exempting these residents. Traditional and social media relations and grassroots advocacy through Lobby Wednesday discussions and member email campaigns were part of the strategy to try to advance this legislation.
And while the push to exempt long-stay residents from the managed care system did not resonate with lawmakers this session, FHCA was successful in defeating legislation that called for managed care companies to negotiate providers’ reimbursement rates.
HB 7117 by Rep. Travis Cummings (R-Orange Park) and SB 916 by Sen. Denise Grimsley (R-Lake Placid) failed to pass. You may recall this legislation included language that would have allowed managed care companies to negotiate rates with providers, a provision FHCA was successful in having struck down before the bill saw a final vote. Had this legislation passed, it would have revamped Florida’s Medicaid managed care system and required AHCA to fine managed care plans which fail to pay providers timely - a provision from SB 682 by Sen. Kelli Stargel (R-Lakeland).
ASSISTED LIVING FACILITIES
Prior to session, FHCA was alerted that certain county property appraisers were contending that assisted living facilities (ALFs) are not health care facilities. As a result, these ALFs were being charged property taxes. FHCA educated the Legislature as to the role assisted living facilities play in the continuum of long term health care and, therefore, should not be levied property taxes.
This year's tax package passed [HB 7109 by Rep. Jim Boyd (R-Bradenton) and Sen. Kelli Stargel (R-Lakeland)] and includes a provision that exempts ALFs from property taxes.
OTHER BILLS OF INTEREST
While the Legislature began the session with talk of creating major reforms to Florida’s health care system, many of the issues below were not significant enough to make House and Senate leaders’ "must pass" list. After much attention, issues such as the regulation of medical marijuana, expanding the scope of nonphysician providers, greater roles for ambulatory surgical centers and the creation of recovery care centers, and workers’ compensation all failed in the waning days of the session. A number of bills actively worked by FHCA also fell into this category, as both chambers were unable to come up with a compromise on the proposals they put forth.
Recovery Care Centers
HB 145 by Rep. Paul Renner (R-Palm Coast)/SB 222 by Sen. Greg Steube (R-Sarasota) failed to pass. This legislation would have created a new recovery care center license in Florida and allowed patients to receive services up to 24 hours in an ambulatory surgical center. As part of its lobbying efforts, FHCA worked to ensure these providers remained focused on post-surgical recovery rather than provide rehabilitative care that would typically be delivered in a skilled nursing center.
Agency for Health Care Administration Regulatory Bill
HB 1195 by Rep. Alex Miller (R-Sarasota)/SB 1760 by Sen. Denise Grimsley (R-Lake Placid) failed to pass. To ensure nursing centers were not negatively impacted by this legislation, FHCA collaborated with the Agency for Health Care Administration (AHCA) on several provisions related long term care, with particular focus on language related to background screening, change of ownership and the licensure process.
Employees Working in a Health Care Setting
HB 1207 by Rep. Daisy Baez (D-Coral Gables)/SB 1712 by Sen. Darryl Rouson (D-St. Petersburg) failed to pass. This legislation added employees working in hospitals, specifically physicians, registered nurses, employees, agents or volunteers, to the list of professionals who trigger a reclassification of certain assault and battery offenses when committed while on duty. Although it failed to advance, FHCA was successful in seeing HB 1207 amended to include said professionals who work in nursing centers.
HB 1207 by Rep. Daisy Baez (D-Coral Gables)/SB 1712 by Sen. Darryl Rouson (D-St. Petersburg) failed to pass. This legislation added employees working in hospitals, specifically physicians, registered nurses, employees, agents or volunteers, to the list of professionals who trigger a reclassification of certain assault and battery offenses when committed while on duty. Although it failed to advance, FHCA was successful in seeing HB 1207 amended to include said professionals who work in nursing centers.
Medical Marijuana
HB 1397 by Rep. Ray Rodrigues (R-Ft. Myers)/SB 406 by Sen. Rob Bradley (R-Orange Park) related to medical marijuana regulations failed to pass. There were several medical marijuana bills filed this session, each of which came with contrasting approaches. FHCA’s priority was to protect members in the final outcome by educating legislators and their staff about the conflict nursing centers face between Florida’s constitutional amendment and federal law.
Workers' Compensation
HB 7085 by Rep. Danny Burgess (R-Zephyrhills)/SB 1582 by Sen. Rob Bradley (R-Orange Park) failed to pass. Florida lawmakers sought to reform the state’s workers compensation system after a 2016 Florida Supreme Court ruling led to a 14.5% increase in workers’ compensation insurance rates. While both House and Senate each passed their respective versions of the bill, they were unable to agree on attorneys fee caps and reimbursement cuts to hospitals that provide outpatient treatment to injured workers.
WHAT'S NEXT
Now that legislators are returning to their districts, FHCA wants to encourage you to invite them into your center so we can continue educating them about what’s important to the long term care profession and the residents cared for every day. In the coming weeks, we will be compiling the 2017 Legislative Scorecard. This is an effective grassroots advocacy tool that measures lawmakers’ support of our issues and offers more information about the outcomes from session.
In addition, FHCA will be providing more information and resources to members about the Prospective Payment System in the coming months, including an educational session at Annual Conference. This and other opportunities will be designed to help providers better understand the quality components and how to plan and adapt to the new payment structure.
Be on the lookout for more information about the Governor's action on the budget, as well as how to prepare your team for PPS. On behalf of the entire team at Florida Health Care Association, thank you again for the ongoing encouragement, support and resources that allow us to advocate on your behalf.
*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). Watch your weekly Focus on Florida e-newsletter for updates on the Governor's action and effective dates on the bills we've reported on above.
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