Amendments Fly on a Stormy Monday

As FHCA staff headed back to the office after a day at the Capitol, the dark clouds began swirling around us. A tornado warning has been issued for the City of Tallahassee, which resulted in us picking up our pace and thankfully making it inside before the rain and hail arrived.

Things were a bit stormy inside the Capitol, as well, as the amendments started flying for a health care bill we've been tracking. HB 651, sponsored by Rep. Matt Hudson (R-101), is the Agency for Health Care Administration's bill which contains several "deregulation" provisions. It appears to be the perfect "health care vehicle" to move its way through session, and while some of the amendments stayed and some did not, in the end it is still a bill supported by FHCA. The next stop the bill will make is the House floor, so there appears to be a silver lining on the horizon. The Senate companion, SB 2286 sponsored by Sen. Andy Gardiner (R-9), is currently in the Senate Judiciary Committee.

Most of the House Health Care Services Appropriations Committee was taken up by HB 433, sponsored by Rep. Ken Roberson (R-71). FHCA supports this bill, which implements a "formulary" for nursing homes similar to the one that has been in use by hospitals for nearly 25 years. The debate primarily centered around whether the physician was notified prior to the dispensing of the substituted drug (what we have now) or simply notified (the way a formulary system works). A hand-written amendment, filed during the committee meeting by Rep. "Doc" Renuart (R-18), added the "prior to dispensing" language, which is not in the companion Senate bill (SB 1868) also set to be heard later this week. This issue is far from over.

For FHCA, it will be a busy week as we welcome our members to town for our last Lobby Wednesday. The House and Senate, for their part, will spend lots of time in Session, and anything can happen when legislators are on the floor. FHCA will continue tracking these bills, as well as our important reimbursement issue, and will continue keeping members up-to-date as things progress.

A Holiday Break

The halls of the Capitol are quiet today as House and Senate members left Tallahassee late yesterday for the Easter and Passover holidays. Many were concerned about possible flooding along I-10, however that did not stop lengthy budget meetings that went late into the evening.

In the end, budget bills were positioned for a floor debate next week. Next week is back to "business as usual," as policy committees will meet to move several important regulatory bills. Included is HB 651 by Rep. Matt Hudson (R-101), and the companion, SB 2286 by Senator Andy Gardiner (R-9), which are the deregulation bills put forth by the Agency for Health Care Administration. In addition, FHCA staff and lobbyists continue to work on other priorities of the Legislative Committee, including reimbursement, resident voting, ombudsman issues, duplicative inspections and reports and guardianship fees.

FHCA's last Lobby Wednesday will be on April 15th, and a large crowd is expected. Participation at these events has far exceeded last year's numbers, and FHCA appreciates everyone who takes the time to come to Tallahassee and help advocate for our critical long term care issues.

House Budget Starts to Take Shape

The House Appropriations Council on General Government and Health Care approved its half of the state's budget today, which includes health care funding. During the meeting, Rep. Carl Domino (R-83) stated that the Healthy Seniors budget contains only minor cuts in programs for seniors. Rep. Jimmy Patronis (R-6) reported that the Medicaid budget is $18.1 billion, with $3.5 billion coming from the state's general revenue fund. The federal stimulus money allowed the state to reduce its funding by 19.1 percent. The budget included no cut in rates for hospitals or most Medicaid providers. Rep. Kevin Ambler (R-47) stated that nursing homes have a 2.5 percent cut due to an increase in the Nursing Home Diversion Program.

In discussing the Budget Implementing bill, Rep. Oscar Braynon (D-103) offered an amendment to strike language which extends the moratorium for another year on nursing home staffing above 2.6 CNA hours. He, as well as Rep. Yolly Roberson (D-104), called for higher staffing and the funds to pay for it. Rep. Ambler provided an extensive defense of the 2.6 hour staffing, including findings from a recently released Agency for Health Care Administration report, as well as the current budget situation. Rep. Braynon withdrew the amendment and asked that everyone continue to look at this issue.

In the end, the Council approved both the budget and the budget implementing bill along party lines. FHCA will continue to monitor the proposed cuts to nursing homes, urging legislators of the negative effect these cuts would have on nursing home quality care for residents.

Press Event Brings Together Elder Care Advocates to Oppose Nursing Home Funding Cuts

Today, as legislators considered millions in funding cuts to nursing home care, Senator Nan Rich (D-Weston) and Rep. Mark Pafford (D-West Palm Beach) joined Florida Health Care Association (FHCA) Chair Deborah Franklin, Leslie Spencer of AARP, Cloreta Morgan of SEIU and other elder care advocates to urge legislators to use federal stimulus dollars as they were intended – for health and human services – and not cut funds for nursing home care. Currently, the Senate had proposed $81 million and the House $69 million in funding cuts to the Medicaid program, while taking over $780 million of federal stimulus dollars designated for health care and redirecting them into other areas.

“Nursing homes cannot be treated as just another line item in the state budget,” said Deborah Franklin, FHCA Chair. “Washington has provided the much-needed relief…we cannot allow these millions of dollars in cuts to nursing home care.”

Franklin noted during today's event that the solution for funding nursing home care passed in the January 2009 special session with the Quality Assessment Program. Providers began self-imposing a 5.5 percent assessment on April 1, 2009 to allow the state to draw down more than $390 million in federal money. This is in addition to the $4.2 billion that Florida Medicaid will receive in federal stimulus dollars over the next 27 months.

Florida legislators have no reason to impose these cuts when the funding is available through the federal stimulus package. They are simply unnecessary and unacceptable and threaten to undo relief from the Quality Assessment Program, as well, which has barely begun to take affect,” Franklin said.

“We have witnessed a dramatic improvement in nursing home care, and that's a credit to the hard work of the nurses and CNAs who do health care's toughest job,” said Senator Nan Rich. “Our state is in a fiscal crisis that is soon to turn into a moral crisis if we continue cutting critical services for our most vulnerable citizens.”

Rich and Franklin both noted that the elder care reform (SB 1202) that passed in 2001 that required increased minimum staffing standards has resulted in dramatic improvements to nursing home quality. Florida hired over 12,000 nurses and CNA positions over the past eight years, and today has among the highest ratio of staff-to-resident care in the nation. Maintaining steady quality improvements for resident care is a goal strongly supported by elder care advocates including AARP, Florida Association of Homes and Services for the Aging, Florida Catholic Conference, Florida CHAIN and the Service Employees International Union, among others.

The Second Half

As the last half of the 2009 legislative session begins on a humid Monday morning, all eyes are on the state budget. Many committee meetings are packed into this shortened work week (which will last only 2.5 days), and while regulatory and policy issues are important, no one can escape the ever presence of the budget. There is much concern by everyone regarding the state's use of federal stimulus dollars, decisions to cut provider rates and the growing rift between legislative members in the two chambers over just who makes the final decisions.

Let it be said that this short week may be more exciting than week's past. We're jumpstarting this Monday with a press conference today at 12:15 p.m. on the 4th Floor of the Senate Rotunda to address our concerns with these provider cuts when money is available through the stimulus package. FHCA will be joined by Senator Nan Rich (D-Weston), Leslie Spencer of AARP and Cloreta Morgan of SEIU. Watch for our next update with more on this event, and the resulting discussions that surround the state budget.

Weathering the Storm

As Tallahassee continues to receive unending rain, our dedicated FHCA members braved the weather and made their way up to the Capitol for their legislative visits. The weather may have dampened some of the Dade Day activities, but with a captive audience in the Capitol, our members were able to see many more of their legislators.

This is very important, as we are in the midst of serious budget problems and need everyone's support to help educate legislators to the extent of the problem. The proposed nursing home funding cuts - $81 million in the Senate and $69 million in the House - could threaten quality care and quality of life for our state's frail elders. These cuts are unacceptable, particularly when money is available from the federal stimulus package, yet lawmakers are moving over $780 million of stimulus dollars out of health and human services and into other areas. FHCA members, family members of residents and long term care staff are encouraged to contact their legislators and urge them to oppose these funding cuts and use the stimulus dollars as they were intended - to fund the Medicaid program. You can click here, or use the Take Action link to the right under the FHCA Online Resources section to send this important message to your legislators.

The state budget is often one of the last bills to get worked out during the session, so we know there is a process ahead, With the magnitude of the funding cuts, however, we cannot afford to wait or let up on our elected officials.

Next Monday, April 6th, FHCA will host a press conference with Senator Nan Rich and other elder care advocates to oppose these cuts and raise awareness about using the stimulus as it was intended. If you're in town, please stop by the 4th floor Senate Rotunda at 12:15 p.m. to show your support. In the meantime, stay tuned for more on this important issue next week.