FHCA Provider Program - Progress on PPS & Managed Care

Members from Clear Choice Health Care joined FHCA at the Capitol Thursday for a special Lobby Day focused on the managed care priority. Watch how their visits helped advance the Senate Bill 682 by Sen. Kelli Stargel, which exempts long-stay residents from the Medicaid managed care system.

FHCA Provider Program - April 7, 2017

At the halfway mark of the legislative session, FHCA held a press event on the Prospective Payment System with over 100 of its members in town for Lobby Wednesday, who also testified and waived in support as the Senate Appropriations Committee took up the vote. Certificate of Need and Managed Care were also significant topics of discussion on the House side.

House Bill Would Give Managed Care Companies Ability to Dictate How Nursing Centers are Reimbursed

Emmett Reed, executive director of the Florida Health Care Association, issued the following statement after the House Health and Human Services Committee addressed the reimbursement system for skilled nursing centers in proposed committee bill 17-03:

“While we are pleased the committee recognizes the importance of ensuring that skilled nursing centers receive prompt reimbursement for the crucial services they provide to elders, we remain deeply troubled by language in the bill that would require our centers to negotiate rates with managed care companies. Nursing center care for Medicaid residents is already significantly underfunded, and giving managed care companies the ability to reduce those rates even further would jeopardize the care of our state’s seniors. Centers would be left with no choice but to cut services that our residents depend on to enhance their quality of life. 

“Today’s reimbursement system fails to adequately reward nursing centers for providing high quality care, for being efficient users of tax dollars, and for investing in improvements to their facilities. Florida’s seniors, and the providers who care for them, would be best served by the prospective payment system that provides strong incentives for quality and a multi-year transition period to give providers time to adapt. This approach was adopted yesterday by the Senate Appropriations Committee, and we urge the House to move in a similar direction.”

House and Senate Budgets Released: Medicaid Funding for Nursing Center Care Preserved

The House and Senate Health Care Appropriations Subcommittees released their proposed budgets today. There are no reductions to Medicaid funding for nursing center care in either proposal. This is good news for members and a result of long term caregivers' efforts to educate legislators about the importance of appropriately funding the high-quality care delivered each day.

The Senate budget includes language directing the Agency for Health Care Administration (AHCA) to implement the Medicaid Prospective Payment System (PPS) with all of FHCA's recommendations and the additional funding necessary for transition. At this time, the House budget does not include language implementing the PPS. The proposed House budget reduces the nursing center resident personal needs allowance from $105 to $70 per month, but there is no reduction in the Senate budget.

In addition, the House and Senate budgets both provide for additional funding to serve Medicaid recipients on the Home and Community-Based Services waiting list and additional PACE slots. It should be noted that under both budget proposals, hospitals are subject to large funding cuts - $621 million in the House and $258 million in the Senate.

The budget is one of several priorities the team at FHCA is actively working. Yesterday we saw success on the managed care priority as Senate bill 682 passed out of the Senate Health Policy Committee. The bill allows nursing center residents to be exempted out of managed care after 60 days in a center, creates fines if a managed care company does not timely pay a nursing center, and requires a 1 year any willing provider for plans entering a new area of the state. Though heavily lobbied against by the managed care organizations and AHCA, the bill passed 6-1.

                              

We're nearing the halfway point of the 2017 session, and there is still much work to be done. FHCA wants to remind members that the budgeting process still has a long way to go, as both chambers must agree on a final budget for the session to formally adjourn.

As budget negotiations between the House and Senate continue to unfold in the coming weeks and our priorities of Certificate of Need, managed care and the PPS progress, FHCA needs members' active involvement to be a strong voice at the Capitol. We look forward to seeing more long term caregivers in Tallahassee over the next few weeks for Lobby Wednesdays and appreciate members' support when asked to take action from back home. 

In the meantime, rest assured the FHCA staff and lobby team will continue working tirelessly on members' behalf so the focus can remain on residents and the quality care Florida's long term care providers are delivering.

When it Comes to Nursing Center Care, Trust the Caregivers -- Not the Insurers

In an effort to protect their turf, the health plans behind Florida’s managed care program for Medicaid recipients keep saying they help many older Floridians move from nursing centers to live in community settings. What they fail to tell you is that these elders are just a small fraction of nursing center residents – the reality is that some frail elders simply cannot be properly cared for outside a skilled nursing center.

These health plans, along with the state Agency for Health Care Administration, are basing their assessment on seriously flawed calculations. While they say it would cost taxpayers $200 million to remove skilled nursing centers from managed care, such a carve-out would actually save taxpayers $68.2 million per year.

Florida has a long-standing commitment to help elders stay in their homes or community settings for as long as possible. But we must also recognize that for more and more of the frailest residents, a nursing home is the best, and perhaps only, realistic option.

The state’s erroneous cost estimate is based on an assumption of what it would cost if certain individuals who received home- and community-based services had instead been cared for in a nursing center. But the proposed carve-out focuses solely on exempting long-stay nursing center residents, not those who could otherwise live in community settings. There are no savings to be realized for these individuals because their health and medical needs can only be addressed in a nursing center – they cannot be safely cared for in a home or community setting.

Official state figures show that managed care companies transition only about 4 percent of nursing center residents into home- and community-based care. That means the other 96 percent continue to receive their care in skilled nursing centers. The huge savings touted by the managed care companies simply cannot be realized.

Florida’s system of managed care doesn’t work effectively for long-stay nursing center residents, who can’t take care of themselves or be safely cared for in the community. With those residents stuck in the managed care system, taxpayers are paying approximately $68.2 million in unnecessary fees each year for management services that are not needed, according to a study for the Florida Health Care Association.

In the final analysis, managed care companies are insurance companies, not health care providers – if it doesn’t work for their bottom line, they’re not interested. So when your loved one needs the kind of care that can only be offered in a skilled nursing facility, who would you rather entrust with their care: their insurer or their trained caregivers?

Emmett Reed
FHCA Executive Director

FHCA Provider Program - March 24, 2017

During week three of the legislative session, FHCA members held a successful Lobby Wednesday, making visit to lawmakers on key long term care priorities. Other members traveled to Washington, DC, to protect Medicaid funding at the federal level.