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2017 Legislative Session –
2017 Legislative Session—Stay Informed!
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This is our weekly Legislative Update/Recap report that will continue through the end of Session. Included with this report is the latest copy of the LeadingAge Florida Legislative Bill Tracking Report.
Medicaid Prospective Payment System for Nursing Homes
LeadingAge Florida supports SB 712 by Sen. Aaron Bean which codifies LeadingAge Florida’s alternative model into law. The AHCA proposal would shift $109 million from mostly high-quality nursing homes to mostly lower-quality nursing homes; it therefore threatens the quality of care that is currently delivered by Florida’s nursing homes and will devastate many of the state’s 5-star providers. Because the proposal will mean hundreds of thousands, and in some cases, millions of dollars in losses to high-quality providers, access to Medicaid services for vulnerable seniors will be limited, and quality providers themselves will be threatened. LeadingAge Florida has developed an alternative plan that achieves the goals of simplicity, budget neutrality, and quality without the devastating effects of the AHCA plan. The alternative simply begins with current rates, and allocates the current quality component based on the actual quality performance of the nursing home.
SB 712 has been referenced to three committees. A House companion bill was not filed; however Navigant presented its report to the House Health Care Appropriations Subcommittee on February 15. During the workshop, several committee members raised questions about the model presented by Navigant and heard testimony from members of LeadingAge Florida opposing the model recommended by Navigant. At the conclusion, Chair Jason Brodeur announced that the House will not be pursuing a change to a Prospective Payment System for Nursing Homes during this Legislative Session but will work on it this summer. He further advised that he’d like for the committee to take a look at a more disciplined approach to this issue.
That being said, the Florida Health Care Association has developed its own alternative plan that they hope will be considered this legislative session. We are currently reviewing the proposal to better understand the plan and we’ll keep you posted as its full implications become clearer. We will be reaching out to you with our summary of the proposed plan and action steps that you can take to help us advocate for a payment system that is fair and equitable and rewards quality.
Certificate of Need for Nursing Homes
LeadingAge Florida supports amendments to HB 7 by Rep. Alex Miller and SB 676 by Sen. Bradley removing provisions in the bills that repeal the certificate of need requirement for nursing homes. Without a Certificate of Need process Florida would experience a significant growth in nursing home beds. This growth would outpace population growth and corresponding need for new beds. Nursing homes are the most expensive component of the long-term care system and an uncontrolled growth in bed capacity would increase overall long-term care costs.
HB 7 has passed two committees of reference and has one final stop – the House Health & Human Services Committee. No further action was taken on HB 7 this week. SB 676 has been referred to four committees of reference and has not yet been heard in the first committee of reference.
Continuing Care Community Regulatory Reform
LeadingAge Florida opposes the Office of Insurance Regulation’s proposed changes to chapter 651, F.S., until all stakeholders are involved in the process and have the opportunity to identify necessary changes and participate in the development of statutory language. LeadingAge Florida opposes SB 1430 by Sen. Tom Lee and HB 1349 by Rep. Cyndi Stevenson that, if passed, would enact OIR’s excessive regulatory reform proposals into law.
LeadingAge Florida and its 56 CCRC members support thoughtful regulatory reform that protects Florida’s seniors and their investments in senior care. The lengthy bill, developed by the Office of Insurance Regulation (OIR) without input from stakeholders, makes major revisions to almost every section of Ch. 651, F.S., (the law governing the regulation of continuing care retirement communities) and creates another eight sections of law.
SB 1430 has been referenced to four committees. HB 1349 has been referred to the House Insurance & Banking Subcommittee, Health & Human Services Committee and the Commerce Committee. Neither bill has been scheduled for a hearing.
LeadingAge Florida met on Friday with Representative Cyndi Stevenson, representatives of Sen. Tom Lee, the Office of Insurance Regulation, FLiCRA and the Department of Financial Services to continue discussions on Senate Bill 1430 and House Bill 1349 – the CCRC reform bills. Earlier in the week, FLiCRA released an amendment to the bill that would eliminate many of the provisions in the bill that our members have found most objectionable. The amendment represents a good starting point for LeadingAge Florida to discuss potential reforms to chapter 651, FS, for consideration during the 2017 Session.
While LeadingAge Florida will continue discussions with all of the stakeholders on the amendment as presented by FLiCRA, we remain firm in our opposition to the bills in the House and Senate as they have been filed.
Affordable Senior Housing
LeadingAge Florida supports an amendment to SB 854 by Sen. Jeff Brandes and HB 1013 by Rep. Newton adding a representative of LeadingAge Florida to the affordable housing task force created in the bills and a requirement for a task force recommendation on affordable senior housing.
SB 854 and HB 1013 both passed their first committees of reference this week. The Florida Housing Finance Corporation is supportive of a LeadingAge Florida amendment to the bill and we are working on such an amendment for consideration in the next committee stop.
Activity on LeadingAge Florida Monitored Bills
Health Care Facility Regulation
HB 1195 by Rep. Alex Miller is the Agency for Health Care Administration’s (AHCA) healthcare regulatory reform package; it clarifies statutory requirements, eliminates confusion, and allows the AHCA to operate more efficiently. According to the sponsor, the proposal strikes the right balance of protecting patients and reducing regulations. It addresses unlicensed activity of assisted living facilities (ALFs). AHCA is charged with regulating any unlicensed ALF activities. Since 2013, AHCA conducted 500 unlicensed investigations confirming at least 200 were in violation. Regulatory action is often difficult and faces many loopholes. The bill makes several changes to close loopholes increasing the ability for AHCA to conduct enforcement regulations.
It also eliminates licensure requirements for clinical laboratories to rely on the federal requirements which are the Clinical Laboratory Improvement Amendments (CLIA) regulations.
HB 1195 passed out of its first committee of reference this week and has two more committees to go. The companion, SB 1760 by Sen. Grimsley has been referenced to four committees and has not yet been scheduled for a hearing.
Recovery Care Centers
SB 222 by Sen. Steube extends the time a patient may stay in an ambulatory surgical center to 24 hours and creates the recovery care center license. The bill provides that recovery care centers provide postsurgical and post-diagnostic medical and general nursing care to patients for whom acute hospitalization is not required and an uncomplicated recovery is expected. A patient’s stay in a recovery care center is limited to 72 hours. On March 14, the bill was amended in the Senate Health Policy Committee to remove all provisions relating to recovery care centers. As amended, the bill only increases the length of time a patient may stay at an ambulatory surgical center to 24 hours. The bill has three more committees of reference.
HB 145 by Rep. Renner changes the allowable length of stay in an ASC from less than one working day to no more than 24 hours, which is the federal Medicare length of stay standard. The bill creates a new license for a Recovery Care Center (RCC), defined as a facility the primary purpose of which is to provide recovery care services, to which a patient is admitted and discharged within 72 hours, and which is not part of a hospital. The bill has passed all of its committees of reference two committees of reference and has been placed on the House Calendar.
HB 863 by Rep. Roth and SB 414 by Sen. Grimsley create a CON exemption for hospice services provided in a not-for-profit retirement community that shares a controlling interest with a teaching nursing home, which has held such designation for five years and is part of the not-for-profit retirement community. Miami Jewish Health Systems, located in Miami-Dade County and The Joseph L. Morse Health Center, located in Palm Beach County, meet this criteria. HB 863 was reported favorably in its first committee of reference and has one more committee of reference. SB 414 has been referred to three committees and has not yet been scheduled for a hearing.
Advanced Registered Nurse Practitioners
HB 129 by Rep. Plasencia and SB 96 by Sen. Steube revise the definition of the term “medical director” to include certain physician assistants and advanced registered nurse practitioners (ARNPs), authorizing an ARNP or PA to serve as the medical director of a health care clinic, if employed or under contract with the clinic. HB 129 has passed both of its committees of reference and heads to the House calendar.
SB 96 has been referenced to three committees and has not yet been heard in committee.
Other Activities of Interest to LeadingAge Florida
Fiscal Year 2017-18 Budget
Gov. Rick Scott has proposed an $83.5 billion budget for the fiscal year that starts July 1, up about $1.2 billion from the current year. In the proposal, Scott called for $618 million in tax cuts, increased education spending and cuts in hospital funding. The Legislature is not expected to face a shortfall in the 2017-2018 budget, but by the following year, lawmakers could be $1.3 billion short of how much they will need to cover expected spending, with a $1.9 billion hole projected the year after that.
This week, House budget subcommittees came up with recommendations on reductions to help reduce future shortfalls, including, cuts in payments to hospitals, reductions in spending on universities and scaling back early-learning and other public-education programs.
The Revenue Estimating Conference will be meeting on March 17 to come up the latest general revenue projections.
House Health Care Appropriations Chairman Jason BrodeurLe proposed the Legislature not increase some funding to reimburse health-care providers. But he also suggested $220.6 million in cuts to inpatient and outpatient hospital reimbursements. Chair Brodeur outlined potential budget reductions the chamber may consider this session, which included a proposed $75 million hit to Florida nursing homes.
Brodeur’s committee was tasked with recommending reductions to meet two different potential cuts: a low of $275.8 million in reductions or a high of $573.8 million. The proposed hit to Florida nursing homes is included as an option in the $573.8 million cut, only.
“It became very apparent early on the bulk of our savings we would have to come from Medicaid and how we compensate providers,” Brodeur said.
The House did not provide any written details outlining the proposed cuts. In order to reach the $573.8 million reduction mark, Brodeur recommended the nursing home reduction but said that the $75 million cut could be offset if nursing homes were willing to pony up more “assessments.” Nursing homes agreed to tax themselves in order to draw down matching Medicaid dollars.
Brodeur said that Florida can draw down $40 million in matching dollars that would offset the reductions if nursing homes agreed to a higher assessment.
House Appropriations Committee Chairman Carlos Trujillo stressed that the proposed reductions were a budget “exercise” only. However, he did announce that the chamber would make $1.4 billion in spending to the current year budget and that the cuts would come from reductions to education, health care and general government programs.
A Week in Review – News from the Capitol
Week Two of the 2017 Session
By Leslie Dughi, Director of Government Law & Policy Greenberg Traurig
The second week of the legislative session was marked with the first bill from the 2017 Session being signed into law. House bill 280 by Sen. Randolph Bracy (D-Ocoee) requires Florida juries to unanimously decide that defendants convicted of capital crimes should be put to death for the sentence to be imposed. Governor Rick Scott signed the bill on March 13th and it took effect upon his signature. The new law is in response to the U.S. Supreme Court’s ruling that Florida’s capital punishment law was unconstitutional. Prior to this, Florida was one of two states that did not require jury unanimity for death sentences to be imposed – a violation of the Sixth Amendment, according to the Court.
Legislators continued working on substantive bills, and the House Appropriations Chairs began to release portions of their budget proposals. Rep. Carlos Trujillo (R-Doral), Appropriations Chair, announced the House would cut at least $1.4 billion from the state budget; however the specifics of the budget cuts are not expected until the third or fourth week of session. Some of the cuts that have been mentioned include a $220 decrease in inpatient and outpatient hospital rates and an $80 million reduction in state dollars to public universities. Increasing higher education funding is a priority of Senate President Joe Negron (R-Palm City).
On Monday, March 20, the Constitution Revision Commission (CRC) will hold its organizational meeting in Tallahassee. The CRC is chaired by businessman and former Chair of Governor Scott’s Commission on Healthcare and Hospital Funding Carlos Beruff. Scott’s former Policy Director, Jeff Woodburn, will serve as the Commission’s executive director.
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