2018 Legislative Session—Stay Informed!
The 2018 regular legislative session was scheduled to end by no later than midnight tonight, but is now expected to end on Sunday, March 11, when lawmakers vote on a new $88.7 billion state budget. The session had to be extended because budget negotiators did not meet a deadline for agreeing on the spending plan.
This is our final weekly Legislative Update/Recap report, and includes the latest copy of the LeadingAge Florida Legislative Bill Tracking Report. A post Session report will be forthcoming.
Activity on LeadingAge Florida Priority Bills
Continuing Care Communities
SB 438 by Sen. Lee/HB 783 by Rep. J. Grant
The CCRC bills filed for the 2018 Session were the result of over 18 months of discussions and negotiations between LeadingAge Florida members, FLiCRA and OIR and represented a balanced approach to regulatory revisions to chapter 651, FS. This legislation will not pass the Legislature this session.
LeadingAge Florida supported SB 438 throughout the legislative process as a thoughtful, balanced approach to help address oversight and regulations concerns, ensuring residents’ investments will be protected and that providers can continue to successfully operate. Unfortunately, changes were made to HB 783 that removed important provisions that protected residents and providers, and our efforts to have those provisions restored were not successful.
We are disappointed that CCRC reform will not pass this year; however, LeadingAge Florida is committed to continuing our work on improved regulations for CCRC residents and providers in collaboration with legislative members, OIR, FLiCRA and other stakeholders.
Hurricane Preparedness, Response and Recovery
This week, the Florida Legislature passed HB 7099 ratifying the Agency for Health Care Administration’s (AHCA) rules requiring nursing homes to have generators and 72-hour fuel supplies on site by June 1, 2018. Changes incorporated into the new rule allow for flexibility in the types of systems or equipment used to maintain the safe indoor air temperature, including portable generators, and provide for an extension of the timeline to January 1, 2019 for compliance, among other changes negotiated with the Governor’s office and AHCA.
The bill becomes law as soon as the Governor signs it, and the rules are adopted by the Secretary of State.
SB 7028 ratifying the ALF generator rules also passed the Legislature on Friday afternoon. This bill also becomes law as soon as the Governor signs it, and the rules are adopted by the Secretary of State.
LeadingAge Florida will be hosting a webinar on the nursing home and ALF rules later this month. Details on the date and time will be forthcoming.
Several bills incorporating recommendations of the Select Committee on Hurricane Response and Preparedness passed the House but appear to be stalled in the Senate. These bills include:
HB 7085 by the House Health & Human Services Committee relating to Health Care Disaster Preparedness and Response incorporates some recommendations made by the Select Committee on Hurricane Response and Preparedness relating to emergency management plans and special needs shelters. In an effort to address shortages in special needs shelters reported during Hurricane Irma, the bill expands the list of people who could help out in shelters during an emergency. The bill also requires home health-care providers and nurses to develop emergency management plans for their patients.
As it relates to nursing homes and ALFs, the bill adds components that must be included in the facilities’ comprehensive emergency plans to address inadequacies identified in the facilities’ plans in testimony to the Select Committee. The bill also provides enforcement authority to AHCA to ensure that facilities comply with the new plan requirements and follow their plans during an emergency. Facilities could face $500 fines if they do not have plans and could be subject to disciplinary action for not abiding by details of the plans. The bill also requires local emergency management agencies to establish procedures to allow health care facility staff to travel to and from work during declared curfews.
HB 7083 by the Government Accountability Committee relating to Emergency Management extends the number of days that certain state employees may be granted administrative leave to participate in federal disaster relief services; authorizes the Florida Hurricane Catastrophe Funds to be used for specified purposes; and provides specified requirements for the state comprehensive emergency management plan and county emergency management plans; among other provisions.
HB 7079 by the Oversight, Transparency & Administration Subcommittee relating to Public Records/Disaster Response creating a public records exemption for specific information of individuals using public shelters during an emergency.
It is expected that a taxation package will pass the Legislature. HB 7087 by House Ways & Means Committee provides for a wide range of tax reductions and modifications designed to directly impact both households and businesses, including an exemption for generators for nursing homes and ALFs. The bill includes the process to be followed to receive the tax exemption and provides that the exemption is limited to a maximum of $15,000 in tax for the purchase of the equipment for any single facility. The exemption takes effect upon becoming a law but is retroactive to July 1, 2017.
Activity on LeadingAge Florida Monitored Bills
SB 622 by Sen. Grimsley relating to Health Care Facility Regulation is the Agency for Health Care Administration’s regulatory package for 2018. The bill passed the Legislature earlier this week. While the bill, in part, is a clean-up bill, it also includes provisions relating to unlicensed assisted living facilities and creates a felony of the third degree penalty for operating or maintaining an unlicensed ALF. Specifically, the bill provides that any person who owns, operates, or maintains an unlicensed ALF after receiving notice from the agency that licensure is required and to cease such operation commits a felony of the third degree. It also prohibits an ALF from operating for more than 120 consecutive days without an administrator who has completed the core educational requirements.
HB 551 by Rep. Burton has passed the Legislature. The bill provides a public records exemption for health care facilities for building plans, blueprints, schematic drawings, & diagrams of certain health care facilities.
Current law provides an exemption from public records for building plans, blueprints, schematic drawings and diagrams that depict the internal layout or structural elements of an attractions and recreation facility, entertainment or resort complex, industrial complex, retail and service development, office development, or hotel or motel development held by an agency. These bills expand the exemption to hospitals, ambulatory surgical centers, nursing homes, hospices, or intermediate care facilities for the developmentally disabled.
SB 280 by Sen. Bean relating to Telehealth passed the Senate and is in House Messages. It is unclear as to whether the House will take this bill up out of messages.
The bill provides specific authorization for the provision of health care services through telehealth. Telehealth is the provision of health care services using telecommunication technologies, which allows licensed practitioners in one location to diagnose and treat patients at a different location. The bill will remove regulatory ambiguity regarding the provision of health care services using this technology because it is not currently addressed in Florida Statutes. The bill includes some of the recommendations included in a report by the Telehealth Advisory Council, such as requiring health-care practitioners who provide care through telehealth to be licensed. The bill also includes the advisory council’s recommendation to ban the use of telehealth for prescribing controlled substances to treat chronic or nonmalignant pain or to certify patients for medical marijuana treatment.
Budget Update by Dr. Erwin Bodo
The budget conference committee dealing with health and human service agreed on the following funding issues:
- Increasing the personal need allowance from $105 to $130 per month for institutional residents.
- $750K for reducing the waitlist in the Alzheimer’s Disease Initiative program.
- $500K for reducing the waitlist in the Community Care for the Elderly program.
- $800K for reducing the waitlist in the Home Care for the Elderly program.
- $50K for a study to determine the feasibility if a PACE program in Clay, Putnam, and Bradford Counties.
- Funding for 475 additional PACE slots:
- 100 slots in Miami-Dade County,
- 100 slots in Lee County,
- 100 slots in Collier County,
- 75 slots in Martin County, and
- 100 slots in Baker, Clay, Duval, Nassau, and St. Johns counties.
- Transition funding of $9.8 million for nursing homes. This will allow AHCA to pay nursing homes no less than their September 1, 2016 Medicaid rate. The Legislature also directed AHCA to implement caps on rate changes to ensure that losses due to the new PPS are mitigated. (It is not known how this will be implemented.)
- Improved nursing home payment funding of $128 million. This is directed towards enhancing the Quality Incentive to 8.5% of the non-property related payments and increasing the Direct Care price to 105% of the Direct Care median.
- Additional funding for high-quality nursing homes through the use of the FY 2017-18 budget surplus in the nursing home line item. AHCA will use these funds to remit a Supplemental Quality Incentive Payment to nursing facilities with a total CMS 5-star score of "5" in the latest rating report. Each qualifying nursing facility will receive an incentive payment based on its pro rata share of the total Medicaid days provided by all nursing facilities that qualify for the incentive payment.
- Reduced Medicaid retroactive eligibility for non-pregnant adults to the first day of the month in which the application is made. (Currently, the retroactive eligibility period is 90 days.)
- $500K for a feasibility study for building a Veterans’ nursing home in Marion County.
The final version of the budget has been printed. By law legislators must have a 72-hour wait period prior to the final vote. Amendments are no longer allowed.
As a practical note, once the final budget is released and is signed by the Governor, the agencies will start their work to implement the new provisions. AHCA will have to modify the Title XIX Long-Term Care Reimbursement Plan, develop a draft rule, hold a rule workshop, and then hold a formal rule hearing. The new payment plan must address numerous details that were not included in the PPS changes passed last year or this Legislative Session. These include provisions related to:
- Cost reporting changes,
- Data submission cut off dates,
- Interim rate changes,
- Inflation calculation changes, and
- Methods for calculating rates for nursing homes that are exempt from the PPS.
We expect these activities will not conclude before the end of the summer. The new PPS system starts on October 1.
Activity on Other Issues of Interest
Reaction to the Marjory Stoneman Douglas High School in Parkland, FL, Shooting
This week, the Legislature passed the “Marjory Stoneman Douglas High School Public Safety Act”, and the Governor signed the bill into law this afternoon. The bill raises the minimum age to buy rifles from 18 to 21 and creates a waiting period on sales of the weapons. It also creates a “guardian” program that enables teachers and other school employees in participating districts to carry handguns if they complete law enforcement training. The bill provides $400 million in funding for school hardening initiatives and expanding mental health programs.