2017 Legislative Session—Stay Informed!
The 2017 Legislative Session will be remembered for many things, including the failure to end on time and the rocky relationship between Speaker Richard Corcoran and Governor Rick Scott over tourism marketing and business incentives, but most notably for what didn’t pass the Legislature. The 2017 Session was one of the least active in terms of bills passed since at least 1998 (as far back as records go). This year, the Florida Legislature passed 249 bills, representing only 8% of the bills filed, as compared to passage of 15.4% of the total bills filed in 2016. Except for 2015, when the House went home three days early, no other session since 1998 has passed fewer than 264 bills.
Major legislative initiatives that did not pass this year included bills relating to: gambling, medical marijuana, workers’ compensation, insurance reform, restructuring of the state’s Medicaid Managed Care program, health care facility regulation, health insurance, recovery care centers, trauma centers, expanded authority for Advanced Registered Nurse Practitioners, certificate of need repeal, and concealed-carry and other gun rights-related issues, among other issues.
For LeadingAge Florida, it is what did not pass the Legislature this Session that demonstrates the success of months of intensive and extremely active advocacy efforts by LeadingAge Florida’s advocacy team and members.
Legislation sponsored and supported by the Office of Insurance Regulation rewriting
the regulatory chapter of law for Continuing Care Retirement Communities did not
get a committee hearing in either chamber. Had the legislation passed as written, it
would have been detrimental to the viability of Florida’s CCRCs as well as the future
growth of and investment in CCRCs in Florida.
Proposals implementing a Medicaid Prospective Payment System for nursing homes
that would have shifted funding from mostly high quality nursing homes in Florida to
mostly low quality homes effective in 2017 was defeated twice – the Agency for Health
Care Administration’s Navigant plan was overwhelmingly rejected by the House Health
Care Appropriations Subcommittee, and the Florida Health Care Association’s plan,
incorporated into the Senate Budget bills, was delayed for one year and is subject to
modification based on recommendations from a workgroup created in the budget’s
Legislation repealing the certificate of need requirements for hospitals, nursing homes,
hospices, and intermediate care facilities for the developmentally disabled was amended
in the House to remove the repeal requirements for all facilities except for hospitals.
The legislation passed the House but was never heard in the Senate. The Senate
companion bill was referred to four committees in the Senate and was not heard
The one bill the Legislature is constitutionally required to pass, the budget, was not passed during the 60 day regular session – the Legislature went into overtime and extended for three days to pass the FY 2017-18 General Appropriations Act, SB 2500, and several implementing bills. As with any bill passed by the Legislature, the budget is subject to final action by the Governor. For many reasons, the $82.4 billion budget passed by the Legislature will be closely scrutinized by the Governor and may be subject to a veto. If not vetoed outright by the Governor, we can expect Governor Scott to exercise his line item veto authority. The approved budget is $1.1 billion less than Gov. Scott proposed. Before the session began, Scott proposed $618 million worth of tax cuts in his budget – the budget passed decreased this amount to $91 million. Many more of the Governor’s spending proposals were rejected by the Legislature as well, adding to the speculation that he may veto the budget outright.
The budget bills include a nearly 300-page education bill, SB 7069, put together mainly in private meetings, that includes a $419 million appropriation and proposals from possibly as many as 54 other bills on a range of issues, including changes to testing and teacher bonuses, mandatory recess for elementary schools and funding for new charter schools to compete with failing public schools. Further, Gov. Scott’s budget included $216 more per student, but the Legislature’s budget increased spending by only about $25 per student. For these reasons and others, there are increasingly more calls for the Governor to veto the bill.
The General Appropriations Act and conforming bills include a $34.2 billion health care budget. This total does not include up to $1.5 billion for the Low Income Pool, a program that reimburses health providers for charity care. A yet-to-be-announced public hearing would be held on how to distribute those funds. The health care implementing bill, SB 2514, expands the Medicaid managed long-term care program to include people who aren't elderly but who may require long-term care services, specifically individuals with cystic fibrosis who qualify for hospital care, will be enrolled in the Medicaid managed long term care plan by January 1, 2018, as will individuals who currently are enrolled in the Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic Fibrosis Waiver, and the Project AIDS Care Waiver, pending approval by the federal government.
SB 2514 also includes the changes to the law directing Florida to use a prospective payment reimbursement methodology, effective October 1, 2018, to set nursing home provider reimbursement rates. Proviso language in the General Appropriations Act, SB 2500, directs the Secretary of the Agency for Health Care Administration to convene a working group to review relevant issues and make recommendations specific to the transition to a prospective payment system for nursing home reimbursement under the Florida Medicaid program. The group is to consist of representatives of nursing home providers and other interested stakeholders. The proviso describes the focus of the workgroup and allows the agency to retain the services of a consultant to assist with the support of this working group. The working group is to submit a report and any recommendations to the agency, the Governor, the President of the Senate, and the Speaker of the House of Representatives by December 1, 2017.
Funding in the 2017-18 General Appropriations Act for the elderly includes:
• PACE - no additional funding, no new slots
• Home Care for the Elderly - $1 million in new funding (about a 300 person reduction in the
• Community Care for the Elderly - $4 million in new funding (about a 500 person reduction
in the wait list)
• Alzheimer’s Disease Initiative - $3 million in new funding (about a 300 person reduction
in the wait list)
• Specialized Alzheimer’s Day Care Centers - $1 million
• Personal needs allowance for nursing home residence remains at the current $105
per month level
The 2017-18 budget approved by the Legislature continues to raid the affordable housing trust fund by more than $150 million. Given concerns about cuts for affordable housing at the federal level, housing advocates see this is as a big loss for Florida. The implementing bill, SB 2502, creates a workgroup on affordable housing. The workgroup shall develop recommendations for addressing the state’s affordable housing needs which will be presented to and approved by the board of directors of the Florida Housing Finance Corporation. The workgroup shall submit a report including its recommendations to the Governor, the President of the Senate, and the Speaker of the House of Representatives by January 1, 2018.
Once the Legislature sends Gov. Scott the 2017-18 budget, the governor has 15 days to sign, exercise his line-item veto power, or veto the entire budget. If the governor decides to veto the entire budget, the Legislature has the opportunity to head back to the capital city to override the veto. To do that, they’ll need two-thirds of the members present and voting for a veto-override.
Another issue that may bring legislators back to the Capitol for a Special Session is their failure to pass legislation to implement a constitutional amendment passed by 71 percent of voters relating to medical marijuana. The main issue the two chambers could not reach agreement on was whether or not to place caps on the number of dispensaries each licensed grower could open. Now, it's up to the Florida Department of Health to create a medical marijuana infrastructure in the state.
Included in the limited number of proposals that passed the Legislature is a bill already signed by Gov. Scott that creates statewide regulations for ride-booking companies, like Uber and Lyft. The legislation, among other things, requires ride-booking companies, like Uber and Lyft, to carry $100,000 of insurance for bodily injury of death and $25,000 for property damage while a driver is logged on to their app, but hasn’t secured a passenger. While with a passenger, drivers would be required to have $1 million in coverage. It also requires companies to have third parties conduct local and national criminal background checks on drivers. The law pre-empts local ordinances and rules on transportation network companies.
HB 7109 relating to Taxation was passed by the Legislature and approved by the Governor (Chapter No. 2017-036). Included in the bill are provisions providing a 50 percent discount in property taxes to certain multifamily projects that provide affordable housing to low income persons and families, and exempting charitable 501(c)(3) Assisted Living Facilities from property tax.
The Legislature also approved putting a constitutional amendment on the 2018 ballot that would increase the homestead property tax exemption, cutting property taxes by $644 million annually.
LeadingAge Florida’s 2017 Legislative Priorities
Prior to the convening of the 2017 Legislative Session the LeadingAge Florida Board of Trustees approved several 2017 Public Policy Priorities. These priorities and the outcomes of LeadingAge Florida’s advocacy efforts on these issues are described below:
• Medicaid Prospective Payment System for Nursing Homes - Oppose the final model recommended by Navigant in the report to the Governor and Legislature, motivate LeadingAge Florida members to vigorously advocate against the implementation of the new payment plan, and present a fully developed alternative model incorporating the positive aspects of the Navigant plan without disrupting the current level of quality care provided.
LeadingAge Florida opposed the Prospective Payment System model developed by the Agency for Health Care Administration, and was successful in advocating for the rejection by the House Health Care Appropriations Subcommittee of the Navigant model, with a commitment by the subcommittee to review the PPS rating setting issue over the interim. LeadingAge Florida also developed an alternative model that was filed as SB 712 by Sen. Aaron Bean that retained elements of the AHCA plan, while preserving quality nursing home care.
Most importantly, LeadingAge Florida led its members in an aggressive advocacy campaign to oppose both the Navigant and Florida Health Care Association’s proposed PPS plans. The advocacy efforts by our members included testimony at committee hearings, member visits during Legislative Days, hosting press conferences in Tallahassee, St. Petersburg and Jacksonville, targeted outreach to legislators by staff, residents and community members through phone calls and emails, outreach to local media outlets, and a comprehensive media and communications strategy. LeadingAge Florida was joined in many of these efforts by our partners, the Florida Conference of Catholic Bishops and the Florida Life Care Residents Association (FLiCRA), whose efforts contributed significantly to successfully advocating our position.
While the FHCA model was included in the final budget health care implementing bill, SB 2514, LeadingAge Florida was successful in getting a one-year delay in the implementation date and a workgroup created by AHCA to study the model and make recommendations on changes to the Governor and Legislature.
The St.PetersBlog in declaring winners & losers emerging from the 2017 Legislative Session recognized LeadingAge Florida as a winner stating:
LeadingAge Florida — The nursing home association, four- and five-star nursing homes,
and Florida seniors fought to make sure their voices were heard in opposition to a
proposed prospective payment system plan. When the dust settled on the Session, it
appeared they got through. The implementation of the plan was delayed for a year and
a workgroup was established to come up with recommendations for the plan that will make
sure all parties are in agreement and Florida’s frailest seniors do not become collateral
• Preserve the Certificate of Need for Nursing Homes - LeadingAge Florida supports the retention of a CON process for nursing home beds.
LeadingAge Florida supported 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. As anticipated, based on a commitment secured by our advocacy team very early on, HB 7 was amended in its last committee of reference to remove nursing homes, hospices, and intermediate care facilities for the developmentally disabled from the proposed CON program repeal in the bill. The amendment was offered and adopted and the bill passed the House repealing only the CON requirements for hospitals. The legislation died in the Senate.
• Support FLiCRA’s proposed legislative changes to Chapter 651, FS, as modified by LeadingAge Florida’s internal workgroup - LeadingAge Florida supports the Florida Life Care Resident Association’s (FLiCRA) proposed changes to Chapter 651, F.S., with the revisions recommended by LeadingAge Florida’s internal workgroup.
LeadingAge Florida and FLICRA reached agreement on a limited number of changes to chapter 651, FS, however, upon introduction of SB 1430 by Sen. Tom Lee and HB 1349 by Rep. Cyndi Stevenson, the OIR CCRC regulatory reform legislation, LeadingAge Florida’s advocacy efforts shifted from supporting any changes to chapter 651, FS, to opposing SB 1430 and HB 1349.
• Oppose 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 opposed SB 1430 by Sen. Tom Lee and HB 1349 by Rep. Cyndi Stevenson that, if passed, would have enacted OIR’s excessive regulatory reform proposals into law. The lengthy bills, developed by the Office of Insurance Regulation (OIR) without input from stakeholders, made major revisions to almost every section of Ch. 651, F.S., (the law governing the regulation of continuing care retirement communities) and created another eight sections of law.
The bills created another substantial financial reserve (in addition to the minimum liquid reserve) that OIR had not modeled to determine its effect on individual providers and resident fees. Providers would have been required to comply immediately without a phase-in. Failure to meet the requirement could have resulted in the suspension or revocation of the certificate of authority to operate and sell contracts. The bills imposed significant financial burdens and risks on CCRC residents; there was no dispute on this point – the Office of Insurance Regulation had testified that its analysis shows an increase in costs to residents as a result of the legislation.
LeadingAge Florida and our members were successful in keeping either bill from being heard in committee and are committed to working with all stakeholders during the interim on reasonable, necessary reforms to chapter 651, FS.
• Use Housing Trust Funds for their Intended Purpose
• Support initiatives for innovative senior housing plus services models
As a member of the Sadowski Housing Coalition, LeadingAge Florida supports and advocates for the appropriation of all the state and local housing trust fund money to be dedicated for affordable housing. The 2017-18 budget approved by the Legislature appropriated $137,000,000 for housing but continued the raid of the affordable housing trust fund by more than $150 million.
The implementing bill, SB 2502, creates a workgroup on affordable housing. The workgroup shall develop recommendations for addressing the state’s affordable housing needs. The recommendations shall be presented to and approved by the board of directors of the Florida Housing Finance Corporation. The workgroup shall submit a report including its recommendations to the Governor, the President of the Senate, and the Speaker of the House of Representatives by January 1, 2018, at which time the workgroup shall terminate.
LeadingAge Florida Monitored Bills
LeadingAge Florida’s advocacy team was actively involved in legislation of interest to our members and tracked and monitored the following issues:
Medicaid Managed Care
SB 682 by Sen. Stargel exempted Medicaid recipients who have resided in a nursing facility for 60 or more consecutive days, with certain exceptions, from the Long-Term Care component (LTC) of the Statewide Medicaid Managed Care (SMMC) program. The bill also exempted those recipients in the LTC component who are receiving hospice care while residing in a nursing facility. These recipients would receive long-term care services through fee-for-service Medicaid providers and other medical services through the managed medical assistance component (MMA) of the SMMC program.
The bill also, in part, required a nursing home to be prepared to confirm for AHCA whether a nursing home resident, who is a Medicaid recipient or whose Medicaid eligibility is pending, is a candidate for Home and Community Based Services (HCBS), by the resident’s 50th consecutive day of residency in the nursing home facility. It also provides that a nursing facility resident is not exempt from the LTC managed care program if the resident has been identified as a candidate for HCBS by the nursing facility administrator and any LTC case manager assigned to the resident.
While the Medicaid LTC carve out provisions were not included in any of the House Medicaid Managed Care bills, the last week of Session it was amended onto HB 7117.
HB 7117, a legislative priority of AHCA, in part, consolidated the eleven SMMC program regions into eight regions, increased in each region the minimum or maximum number of plans with which AHCA contracts, directed AHCA to request federal approval to require enrollees to engage in work activities to maintain eligibility, and required AHCA to fine managed care plans for failing to promptly pay provide claims. The state is starting the process of re-procuring health plans for the first time since the managed care system began in 2013. This would have been the session to restructure the program.
Of greater interest to LeadingAge Florida members, HB 7117 deleted the requirement that AHCA establish payment rates for nursing homes participating in the LTC program and required LTC plans and providers to negotiate mutually acceptable payment rates, methods, and terms of payment.
While both chambers seemed to agree on the consolidation provisions, they could not reach agreement on the other provisions in the bill and the legislation died in the final hours of Session. This means AHCA will re-procure health plans for five years based on the current structure of 11 regions.
Health Care Facility Regulation
HB 1195 by Rep. Alex Miller and SB 1760 by Sen. Denise Grimsley were the Agency for Health Care Administration’s (AHCA) healthcare regulatory reform package; the bills clarified statutory requirements, eliminated confusion, and allowed the AHCA to operate more efficiently. According to the sponsor, the proposal balanced protecting patients and reducing regulations. It addressed 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 made several changes to close loopholes increasing the ability for AHCA to conduct enforcement regulations.
The legislation also included a new requirement for a trained, unlicensed staff member in an ALF, when assisting with self-administration of medication, to read the label of the medication aloud to the resident. This change raised concerns among associations representing assisted living facilities.
The legislation died the final days of Session.
Health Care Legislation
Action on health care legislation during the 2017 session included:
HB 543 that returns some state oversight to nursing education programs passed the Legislature.
HB 1077 that would have changed criteria for adding trauma centers died.
HB 7011 that would have allowed advanced nurses who meet extensive education and experiential requirements to practice independently, without the supervision of a physician, and also would have regulated telehealth for in-state and out-of-state professionals died.
HB 145 allowing patients to stay up to 24 hours at ambulatory surgical centers and creating recovery care centers to treat patients for up to 72 hours post-surgery died.
Susan Langston is the Vice President of Advocacy of LeadingAge Florida, a nonprofit statewide association representing the full continuum of care for seniors with members ranging from nursing homes to assisted living facilities to continuing care retirement communities.