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2017 Legislative Session –
Legislative Bulletin
Week Three: March 24, 2017

2017 Legislative Session—Stay Informed!
LeadingAge Florida continues to host our weekly Legislative Session Weekly Briefing conference call which will continue every Friday at 10:00 am EDT through the end of Session. To participate:

Call in number: 1-866-200-9760
Participant Pin: 7020321#

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.

LeadingAge Florida 2017 Public Policy Priorities

  • 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.
  • Preserve the Certificate of Need for Nursing Homes.
  • Support FLiCRA’s proposed legislative changes to Chapter 651, FS, as modified by LeadingAge Florida’s internal workgroup.
  • 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.
  • Use Housing Trust Funds for their Intended Purpose
  • Support initiatives for innovative senior housing plus services models.

Activity on LeadingAge Florida Issues/Priority Bills

Medicaid Prospective Payment System for Nursing Homes
LeadingAge Florida met this week with the Florida Health Care Association to learn more about FHCA’s alternative prospective payment plan that they hope will be considered this legislative session. The proposal is a minimally modified version of the Navigant plan that relies on a $65 million increase in the Medicaid budget for each of the next three years. Generally, the plan:
  • Retains two geographic regions – North and South, though it adds Palm Beach and Okeechobee Counties to the South Region; but it includes Collier, Lee, and Sarasota Counties in the North Region, ignoring the cost realities in those counties
  • Retains the Navigant quality matrix, except that it reduces the quality threshold a nursing home would have to reach to earn funding as a result of quality from the 30th percentile to the 20th percentile
  • Reduces the funding component for quality from 7% to 6%
  • Shifts $44 million in funding that would be spent on care to instead be spent on property
  • Includes a three-year “hold harmless” provision where all providers negatively impacted would receive their current rates
  • Caps gains and losses in years 4 & 5
  • Is based on an assumption of being fully funded each year for three years
There is no requirement that providers who receive new money under the plan actually spend the money on care. Further it retains the Navigant rate setting method, which would result in the highest-quality providers losing significant funding if the Legislature cannot guarantee new funding for Medicaid nursing home reimbursement for the next three years.

The proposal will be discussed by LeadingAge Florida leadership the first of next week, and we will be reaching out to you with our position on 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
There has been no further movement on the House and Senate bills that include the repeal the CON requirements for nursing. As previously advised 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.

In follow-up to the meeting last week with Representative Cyndi Stevenson, representatives of Sen. Tom Lee, the Office of Insurance Regulation, FLiCRA and the Department of Financial Services, LeadingAge Florida continues to provide input to OIR and FLiCRA on legislative proposals presented for discussion. While these discussions continue, there has been no movement in terms of the bills being scheduled for a committee hearing. 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. While the House and Senate Insurance and Banking Committees are scheduled to meet next Monday, March 27th, neither bill is on the agenda.

Affordable Senior Housing
LeadingAge Florida has prepared 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.

SB 854 and HB 1013 both have passed their first committees of reference but have not yet been scheduled for another committee hearing.

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 last week and has two more committees to go. The companion, SB 1760 by Sen. Grimsley is scheduled to be heard in its first committee of reference on Monday, March 27.

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 two more committees of reference and has not yet been scheduled for another hearing.

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 and is on the House Special Order Calendar for Wednesday, March 29th.

HB 543 – Regulation of Nursing
HB 543 by Rep. Pigman and SB 328 by Sen. Grimsley relating to the regulation of nursing is a Medical Quality Assurance (“MQA”) bill addressing nursing education. Several years ago, Sen. Grimsley, then Rep. Grimsley, in responding to a nursing shortage relaxed and increased the number of nursing schools available in Florida. It has been largely a successful program. This bill deletes a provision that requires graduates who do not take a licensure exam within 6 months after graduation to complete a licensure examination prep course.

Further, it restores the Board of Nursing (“BON”) authority to conduct on-site evaluation of new program applicants, and restores BON rulemaking authority related to nursing curriculum and program implementation plans. It prohibits a program that has been terminated by the BON from re-opening under a new name for a period of three years. It requires all nursing programs placed on probation status to notify their students and applicants of the implication of that status.

The bill was amended to add some clarifying language to several licensure programs within the Department of Health (“DOH”). Specifically, it grants the DOH the authority to adopt rules to implement the federal Conrad 30 Waiver Program. It authorized the DOH to request a date of birth on application. It requires denial of license or renewal if applicant has outstanding balances due following a disciplinary proceeding.

It permits the waiver of licensure or renewal up to two years for a license profession if the DOH determines revenues will exceed the amount to regulate that profession. It requires pain clinics to register with the DOH. It allows for advances registered nurse practitioners (“ANRP”) to maintain a copy of their protocol at the facility or office where they practice. It allows them to enter into a protocol with at least one physician within that practice. It exempts third party logistic providers who store or fill orders for manufacturers of certain dialysis drugs and supplies from pharmacy licensure.

HB 543 passed its last committee of reference this week. SB 328 is on the agenda for its last committee of reference on Monday, March 27th.

A Week in Review – News from the Capitol
Week Three of the 2017 Session
By Leslie Dughi, Director of Government Law & Policy Greenberg Traurig

For the third week of the 2017 Session, Speaker Richard Corcoran’s priority to increase transparency for local officials passed its last committee and will be heard on the floor next week. The bill would increase financial disclosure requirements for city commissioners and other officials for municipalities with total revenues over $10 million and would prohibit a public officer or employee from creating a shell corporation to conduct business with the entity they serve. Because the measure does not have a Senate companion, its fate is uncertain.

A bill approved by the Senate on Tuesday would prevent changes to district boundaries if a challenge is filed within 71 days of the primary election. SB 352 would ensure that revisions made to legislative districts would take effect for future elections. The measure is a product of the confusion that ensued as a result of the 2012 Redistricting effort and the subsequent challenges to the Congressional and Senate maps. The bill will now head to the House where its companion – HB 953 – has not been heard.

On Monday, the 37 members of the Florida Constitution Revision Commission (CRC) were issued the oath of office and reviewed proposed rules on how the Commission would conduct its business. In response to a number of questions on the open government policies, final adoption was deferred to provide members with the opportunity to suggest revisions. No date for final approval has been set. The CRC has scheduled the following hearings to receive recommendations from the public:
  • March 29 at 5:00pm - Fairwinds Alumni Center at the University of Central Florida in Orlando;
  • April 6 at 5:00pm - Frost Art Museum at Florida International University in Miami;
  • April 7 at 9:00am - FAU Stadium Recruiting Room at Florida Atlantic University in Boca Raton;
  • April 12 at 4:00pm - The Center for Fine and Performing Arts at the University of West Florida in Pensacola.
Florida is the only state in the union which allows proposed Constitutional Amendments to
be placed directly on the ballot by referral of a Commission. The state’s Constitution mandates the CRC to convene every 20 years. The 2017 Commission is the third commission to deliberate since it was first established in 1977.

The CRC is chaired by Carlos Beruff, businessman and former Chair of Governor Scott’s Commission on Healthcare and Hospital Funding. Scott’s former Policy Director, Jeff Woodburn, will serve as the Commission’s executive director.

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