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2017 Legislative Session –
Legislative Bulletin
Week Seven: April 21, 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
As previously advised, the Senate and House have each passed their Appropriations and conforming/implementing bills. The Senate Appropriations Bill, SB 2500, and Senate Health Care conforming Bill, SB 2514, include the funding and amendatory language to implement the Florida Health Care Association prospective payment system proposal. The House appropriations and conforming bills do not include a PPS proposal.

While the House and Senate must reach agreement by budget negotiations through a conference committee process, this consensus-reaching process has not yet begun. The two chambers are still working to come to agreement on the amount of funding to be allocated to each budget area, including health care. It is anticipated that agreement will be reached on the allocations prior to the beginning of next week and that budget negotiations will begin then.

LeadingAge Florida continues our efforts to convince legislators to reject the bad PPS plan included in the Senate budget. Our efforts include joining with FLiCRA in our outreach to legislators through emails and phone calls, along with press conferences and social media activities. We also have been meeting with key legislators, including the minority leaders in both the House and Senate.

Legislation tied to the issue of nursing home reimbursement is HB 7117 by the House Health & Human Service Committee. HB 7117, in part, consolidates the eleven SMMC program regions into eight regions, increases in each region the minimum or maximum number of plans with which AHCA contracts, directs AHCA to request federal approval to require enrollees to engage in work activities to maintain eligibility, and requires AHCA to fine managed care plans for failing to promptly pay provide claims. This bill deletes the requirement that AHCA establish payment rates for nursing homes participating in the LTC program and requires LTC plans and providers to negotiate mutually acceptable payment rates, methods, and terms of payment. This week, HB 7117 passed the House Health Care Appropriations Subcommittee, its only committee of reference. The House minority members of the subcommittee voted against the bill as they expressed concern that more work needs to be done on the proposed PPS plan, and other provisions in the bill. HB 7117 is scheduled to be heard by the full House on Tuesday, April 25.

The Senate companion to this bill, SB 916, by Sen. Grimsley relating to the Statewide Medicaid Managed Care program, deletes the fee-for-service reimbursement option for provider service networks (PSNs), and combines regions, re-groups counties within new regions, and revises the plan limitations within the regions for the procurement process for the Medicaid Managed Medical, among other provisions. The bill does not include a provision requiring negotiated rates. SB 916 is scheduled to be heard by its last committee of reference on Tuesday, April 25.

Certificate of Need 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. As it now stands, CS/CS/HB 7 eliminates the CON program for hospitals and hospital services only. The bill passed the House this week and has been referred to committees in the Senate.

There has been no action on the Senate companion. 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. The OIR’s legislative proposal was filed as SB 1430 by Sen. Tom Lee and HB 1349 by Rep. Cyndi Stevenson.

The bills have not been scheduled for a committee hearing in either the House or the Senate. And time has essentially run out for bills that have not been heard in at least one committee of reference. At this point in the legislative session, we don’t anticipate either bill moving forward.

Affordable Senior Housing
Neither SB 854 by Sen. Jeff Brandes nor HB 1013 by Rep. Newton has had another committee hearing; however, the Senate Appropriations Bill, SB 2500, and Implementing Bill, SB 2502, include the provisions of these bills creating the Affordable Housing Task Force in the budget. We are working to amend the language to include a representative of affordable housing for the elderly (LeadingAge Florida) on the task force. This will be an issue to be resolved during the budget negotiations.

Activity on LeadingAge Florida Monitored Bills

Medicaid Managed Care
SB 682 by Sen. Stargel exempts 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 exempts 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.

This week SB 682 passed its last committee of reference. At this point, the Medicaid LTC carve out provisions are not included in any of the House Medicaid Managed Care 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 the House this week. The companion, SB 1760 by Sen. Grimsley passed the HHS Appropriations Subcommittee earlier this week.

Advanced Registered Nurse Practitioners (ARNPs)
SB 634 by Senator Campbell and HB 645 by Rep. Lee, Jr., authorize PAs and ARNPs to initiate involuntary examinations under the Baker Act. The PA or ARNP must execute a certificate stating that a person he or she examined within the preceding 48 hours appears to meet the criteria for an involuntary examination for mental illness. Under current law, only a physician with experience in the diagnosis and treatment of mental and nervous disorders, clinical psychologist, psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker may initiate an involuntary examination by executing the certificate.

HB 645 has passed all of its committees of reference and has been placed on House Calendar. SB 634 has passed three of its four committees of reference and is now in the Rules Committee.

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

There was an expectation that House and Senate leaders would begin budget negotiations this weekend. However, their inability to agree on initial funding allocations delayed the appointment of the budget conference committee and legislators went home late Thursday afternoon. With only two weeks remaining upon their return Monday, time is growing short to reach an agreement by the scheduled end of session on May 5.

On the heels of an advisory opinion released on Thursday by the Florida Supreme Court that approved proposed constitutional amendment language requiring voters to approve any gambling expansion, a legislative conference committee meeting was cancelled the same day.

The opinion, requested by Attorney General Pam Bondi, allows an anti-gambling organization Voters In Charge to begin collecting signatures to place language on the November 2018 ballot. Sen. Bill Galvano (R- ), Co-Chair of the conference committee developing a compromise between the House and Senate proposals, cancelled the Thursday meeting saying he wants “…to digest the ruling before moving forward”. In question is whether or not the proposed constitutional amendment would, if approved by the voters, apply retroactively. Later, the House Co-Chair of the conference committee noted he did not believe the ruling would hinder the reaching a compromise before the end of session.

On Wednesday, freshman Senator, Frank Artiles (R-Miami) made a public apology on the Senate floor for inappropriate comments made Monday evening to Sen. Audrey Gibson (D-Jacksonville). President Joe Negron stripped Artiles of his committee chairmanship and ordered an investigation by a special master in response to a complaint filed by the Senate Democratic Caucus. Today, however, due to mounting pressure, Sen. Artiles submitted his immediate resignation from the Florida Senate.

Constitution Revision Commission (CRC). The Commission did not meet this week; however, next week the following meetings are scheduled: April 26 in Gainesville and April 27 in Jacksonville. Additional meetings are set for May 3 in Bay County; May 10 in Lee County; and May 17 in Hillsborough County. To remain updated on the work of the CRC, please access the following website: http://flcrc.gov/

On to Insurance Matters…

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