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2017 Legislative Session –
Legislative Bulletin
Week Six: April 17, 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
This week, the Senate and House each passed its 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.

The House and Senate must reach agreement by budget negotiations through a conference committee process. The Senate will be hosting the negotiations. As soon conferees are appointed, the chambers will haggle over allocations -- a nonbinding agreement between the House and Senate providing a specific amount of money each budget category has to spend going into budget conference negotiations. The next step is for the conferees to negotiate the line-items and language until they agree to the exact same budget. The PPS plan will be part of these negotiations.

LeadingAge Florida is at a critical point in our efforts to convince legislators to reject a bad PPS plan that results in 152 nursing homes with 4 or 5-star ratings losing funding, while 97 homes with 1 and 2-star ratings gain funding. The plan shifts $44 million in funding that would be spent on care to instead be spent on property, and lacks any requirement that providers who receive new money under the plan spend the new dollars on care.

Our most recent Call to Action focuses our efforts on the two decision makers for the health care budget: Senator Jack Latvala, Chair, Senate Appropriations Committee, and Representative Jason Brodeur, Chair, House Health Care Appropriations Subcommittee. We ask for your help once more in reaching out to them with the messages in the Call to Action.

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 has been placed on Special Order Calendar for consideration by the House on April 18th.

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
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.

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.

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.

The bill passed its second committee of reference this week. Amendments previously adopted, in part, require a nursing home to be prepared to confirm for the 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.

At this point, the Medicaid LTC carve out provisions are not included in any of the House Medicaid Managed Care bills.

SB 916 by Sen. Grimsley relating to the Statewide Medicaid Managed Care program passed its second committee of reference this week. The bill 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.

Last week the House Health & Human Services Committee introduced PCB HHS3 relating to Statewide Medicaid Managed Care Program. The bill as filed, 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.

Of greater interest to LeadingAge Florida members, HB 7117 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. The bill is scheduled to be heard by the House Health Care Appropriations Subcommittee, its only committee of reference, on Monday, April 17th. The Senate companion to this bill, SB 916, does not include a provision requiring negotiated rates.

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 has passed out of all of its committees of reference and is on the House Special Order Calendar for Tuesday, April 18th. The companion, SB 1760 by Sen. Grimsley is on the HHS Appropriations Subcommittee agenda for Tuesday, April 18th.

Recovery Care Centers
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.

HB 145 passed the House and has been referred to committees in the Senate. The companion bill, SB 222 by Sen. Steube, includes the extension of time for a patient to stay in an ambulatory surgical center to 24 hours but does not include the recovery care center language. The bill has two more committees of reference and has not yet been scheduled for another hearing.

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

Prior to leaving for the Easter Holiday, the House and Senate approved their respective budgets setting the stage for a conference committee to negotiate the differences. The Senate unanimously approved their $83.2 billion budget Wednesday, followed by House approval of their proposal along party lines by a vote of 89 to 26 on Thursday.
The House budget is $2 billion less than the Senate measure because it does not include supplemental Medicaid dollars from the federal government. However, this week’s confirmation from the Trump Administration that Florida will receive $1.5 billion in Medicaid Low Income Pool (LIP) funds will hopefully make the final negotiations easier.

The Senate approved SB 10 by Sen. Rob Bradley (R-Orange Park), President Negron’s water policy priority, and it now heads to the House. The approved bill was more streamlined than what Negron initially proposed and would build a reservoir south of Lake Okeechobee to curb discharges to the St. Lucie and Caloosahatchee rivers. Instead, the discharges of between 100 –120 billion gallons would be sent into the Everglades and Florida Bay. Previously, the plan would have built the reservoir on state-owned and privately-owned property. Ultimately, the approved measure would only build on land already owned by the state.

The bill will now head to the House where its companion bill, HB 761 by Rep. Thad Altman (R-Indialantic), has not been heard. After passage of the Senate bill Wednesday, House leaders indicated they would give the issue serious consideration. One area of concern for the House, issuing bonds to pay for the project, remains in the bill.

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