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2017 Legislative Session –
Legislative Bulletin
Week Eight: April 28, 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.

The House and Senate have reached agreement on the budget allocations, House and Senate budget conferees have been appointed, and the conference committees have begun holding meetings in an effort to reach consensus. The Health Care conference committee has met twice and, as of this point, agreement has not been reached on the PPS proposal. It remains in the Senate budget but the House has not accepted this position. The committee will continue to meet today and try to come to consensus by Saturday. If this issue is not resolved by that time, it will be bumped up to the Full Appropriations Conference Committee.

LeadingAge Florida continues our efforts to convince legislators to reject the bad PPS plan included in the Senate budget. Last week we provided House Health Care Appropriations Subcommittee Chair Brodeur alternative proviso language directing the Agency for Health Care Administration to further study and develop a PPS proposal for submission to the 2018 Legislature.

This week, we sent emails to each House Health Care Appropriations Subcommittee member and his or her aide advising them that the PPS plan currently included in the Senate Appropriations Bill, SB 2500, fixes none of the issues that caused the committee members to reject the Navigant proposal earlier this year. The email included a chart with the percentage of nursing homes in the counties in their district that will lose funding and the total amount that the nursing homes will lose under the Senate PPS plan. The information provided to the members is compelling in that the counties in just these 15 House Health Care Subcommittee member districts stand to lose about $40 million.

LeadingAge Florida also submitted an alternative plan to the PPS plan in the budget - the plan developed over several months by our PPS Task Force and reimbursement expert, Dr. Erwin Bodo. This plan is revenue neutral and not dependent on $57 million in new funding; recognizes size and geographic location variations in staffing and operating costs; establishes reasonable payment limits; minimizes losses and gains; incorporates quality incentives; and does not shift $44 million from direct care to property. The LeadingAge Florida plan is not dependent upon a 6 year transition plan but instead limits losses and gains to 5% in the first year. The transmittal letter included legislative language needed to implement the plan along with a chart comparing the impact of the LeadingAge Florida plan with the Senate budget plan. The letter and plan were also sent to the Senate HHS Appropriations Subcommittee members and House and Senate leadership. To view the cover letter and plan, please click here.

Legislation related 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 and is in Senate messages.

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 passed its last committee of reference this week and is on the Senate Calendar.

Certificate of Need for Nursing Homes
There has been no further movement on HB 7. It passed the House and has been referred to committees in the Senate. There has been no action on the Senate companion.

Continuing Care Community Regulatory Reform
Since SB 1430 by Sen. Tom Lee and HB 1349 by Rep. Cyndi Stevenson have not had a committee hearing this Session, the bills are both dead for the 2017 Session. Right after this Session, LeadingAge Florida will begin organizing meetings to discuss possible CCRC regulatory reform for the 2018 Session.

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. The provisions are not in the House budget so this issue will be resolved during the budget conference committee process.

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.

SB 682 is on the Senate Calendar on 2nd Reading. 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 is on the Appropriations Committee agenda for Monday, May 1.

Hospice Services
HB 863 by Rep. Roth relating to Hospice Services passed the Legislature this week. The bill grants a CON exemption for a hospice program established by an entity that shares a controlling interest with a not-for-profit retirement community that offers independent living, assisted living, and skilled nursing services in a facility located on the same premises as a teaching nursing home for a minimum of five years. It also limits the CON exemption to one hospice program per teaching nursing home. The bill will go to the Governor for his action.

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

The eighth week of session began without budget allocations, conference committee appointments and a budget deal. As a negotiating tactic, the House held an Appropriations Meeting to approve an unprecedented a “Standard Operating Budget that would continue the current year funding levels into the next fiscal year. Senate President Joe Negron responded by comparing the move to Congress which uses continuing budgets to avoid government shutdowns.

Throughout the week, rumors of a budget agreement and subsequent negotiations break down continued. Mid-morning Thursday, the House and Senate separately announced to their Chambers that agreement had been reached. The first meeting of the conferees was held at 1:30 pm and subcommittee conference committees met later in the evening and again this morning.

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