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2018 Legislative Session Public Policy Priorities

LeadingAge Florida’s Position on Legislation

Continuing Care Retirement Community Regulatory Reform:

LeadingAge Florida supports the amendment to SB 438 by Sen. Tom Lee (R-Brandon) that provides a balanced approach to reform of chapter 651, F.S., relating to continuing care contracts, and incorporates policy changes proposed by the Office of Insurance Regulation, FLiCRA, on behalf of residents, and LeadingAge Florida, representing providers. The amendment provides:

  • Enhanced regulatory authority to the Office of Insurance Regulation to protect residents in continuing care retirement communities by providing financial triggers for OIR to identify and take corrective action against a financially challenged continuing care retirement community early enough to avoid a bankruptcy or insolvency.
  • Changes to the process for a certificate of authority, an expansion and an acquisition, among other things, that would result in a less burdensome application process for providers.
  • Enhanced disclosure of information and other protections for residents.

LeadingAge Florida supports efforts to conform HB 783 by Rep. J. Grant (R-Tampa) to SB 438, once amended, and will address remaining member issues as the bills move through the committee process.

Hurricane Preparedness, Response & Recovery:

LeadingAge Florida members support the spirit of the emergency generator rules and continue to work toward acquiring and maintaining sufficient generator capacity to keep residents cool during a loss of power. Concerns regarding unrealistic timelines imposed by the emergency rules have been addressed in the latest rules proposed by the Agency for Health Care Administration for nursing homes. LeadingAge Florida supports legislation ratifying the nursing home proposed rules, and legislative proposals consistent with the parameters provided in the nursing home rule.

  • Several bills have been filed that place requirements on nursing homes and assisted living facilities regarding emergency generators, and that treat nursing homes and ALFs as priorities for power restoration.
  • LeadingAge Florida supports these legislative proposals provided the emergency generator requirements do not exceed those included in the emergency and proposed rules.
  • LeadingAge Florida looks forward to working with legislators to ensure that Florida’s seniors are protected and receive the highest possible quality of care at all times.

Use Affordable Housing Trust Funds for their Intended Purpose:

As a member of the Florida Sadowski Housing Coalition, LeadingAge Florida supports HB 191 by Rep. Shaw (D-Tampa ) and SB 874 by Sen. Passidomo (R-Naples) that prohibit the transfer or use of the state and local housing trust money for any other purpose.

  • LeadingAge Florida opposes sweeping any of the $322 million anticipated for low-income housing to other state priorities.
  • If trust fund dollars are used as intended, it would create 30,000 jobs and about $4 billion in positive economic benefit, according to the Florida Housing Coalition.

Nursing Home and Related Health Care Facilities:

LeadingAge Florida opposes SB 896 by Sen. Farmer (D-Fort Lauderdale) and HB 655 by Rep. Edwards (D-Sunrise) that provide for enhanced regulation of nursing homes. The bills impose new regulatory requirements that are extreme, intrusive and without merit, and threaten the high standards and quality of care provided by most nursing homes in Florida.

  • SB 896/HB 655 remove limits on the award of punitive damages for nursing homes and assisted living facilities. These limitations were the result of thorough and thoughtful negotiations between legislative leaders, the trial bar and providers in the early 2000’s, in exchange for the limitations, providers increased the staffing ratios resulting in higher quality of care for residents.
  • Other provisions in the legislation, including use of electronic monitoring devices in nursing homes, significant modifications to the Ombudsman program and considerable enhancement of the authority of the ombudsman, increased reporting requirements, and additional penalties, among others, are major regulatory changes that need thorough review and discussion.


2018 Senior-Related Issues

Several bills relating to seniors, senior care and senior care providers have been filed along with proposals for consideration by the Constitution Revision Commission. A listing of bills of interest filed to date and CRRC proposals is provided below.

Legislative Proposals

Continuing Care Retirement Community – Care Contracts - SB 438 by Sen. Lee/HB 783 by Rep. J. Grant

  • Provide enhanced regulatory authority to the Office of Insurance Regulation to protect residents in continuing care retirement communities by providing financial triggers for OIR to use to identify and take corrective action against a financially challenged continuing care retirement community early enough to avoid a bankruptcy or insolvency.
  • Provide changes to the process for a certificate of authority, an expansion and an acquisition, among other things, that would result in a less burdensome application process for providers.
  • Provide enhanced disclosure of information to residents.

Hurricane Preparedness, Response & Recovery – Several bills have been filed that, in part:

  • Place requirements on nursing homes and assisted living facilities regarding emergency generators.
  • Require the Agency for Health Care Administration to determine compliance with emergency power requirements through unannounced inspections.
  • Treat nursing homes and ALFs as priorities for power restoration.
  • Create the Florida Strategic Fuel Reserve Task Force within the Division of Emergency Management to develop a recommended strategic fuel reserve for natural emergencies and major disasters.
  • Prohibit workers from being fired for following mandatory evacuation orders.
  • Create the Emergency Power Systems Matching Grant Program to provide matching funds to certain public and private health care facilities for purchasing generators.
  • Mandate that tolls be suspended in counties with a declared state of emergency.

Nursing Homes and Related Health Care Facilities – HB 655 by Rep. Edwards/SB 896 by Sen. Farmer

  • Require more detailed patient safety records.
  • Allow for undercover evaluations by the Office of the State Long-Term Care Ombudsman to investigate alleged violations, reporting said violations to the Agency for Health Care Administration, and the agency would then impose civil penalties of up to $5,000 or $10,000, depending on the subsection violated.
  • Make report cards on nursing homes accessible and transparent to the public.
  • Increase transparency.
    • Stop AHCA from redacting information on nursing homes.
    • Make report cards on nursing homes accessible and transparent to the public.
  • Reinstate an independent ombudsman.
    • Require a review by the ombudsman of all nursing homes’ emergency plans annually.
  • Put in place anti-retaliatory measures for whistleblowers.
  • Allow the use of electronic monitoring devices in resident room.
  • End limitations on punitive damages.
  • Require all nursing homes to have liability insurance – maintain general and professional liability coverage in an amount not less than $1 million per claim, with a minimum annual aggregate of not less than $3 million; If the agency determines that a resident died as the result of abuse or neglect, it shall immediately impose a $1 million civil penalty on the facility.
  • Require an Internal Resident Safety & Quality of Care coordinator program.

Nursing Home & ALF Resident Rights – HB 443 by Rep. Slosberg/SB 830 by Sen. Farmer & HB 331 by Rep. Slosberg/SB 1428 by Sen. Taddeo

  • Authorize AHCA to take action again a facility for failure to provide residents and the State Long-Term Care Ombudsman Program with facility contact information.
  • Give residents the right to access their personal and medical records.
  • Provide notice  requirements regarding relocation or termination of residency from an assisted living facility.

Elder Abuse Fatality Review Teams – HB 259 by Rep. Watson/SB 422 by Sen. Gibson

  • Create Elder Abuse Teams in each judicial circuit to review elder abuse-related deaths.
  • Deaths reviewed are limited to cases that have been closed.
  • Teams are to make policy and other recommendations regarding prevention of abuse-related deaths to the Governor, Legislature, and Departments of Children and Families and Elder Affairs.

Hospice Care – HB 497 by Rep. Stone/SB 724 by Sen. Garcia

  • Authorize hospice to provide palliative care to seriously ill patients and their families in addition to terminally ill patients.

Senior Advocates – SB 500 by Sen. Garcia

  • Establishes the Senior Advocate Program in the Office of Public and Professional Guardians in DOEA.
  • Provides the purpose of the program is intended to strengthen and secure the legal rights, dignity, autonomy, quality of life, and quality of care of vulnerable seniors by providing volunteer advocates for vulnerable seniors age 60 years and older.
  • Provides that to resolve concerns regarding vulnerable seniors and improve their quality of life, senior advocates may collaborate with family members of vulnerable seniors, local social and health care service providers, behavioral health care providers, legal aid organizations, long-term care ombudsmen, religious organizations, food banks, area agencies on aging,  appropriate state agencies, local and state law enforcement agencies, and others.

Registration of Home Caregivers – HB 835 by Rep. Harrell/SB 1362 by Sen. Baxley

  • Authorize local governmental entities to establish a registration program for home caregivers.
  • Define home caregiver as a person who receives any form of compensation for assisting a vulnerable adult with one or more activities of daily living.

Elder Abuse – HB 1059 by Rep. Burton/SB 1562 by Sen. Passidomo

  • Create cause of action for injunction for protection of vulnerable adults from exploitation.

Tax Exemption for the Elderly – HB 1123 by Rep. Berman/SB 911 by Sen. Passidomo

  • Create a sales tax exemption for items that assist in independent living for the elderly.
  • Items exempted include:

Constitution Revision Commission Proposals

Proposal 54 by Commissioner Kruppenbacher

  • Eliminates the certificate of need process for hospitals, nursing homes, hospices and intermediate care facilities for individuals with intellectual disabilities and renders all laws requiring CON to be void and of no effect.

Proposal 88 by Commissioner Heuchan

  • Creates a new section in Article I of the State Constitution to establish certain rights for residents of assisted living facilities and nursing home facilities in this state.
  • Rights described in the proposal include, among others:
    • The right to adequate and appropriate health care and treatment that puts the residents’ needs and best interests first.
    • The right to a safe, clean, comfortable, and homelike environment that protects residents from harm and takes into account this state’s challenges with respect to climate and natural disasters.
    • The right to access courts and a jury system that allows for a speedy trial and relief and remedies, without limitations, for loss, injury, and damages caused to residents and their families by the abuse, negligence, neglect, exploitation, or violation of residents’ rights by the facilities’ owners, operators, employees, professionals, and others who care for residents at such facilities.
    • The right to know and hold accountable all persons or entities who own or operate the facilities.
    • The right that the facilities will have the financial resources or liability insurance in order to ensure that residents and their families are justly compensated for any loss, injury, and damage they suffer because of abuse, negligence, neglect, exploitation, or violations of residents’ rights by owners, operators, employees, professionals, and others who care for residents at such facilities.

2017 Legislative Session 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

LeadingAge Florida’s Position on Legislation

Medicaid Prospective Payment System for Nursing Homes:

LeadingAge Florida opposes the Prospective Payment System model developed by the Agency for Health Care Administration, and has developed an alternative model for consideration that retains elements of the AHCA plan, while preserving quality nursing home care.

LeadingAge Florida supports SB 712 by Sen. Aaron Bean which codifies LeadingAge Florida’s alternative model into law.

  • The 2016 Legislature appropriated $500,000 to the Agency for Health Care Administration (AHCA) to contract for the development of a prospective nursing home payment plan. AHCA requested this issue to reduce the administrative burden and to eliminate the large number of retroactive rate adjustments that occur under the current retrospective payment system.

  • The AHCA/Navigant proposal would shift $109 million from mostly high-quality nursing homes to mostly lower-quality nursing homes; it therefore threatens the quality of care that is currently delivered by Florida’s nursing homes and will devastate many of the state’s 5-star providers.

  • The Navigant prospective payment plan largely ignores historic trends and established business practices and increases payment to lower cost providers at the expense of higher cost, but generally higher quality nursing homes.

  • There is no requirement within the Navigant proposal that funding gained by poor quality nursing homes be used to improve performance or services to residents.

  • There are 143 nursing homes with 4 or 5 star ratings which will lose funding under the Navigant proposal, while 86 nursing homes with 1 or 2 star ratings will gain funding. In these cases, Medicaid funding is lost by nursing homes that are providing high quality care to residents; while nursing homes which have failed to do so, gain funding.

  • The Navigant plan results in extreme loses and gains: the 4 and 5 star nursing homes that lose reimbursement under the plan, lose $42 million; while the 1 and 2 star nursing homes that gain under the Navigant plan, gain $26 million.

  • The current proposals cannot help but:
  • It is highly unlikely that all of those homes that gain additional dollars under the proposed plan will spend these funds to improve their resident care since some of them are already making a profit on Medicaid and have elected not to enhance care in their facilities. Improving care can cost more than the potential Medicaid payment increase.

  • LeadingAge Florida has developed an alternative plan that achieves the goals of simplicity, budget neutrality, and quality without the devastating effects of the AHCA plan. The alternative simply begins with current rates, and allocates the current quality component based on the actual quality performance of the nursing home.

Certificate of Need for Nursing Homes:

LeadingAge Florida supports the retention of a CON process for nursing home beds.

LeadingAge Florida supports 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.

The CON process encourages efficient use of less restrictive long-term care options and, therefore, restrains long-term care cost increases for Medicaid as well as for all other payers.

  • Without a Certificate of Need process Florida would experience a significant growth in nursing home beds. This growth would outpace population growth and corresponding need for new beds.

  • Nursing homes are the most expensive component of the long-term care system and an uncontrolled growth in bed capacity would increase overall long-term care costs.

  • Florida already experiences staffing shortages. The addition of a large number of new nursing home beds would create competition for licensed nurses and certified nursing assistants with concomitant salary and benefit wars. Most new nursing homes would be constructed by large multi-facility, multi- state corporations that could offer higher rates and operate at a loss for a period of time. Their pay structure for direct care, as well as all other staff, could not be matched by most nonprofit and small for-profit nursing home operators.

  • Without some mechanism to control the growth of nursing home beds, a two-tiered system, one for private pay/Medicare and one for Medicaid would emerge.

  • As newly constructed facilities siphon off more profitable private pay and Medicare beneficiaries, quality of care would decline in older nursing homes. Financial challenges would escalate for highly respected nonprofit and small for-profit community nursing homes without the resources to renovate or replace older buildings or corporate resources to rely on.

  • Negative financial impact on the Medicaid budget would be immediate as increased direct care staff wages and benefits would create added pressure on AHCA and the Legislature to increase payment rates.

  • Non-profit and small for-profit nursing homes would be hurt the most by the elimination of the CON. As the research indicates, non-profit homes tend to be among the best in the state. In addition, many are pillars of the community with a long history of serving frail Floridians – some for more than 50 years.

  • Significant increase in the number of nursing homes would create additional workload and increase in licensure inspection staffing.

Continuing Care Retirement Community Regulatory Reform

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.

The proposed changes:

  • Add criteria that impose higher standards for a financially troubled provider to avoid OIR remedial action.

  • Modify criteria for OIR approval of change in general partner, specifically any change in general partner, regardless of the percent of financial interest in the facility (current law is 10%), would necessitate a notification and application to OIR for approval.

  • Clarify that information that by law must be disclosed to prospective residents about expansion plans and other activities should be available to the president or chair of the residents’ council.

  • Require disclosure of information about OIR findings, including outstanding deficiencies, to the president or chair of the residents’ council.

  • Require disclosure of information about a pending sale or change of ownership to the president or chair of the residents’ council.

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.

  • LeadingAge Florida and its 56 CCRC members support thoughtful regulatory reform that protects Florida’s seniors and their investments in senior care.

  • The lengthy bill, developed by the Office of Insurance Regulation (OIR) without input from stakeholders, makes major revisions to almost every section of Ch. 651, F.S., (the law governing the regulation of continuing care retirement communities) and creates another eight sections of law.

  • Continuing care retirement communities are not a typical insurance product. That is why the Florida Legislature, like most other states, created a separate chapter of law to regulate them.

  • All the information OIR needs to monitor the financial condition of continuing care retirement communities and detect financial weaknesses is available in the annual, quarterly and monthly reports and data calls that providers are required to file.

  • With the exception of three recent bankruptcies (one related to a CCRC that opened during the recession and was affected by the depressed housing market and another that blatantly violated the law), there have been no defaults in Florida over the past 25 years. OIR failed to use information readily available through various required reports to detect financial weaknesses for the two CCRCs before they became a major concern.

  • The bill creates another substantial financial reserve (in addition to the minimum liquid reserve) that OIR has not modeled to determine its effect on individual providers and resident fees. Providers will be required to comply immediately without a phase-in. Failure to meet the requirement could result in the suspension or revocation of the certificate of authority to operate and sell contracts.

  • The bill imposes significant financial burdens and risks on CCRC residents; there is no dispute on this point – the Office of Insurance Regulation has testified that its analysis shows an increase in costs to residents as a result of the bill. In one community, just one provision in the bill would result in a $40,000 assessment per resident.

  • Ultimately, the bill threatens and potentially limits an important retirement and care option for seniors in Florida, even as the 70-79 year-old age group is the fastest growing demographic in our state.

  • The bill will not only chill future development of continuing care retirement communities in Florida, it could create unintended financial problems for successful communities that have been in existence for 20 to 65 years.

Use Housing Trust Funds for their Intended Purpose:

As a member of the Florida Sadowski Housing Coalition, LeadingAge Florida supports the appropriation of all the state and local housing trust fund money for affordable housing.

Funding to construct or preserve affordable housing in Florida comes from documentary stamp tax paid on all real estate transactions, which was increased in 1992. Those monies were set aside as state and local housing trust funds.

  • 70% of the monies go to the Local Government Housing Trust Fund for the State Housing Initiatives Partnership (SHIP) program, which funds housing programs in all 67 counties and larger cities.

  • 30% of the monies go to the State Housing Trust Fund for Florida Housing Finance Corporation programs, such as the State Apartment Incentive Loan (SAIL) program.

By allocating the full appropriation of the estimated $292.4 million in the state and local housing trust funds in Fiscal Year 2017-18 into Florida's housing programs 28,300 jobs will be created and $3.57 BILLION in positive economic impact in Florida will result.

The Governor’s Recommended FY 2017-18 Budget would shift almost 77% of the $292.4 million earmarked for low-income housing to other state priorities ($224 million from state and local housing trust funds).

Innovative Senior Housing Plus Services Models

LeadingAge Florida supports initiatives for innovative senior housing plus services models.

LeadingAge Florida supports an amendment to SB 854 by Sen. Jeff Brandes and HB 1013 by Rep. Newt Newton adding a representative of LeadingAge Florida to the affordable housing task force created in the bill and a requirement for a task force recommendation on affordable senior housing.

Investment in housing plus services models helps support aging in place initiatives by preventing admission to higher cost care centers such as nursing homes and assisted living. Participation in a task force created by SB 854 and HB 1013, if enacted, will give LeadingAge Florida a voice in developing recommendations for addressing the affordable housing needs of Florida’s seniors.


2016 Legislative Session Convenes

The 2016 Legislative Session kicked off Tuesday with House Speaker Crisafulli and Senate President Andy Gardiner addressing their respective chambers, followed by Governor Rick Scott presenting the State of the State Address to a joint meeting of the two chambers.

Speaker Crisafulli began his address by stating that, by the end of the first week of Session, both the House and Senate will pass three important bills that were part of last session’s work plan. These bills provide for a comprehensive water policy, expand educational options for students and schools, and strengthen pathways to economic independence for persons with disabilities. The Speaker advised, if the current revenue estimates hold, the House will unveil a $1 billion tax cut proposal that will lower taxes for all Floridians. He stated this will allow businesses to hire more workers and give families meaningful relief so that they can reinvest into Florida’s economy. Speaker Crisafulli spoke of helping to grow Florida’s economy with reduced regulations, incorporating new technologies, improving access to quality, affordable health care and passing pension reform. He specifically mentioned allowing advanced registered nurse practitioners to prescribe certain medications as a way to improve Florida’s healthcare system.

Senate President Andy Gardiner spoke of cutting taxes, passing a balanced budget, and appropriating more K-12 per student funding. He vowed to work with Governor Scott and the House to ensure Florida has the tools needed to recruit and retain businesses that create jobs and grow the economy. Finally, he affirmed his commitment to taking more people off the Agency for Persons with Disabilities waiting list, so they can receive services they need in their homes and communities.

Governor Rick Scott gave his State of the State Address which focused primarily on jobs and economic development. Since taking office five years ago, the state has created more than 1 million jobs. Gov. Scott emphasized his push to cut $1 billion in taxes and create a $250 million Florida Enterprise Fund. Scott's proposed tax cuts are largely aimed at businesses, including the elimination of corporate income taxes for manufacturers and retailers. He also wants to cut sales taxes charged on commercial leases by 1 percent and permanently eliminate the sales tax charged on the sale of manufacturing equipment.

Political observers are predicting that the Legislature will adjourn on time and there will be less discord this year than last year’s session which saw gridlock over redistricting, the budget, Medicaid expansion, health care reform and other issues. Sen. Gardiner acknowledged that some significant bills didn't pass during the 2015 legislative session, with the House adjourning early last April amid a dispute with the Senate over Medicaid expansion. In a display of a more cooperative mindset, in their opening legislative session remarks, both Senate President Andy Gardiner and House Speaker Steve Crisafulli promised to deliver on key legislative priorities of the President and Speaker - water legislation, an education bill and legislation to help people with disabilities get jobs. House Speaker Crisafulli’s state water policy environmental resource bill — the Florida Springs and Aquifer Protection Act — contains provisions for water resource protection and restoration and directs the state to prepare a comprehensive database of all publicly owned lands in Florida. Senate President Gardiner’s legislative package increases education and employment opportunities for residents with disabilities would increase scholarships for disabled students, ranging from public schools to higher education.

The only legislation the Legislature must pass is a balanced budget. This year, more money is available for consideration in the appropriations process because of an improving economy but legislators will still face challenges in passing a $79 billion state budget for the 2016-17 fiscal year which takes effect July 1. An issue will be how much of the Governor’s $1 billion tax-cutting package will be accommodated in the new budget, and what taxes will be cut. The bulk of the cut would include the elimination of the 5.5 percent corporate income tax that is paid by manufacturers and retail businesses. Scott also wants to permanently eliminate the sales tax on manufacturing equipment, an exemption that expires in 2017. The package also includes a reduction in the sales tax that businesses pay on commercial leases, a one-year sales tax exemption on college textbook purchases and sales tax holidays for back-to-school and hurricane supplies.

While House Speaker Crisafulli supports tax cuts, the House’s proposal may not align with the Governor’s proposal and will focus on corporate tax breaks and the commercial lease tax cut. We understand the Senate is starting with a tax cut in the range of $250 million.

A growing Medicaid budget as well as a scheduled reduction in federal funding for Florida hospitals will complicate the final budget deal.

Other major issues coming before the 2016 Legislature include gambling, guns, education, medical marijuana, fracking and a range of healthcare proposals.

Information on LeadingAge Florida’s 2016 Legislative Public Policy Priorities and updates on legislative activities is available on our website.


Bill Introduced on Behalf of LeadingAge Florida will Benefit CCRCs and other Multi-facility Communities


HB 127 by Rep. Cummings (R-Orange Park) and SB 542 by Sen. Stargel (R-Lakeland), filed on behalf of LeadingAge Florida, allow a non-accredited Continuing Care Retirement Community (CCRC) applying for the Gold Seal nursing home designation to submit financial statements prepared by an independent CPA for the community in its entirety as proof of compliance with the financial criteria established by AHCA. If the bill becomes law, a nursing home that is part of a CCRC accredited by a national accreditation organization and meets the minimum liquid reserve requirements in Ch. 651 would still be deemed to meet the financial criteria for the Gold Seal designation.

The language in the bill was proposed by the 2014-15 LeadingAge Florida/FLiCRA Ch. 651 Task Force to address declining interest in accreditation because of the cost and change in focus. At last count, only 6 of the state’s 71 licenses CCRCs were accredited while 7 of 26 Gold Seal nursing homes are part of a CCRC. The bill would eliminate the cost of providing three years of separate financial statements prepared by a CPA for the nursing home if the CCRC is not accredited and wishes to pursue the Gold Seal designation.

HB 127 and SB 542 have both been heard in committee and amended to allow a nursing home that is part of a corporate entity that operates nursing homes, assisted living facilities, or independent living facilities to satisfy the financial soundness and stability requirement of the Gold Seal Program by submitting a consolidated corporate financial statement to AHCA and demonstrating that the corporate entity, in its entirety, meets the financial standards established by AHCA. The Florida Health Care Association requested this amendatory language.

Each bill has one more committee stop before heading to the Floor for consideration by the full House and Senate. There has been no opposition to either bill in committee. 


May 11, 2015


State Ombudsman Program Bill – Legislative Summary CS/SB 7018


CS/SB 7018 by the Senate Committee on Children, Families and Elder Affairs revises a number of operational and internal procedures for the state and local ombudsman councils. Currently the State Ombudsman program is housed in the Department of Elder Affairs, where it will remain. The bill, which passed both chambers, revises the appointment process for three at-large positions to the State Long-Term Care Ombudsman Council. The appointments will be made by the Secretary of the DOEA rather than the Governor. The bill does not appear to have any significant impact on LeadingAge members. However, it does require facilities to provide additional information related to the Ombudsman Program to all residents. It also expands the investigative authority and responsibilities of representatives of the Ombudsman Program.

Changes that affect members are marked with an asterisk*.

To view the enrolled bill CS/SB 7018, click here.

Sections 1-3: s. 400.0060, s. 400.0061 and s. 400.0063 Definitions, findings and legislative intent

  • Creates or revises definitions related to the State Long-Term Care Ombudsman Program.
  • Modifies terminology to conform to other changes in the bill.
  • Clarifies legislative intent.
Section 4-5: s. 400.0063 and s. 400.0065 Program duties and responsibilities
  • Specifies that the State Long-Term Care Ombudsman Council must consist of one "certified” ombudsman for each local council in a district in addition to three at-large members. Requires each local council to select a representative to serve on the state council.
  • Requires the DOEA Secretary (rather than the Governor) to appoint the three at-large positions to the State Council from a list of individuals provided by the state ombudsman.
  • Gives the state ombudsman authority to make or rescind appointments of individuals serving as an ombudsman.
Section 6: s. 400.0069 Long-term care ombudsman districts; local long-term care ombudsman councils
  • Requires the state ombudsman to designate districts and each district to designate a local council.
  • Requires the state ombudsman to certify that at least one employee of DOEA is certified as an ombudsman.
  • Requires each district to convene a public meeting at least quarterly.
  • Adds exploitation to the list of allegations that representatives of the Long-Term Care Ombudsman Program may investigate.
  • Expands ombudsmen investigations to include actions or omissions by providers of long-term care services, other public agencies, guardians, or representative payees which may adversely affect the health, safety, welfare, or rights of residents.
  • Expands the duties of representatives of the State Long-Term Care Ombudsman Program to include providing technical assistance for the development of resident and family councils.
  • Adds owner or representative of a long-term care facility, provider or a representative of the provider of a long-term care service to the list of individuals that may not be appointed as ombudsmen.
  • Requires prospective ombudsmen to complete a level II background screening.
  • Specifies that an ombudsman may not participate in district activities or represent the program until initial training is completed and the individual has been certified by the state ombudsman.
  • Gives the state ombudsman the authority to rescind the appointment of an individual ombudsman as ombudsmen.
Section 7: s. 400.0070 Conflicts of Interest
  • No substantive changes.
Section 8: s. 400.0071 Complaint procedures
  • Requires DOEA, in consultation with the state ombudsman, to adopt rules that include procedures for receiving, investigating, identifying, and resolving complaints.
Section 9: s. 400.0073 State and local ombudsman council investigations
  • Requires a representative of the State Long-Term Care Ombudsman Program to identify and investigate complaints made by or on behalf of a resident related to actions or omissions by providers of long-term care services, other public agencies, guardians, or representative payees which may adversely affect the health, safety, welfare or rights of residents.
  • Makes minor technical changes to the process for dealing with a provider that restricts ombudsman access to the facility.
Section 10: s. 400.0074 Local Ombudsman Council administrative assessments
  • *Requires that the annual onsite administrative assessment of each nursing home, assisted living and adult family care home is resident-centered.
  • Authorizes DOEA, in consultation with the state ombudsman, to adopt rules implementing procedures for conducting onsite administrative assessments of long- term care facilities.
Section 11: s. 400.0075 Complaint notification and resolution procedures
  • *Specifies that the results of an investigation which is determined by the local council to require remedial action "may” (rather than the current "shall”) be identified and brought to the attention of the long-term care facility administrator subject to confidentiality provisions in law.
  • *Requires a representative of the State Long-Term Care Ombudsman Program to establish timeframes for the resolution of an issue between the facility and resident.
  • If imminent danger exists, requires the District manager or local council chair to notify the appropriate state agencies, including law enforcement agencies, the state ombudsman, and the legal advocate to ensure protection of residents.
Section 12: s. 400.0078 Citizen access to State Long-Term Care Ombudsman Program services
  • *Requires long-term care facilities to disclose to the residents that no retaliatory action will be taken when a resident presents a grievance or exercises other resident rights.
  • *Requires long-term care facilities to provide the e-mail address in addition to toll-free telephone number of the State Long-term Care Ombudsman Program to residents.
Section 13: s. 400.0079 Immunity
  • Substitutes "representatives of the State Long-term Care Ombudsman Program" for "ombudsman” when referring to immunity.
Section 14: s. 400.0081 Access to facilities, residence and records
  • No substantive changes.
Section 15: s. 400.0083 Interference; retaliation; penalties
  • No substantive changes.
Section 16: s. 400.0087 Department oversight; funding
  • Requires DOEA to ensure that the State Long-Term Care Ombudsman Program coordinates with Disability Rights Florida.
Section 17: s. 400.0089 Complaint data reports
  • Requires the State Long-Term Care Ombudsman Program to publish quarterly reports of the number and types of complaints received.
Section 18: s. 400.0091 Training
  • No substantive changes -- continues current requirement for representatives of the State Long-Term Care Ombudsman Program to receive 20 hours of training upon employment and 10 hours of annual continuing education.
Section 19: s. 20.41 Department of Elder Affairs
  • Conforms newly defined terms and technical changes with no impact to providers.
Section 20: s. 400.021 Definitions (nursing home)
  • Conforms newly defined terms and technical changes with no impact to providers.
Section 21: s. 400.022 Residents rights
  • *Specifies that nursing homes must provide the telephone number and e-mail address of the State Long-Term Care Ombudsman Program and the phone number of the Elder Abuse Hotline to residents.
Section 22: s. 400.0255 Resident transfer or discharge; requirements and procedures; hearings
  • *Specifies that a resident may request that the State Long-Term Care Ombudsman Program or local ombudsman council review discharge or transfer notices.
Sections 23-26
  • Conforms newly defined terms and technical changes with no impact to providers.
Section 27: s. 400.235 Nursing home quality and licensure status; Gold Seal Program
  • *Clarifies that a nursing home will not qualify for Gold Seal if complaints reported to the state long-term care ombudsman program within 30 months preceding the application for a Gold Seal resulted in a citation for licensure.
Sections 28-36
  • Conforms newly defined terms and technical changes with no impact to providers.
Section 37: s. 429.28 Resident bill of rights
  • *Specifies that ALFs must provide the telephone number and e-mail address of the State Long-Term Care Ombudsman Program and the phone number of the Elder Abuse Hotline to residents.
Section 38-41
  • Conforms newly defined terms and technical changes with no impact to providers.
Section 42
  • Creates an effective date of July 1, 2015.


2015 Legislative Advocacy Briefings

Week One - PDF Available March 6
Week Two - PDF Available March 13
Week Three - PDF Available March 20
Week Four - PDF Available March 27
Week Six - PDF Available April 10
Week Seven - PDF Available April 17
Week Eight - PDF Available April 24       

(FL) Senate Workshop/Senate Plan for Medicaid Sustainability (April 21, 2015) -

Click here.

Week Nine - PDF Available May 1

CCRC Public Policy Update (4/28/15)

ALF Public Policy Update (4/29/15)

Legislative Wrap Up - PDF Available May 1


2015 Public Policy Priorities

This brief summary is provided to assist you when you are meeting with state legislators, candidates and other policy makers. The following are issues identified by LeadingAge Florida that are expected to be addressed during the 2015 Florida Legislative Session:

  • Support requiring hospitals to notify their patients of being placed in observation status.
  • Support amending the Medicaid nursing home reimbursement plan to provide for appropriate inflation indexing of property costs.             
  • Oppose efforts to repeal or restrict the types of adult day services that Nursing Homes and ALFs may provide through the licensure exemption in section 429.905, F.S.
  • Support simplified Gold Seal financial requirements for nursing homes that are part of CCRCs.
  • Support the use of Florida housing trust funds exclusively for housing related issues.
  • Support legislation that may be filed on behalf of a FLiCRA/LeadingAge Florida Task Force to clarify entrance fee refund requirements for Continuing Care Retirement Communities, strengthen the role and responsibility of resident councils and address other regulatory issues.

Read the full description of priorities and stay informed by subscribing to our various communications and weekly Newsletter. Email Jean Krier for details on subscribing.


2014 Legislative Advocacy Briefings


January 8, 2014

Sample Letter to Congressional Delegation Members

LeadingAge has provided instructions on how to contact your Congressional representatives about all of our issues on LeadingAge’s Contact Congress page.

LeadingAge Florida has created sample text specific to the needs of Florida that is available below for you to copy and personalize.


Dear Senator/Congressperson:

On behalf of the members of LeadingAge Florida, who provide high-quality aging services to some of Florida’s neediest seniors, I am asking you to work on their behalf to maximize 2014 funding for senior housing and supportive services programs under the budget plan passed by Congress.

Seniors with moderate incomes living in the community depend on Section 202 and Section 8 programs to meet their basic need for decent, affordable housing. To remain in their communities, these seniors frequently depend on nutrition, transportation and other services funded under the Older Americans Act.

These programs were hit hard by sequestration cuts that took effect early in 2013. Annual funding for these programs typically does not meet the needs of a growing senior population. Sequestration forced cutbacks in congregate and home-delivered meals and lengthened waiting lists for essential housing.

As the House and Senate appropriations committees develop an omnibus spending bill for the rest of this fiscal year, I hope you will work with your colleagues to provide as much funding as possible for programs that enable moderate income seniors to remain in their communities.


Your Name
Your Title
Your Company



September 6, 2013

Participation Needed at Local Delegation Meetings

With all of the competing interests vying for legislators’ time, it is imperative that LeadingAge Florida members share issues facing our association.

Starting this month, members of the Florida Senate and House of Representatives representing each of the Florida's 67 counties’ Local Legislative Delegations will have their annual meetings. The delegations will receive input from local government officials and constituents before the start of the 2014 Legislative Session and are responsible for holding annual meetings in each county they represent to develop the county's legislative program. This includes all local bills, community appropriation requests, county and municipal legislative priorities and serving as a liaison between the Florida Legislature and communities.

That’s where you come in. We need you to attend your local delegation meetings and let the legislators know what is on the minds of LeadingAge Florida's members. Because there are so many Local Legislative Delegations, the best way to cover them all is to encourage other volunteers to attend and speak up! For your convenience, we have included a link to the list of 2013 Local Legislative Delegations along with LeadingAge Florida's 2013 Legislative Priorities. We will update you with the 2014 Legislative Priorities once they have been approved. If you need assistance with additional talking points, please let us know.

The list of Local Legislative Delegations, provided by the Florida House of Representatives, includes delegation members and contacts for the House and the Senate. Check with your delegation to confirm dates and times for local meetings. Please note deadlines for placing agenda items and submitting written materials and required registration forms. We suggest that you contact the delegation office prior to the posted deadline in order to give yourself adequate time to prepare any written materials and/or required registration forms.

One of the chief reasons LeadingAge Florida has had such tremendous legislative success is because of members like you. We encourage you to attend your respective delegation meeting. Let us know how the meeting(s) went and if we can assist you with any planning or issues as a result of the meeting.

 View scheduled Local Legislative Delegation meetings here.


2013 Legislative Advocacy Briefings

Legislative Wrap Up – May 14, 2013 [PDF]

Week Nine - May 3, 2013 [PDF]
Week Eight - April 26, 2013 [PDF]
Week Seven - April 19, 2013 [PDF]
Week Six - April 12, 2013 [PDF]
Week Five - April 5, 2013 [PDF]
Week Four - March 29, 2013 [PDF] 
Week Three - March 22, 2013 [PDF]
Week Two - March 15, 2013 [PDF]
Week One - March 8, 2013 [PDF]

  April 29, 2013

2013 Legislative Budget Update

After two weeks of hard work and numerous committee meetings, including working on the weekend, the final budget report was placed on the desk of the Florida Legislature just after 1 p.m. today. This starts the constitutionally mandated 72-hour "cooling off" period before the Legislature can take a final vote on the $74.5 billion spending plan. This is the only bill the Florida Legislature must pass before adjournment or "Sine Die.” The final spending plan is a larger version than the House, and the Senate passed earlier in the 60-day session as well as the proposal Governor Rick Scott pitched back in February. 

We are still studying the relevant documents, but the following contains some of the major issues of interest to our LeadingAge Florida member’s communities:

Nursing Homes

  • There were no cuts to nursing homes

Home and Community Based Services

  • New PACE slots for:
    • Hillsborough County (75),
    • Lee (100),
    • Palm Beach (100) and
    • Broward (50).

More information will be forthcoming.

March 28, 2013

2013 Legislative Budget Update

The Senate Appropriations Subcommittee on Health and Human Services and the House Health Care Appropriations Subcommittee released their "Chair’s Recommendations.” This represents the first draft of the budget proposal created mostly by committee chairs and staff. The full House and full Senate Appropriations committees are scheduled to take up the appropriations bills during the first week of April. They will amend subcommittee proposals and pass a full appropriations bill for action the following week on their respective chamber floors. We anticipate the Budget Conference Meeting process to likely begin around April 20, whereby committees comprised of House and Senate members work together to resolve differences in their respective budgets.

The list below contains some of the major issues in both the Senate and House chairmen’s recommendations.

• There were no cuts to nursing homes
• 2,415 additional Long –term Care Diversion Waiver slots
• Provides funding for the Medicaid Electronic Health Records Incentive Program
• 100 new PACE slots in Hillsborough County
• Affordable Housing: The Senate has $70 million for SHIP


• There are no cuts to nursing homes. The Chair’s recommends maintaining Medicaid reimbursement for nursing home care at current funding levels
• 200 additional slots in the Assisted Living Facility Wavier
• 1880 additional Long –Term Care Diversion Waiver slots
• Funding for an additional 100 PACE slots in Lee County
• Provides funding for the Medicaid Electronic Health Records Incentive Program
• Affordable Housing: The House has no money allocated at this time

To stay informed about the budget and other legislative issues that LeadingAge Florida is following, don’t miss our Weekly 2013 Legislative Advocacy Briefing Conference Calls every Friday at 10 a.m. EDT. 

January 30, 2013

Earlier today at a press conference, Governor Rick Scott released his proposed $74.2 billion budget that would expand health-care and services to the disabled, give teachers and state employees raises, offer more tax cuts to businesses, and restores cuts to universities. The Governor explained his "Florida Families First” budget was made possible thanks to higher sales tax collections and the slow, but steady turnaround of Florida’s economy. Shortly after the press conference a press release from the Agency for Health Care Administration briefly highlighted some of the key health care issues with even a quote from LeadingAge Florida. To see the press release and other some of the background information please view the press release below. LeadingAge Florida is currently reviewing the proposed budget and we will have a more detailed explanation shortly.

AHCA Budget Press Release

January 9, 2013

2013 Legislative Priorities

This brief summary is provided to assist you when you are meeting with state legislators, candidates and other policy makers. The following are preliminary issues identified by LeadingAge Florida that are expected to be addressed during the 2013 Florida Legislative Session:

  • Support preservation of current sales tax exemptions applicable to "homes for the aged" and non-profit organizations
  • Support safeguards for Medicaid Long-Term Managed Care
  • Oppose futher Medicaid cuts to nursing homes
  • Maintain the moratorium on nursing home certificate of need
  • Oppose efforts to shift money from the affordable housing trust fund to other state funded programs
  • Support resonable governmental oversight for assisted living reforms
  • Support AHCA regulatory reduction

Read the full description of priorities and stay informed by subscribing to our various communications and weekly Newsletter. Email Jean Krier for details on subscribing.

December 11, 2012

Revised 2013 Income Limits

HUD has just issued another posting of income limits briefing material, dated Monday, December 10, 2012, for 2013 income limits.

There was a problem with the calculations used in the previously released set. Please take a look and see how it impacts, if at all, the limits you learned of on the 5th (or 6th) that were meant to go into effect on the 4th.

See below for the previously released Update

LeadingAge to Conduct Call-ins Sessions for Section 202 Refinancing

HUD has established over the past few months new rules for refinancing Section 202 mortgages going forward that include the elimination of debt service savings accounts established under the refinancing. At the same time, HUD issued new guidance for renewing Section 8 contracts and requesting budget based rent increases, guidance which includes the use of current debt service, a market test, and depending on the HUD office, refusal to recognize debt service savings accounts in future budgets.

Because some sponsors seeking to refinance their Section 202 project have been impacted by having to reconfigure refinancing requests that were close to their closing dates or have experienced other issues with previously refinanced Section 202 projects, LeadingAge will be offering a series of two calls-in sessions to learn how Section 202 sponsors are addressing refinancing issues as relates to HUD's contradictions between preservation and asset management policies.

The first call-in session scheduled for Friday, December 14 at 2 pm EST will focus on Section 202 refinancing that have not yet closed, but may have been in progress or close to closing when the new policies were announced.

The second call-in session scheduled for Monday, December 17 at 2 pm EST will focus on the apparent lack of consideration of 202 mortgages that have already been refinanced in adopting the new renewal guide policies, particularly for those that did not get a 20 year contract at refinancing or last renewal.

If members are interested in participating in either of these two call-ins, you will need to RSVP to LeadingAge in order to get the call-in numbers and other logistics for participation. LeadingAge would encourage, but not require, participants to provide them in advance with a brief description of your situation and current status.

Please respond to Colleen Bloom and Nancy Libson.
In the meantime, if you have any questions please contact Tom Randle.

Please Call Your Congressman Now to Protect Charities

December 10, 2012

On Monday, December 10, 2012 you may have received a message from LeadingAge President and CEO Larry Minnix urging the LeadingAge members to find time to call their Congressman on this important issue. As charitable entities, the proposed caps on deductions jeopardize the mission-driven care we provide, and those in need of our charity. We'll be placing our calls, and ask that everyone who values the care and services that charities provide do so as well.

As Larry stated in his email:

"The charitable sector is under silent siege. It has become embroiled in the need to address our country's fiscal woes, which certainly need to be addressed. But, if we have cut back on entitlement programs that help those in need, we will need more donors and donations -- not fewer. Right now, proposals are floating on Capitol Hill that will cap charitable deductions at a time when people are in great need of charity, and institutions that enrich our culture are in need of donations -- perhaps more than ever. Just last week, one of our distinguished leaders, Audrey Weiner, the LeadingAge Board Chair, reported to me that she had contacted her members of Congress, who said they are hearing no expressions of concern about capping the charitable deduction! This is alarming! Without public outcry, Congress may well create a hole that we may not be able to fill.

So, here is what I am asking of all of you:

  1. Read the Johns Hopkins University Listening Post report on nonprofits by Lester Salamon, and make it part of your Board meetings.
  2. Read and sign on to the letter from the Independent Sector, a remarkable organization that represents every corner of the charitable sector. Join the chorus of supporters, which includes nearly 1,000 organizations like yours.
  3. Call 888-277-8686 all this week and repeat our mantra to your legislators:
    "The needs of people are never capped. Nor should we cap the charitable deductions to help them."

We all have a need to give. Many of us will have the need to receive.

This disincentive for charitable donations punishes the vulnerable and those who seek to help them. There are fairer ways to generate tax dollars as well as prudent ways to cut expenses. Instead of further enlarging the hearts of our communities, a cap on charitable deductions could shrink them. We provide this information to you only as a courtesy, there is a timely FREE webinar entitled "The Fiscal Cliff's Twin Threats Against the Work of Charities" Provided by BoardSource.

Wednesday, December 12
3:30 p.m. - 4:30 p.m. ET

Two parts of the fiscal cliff threaten to create massive new burdens on nonprofits and even more work for board leaders. Because of the urgency of this issue, BoardSource has quickly arranged a special webinar to alert our community.

Join Tim Delaney, president and CEO of the National Council of Nonprofits, to learn how the fiscal cliff's scheduled cuts and proposed caps represent twin threats to the work of nonprofits serving individual Americans and local communities. By making funding cuts without reducing the underlying human needs, the demand on nonprofits will increase while the resources for providing needed services will decrease. Capping charitable deductions will further reduce the ability of charitable organizations to meet the increasing need for services.

Register now to learn more about these potentially devastating threats and what each of us can do NOW to voice our views.

December 7, 2012

 2013 Income Limits Released

 On December 4, 2012, the 2013 income limits were released for HUD multi-family programs.

Effectively immediately, HUD multi-family property managers must use the new income limits posted on the HUDUser website.

The new income limits must be used for all new move-in transactions starting with move-ins effective Dec. 4, 2012. Income limits do not apply to existing residents (annual and interim certifications) since income eligibility is determined at move-in. See HUD Handbook 4350.3 Revision 1, Change 3, Paragraphs 3-4.

Due to the Housing and Economic Recovery Act of 2008 (Public Law 110-289) these income limits may not be applicable to projects financed with Section 42 Low Income Housing Tax Credits (LIHTC) or section 142 tax exempt private equity bonds. These projects should use the Multifamily Tax Subsidy Project Income Limits.

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