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Vol. 22 Issue 26


Medicaid Reimbursement Plan – LeadingAge Florida has recently analyzed a “new Medicaid Reimbursement Plan” being circulated by Our Florida Promise (OFP). According to their page on Florida Health Care Association’s website, Our Florida Promise is “… established by nursing home owners and operators to enhance the ability of Florida Health Care Association to properly and successfully impact the legislative process. Our Florida Promise works in partnership with FHCA’s lobbying efforts to advocate for nursing home interests.”

LeadingAge Florida wants to provide members with important information regarding the OFP proposal. It is the goal of LeadingAge Florida to ensure you have the latest information on this topic.

  • The Governor’s FY 2016-17 Legislative Budget Request includes $500,000 for the Agency for Health Care Administration (AHCA) to contract with an independent consultant to develop a Medicaid reimbursement plan.
  • The LeadingAge Florida Board of Trustees voted to gather information and support efforts for additional funding through the legislative budget process to address Medicaid Prospective Plans for nursing homes.
    • LeadingAge Florida supports working with all interested parties to develop and define a fair and equitable reimbursement system.
Brief Analysis of the plan put forth by Our Florida Promise
  • The proposal rewards nursing homes with low staffing ratios and correspondingly low Direct Care costs.
  • Compared to the current system, the OFP plan delivers unacceptable financial losses to non-profit providers.
  • Reimbursements would be shifted under the plan from small, high quality not-for-profit communities to large corporate-owned facilities.
    • Gold Seal Nursing Home communities stand to lose $2.04 Million under the OFP plan.

    • Nursing Homes run by non-profit organizations lose over $11.5 Million in the OFP plan.
    • The negative effect on Single Owner Nursing Homes will be nearly $17 Million.
    • Nursing Homes run by corporate entities (many out of state) will gain $29.96 Million by the plan put forth by OFP.
  • Money would be moved from small, Florida-based, high-quality, not-for-profit organizations and transferred to large, corporate-owned institutions. More nursing homes would get paid less than their cost.
  • Large corporations have significantly lower direct care staffing ratios than other nursing homes.
  • LeadingAge Florida believes any new plan has to have the following priorities:
    • Winners & Losers: Create the least degree of variation for payment rates as compared to the current plan.
    • Respect additional costs associated with high quality of care. Understand not-for-profit communities invest differently as compared to for-profit facilities.
    • Inefficiencies: Address the current weaknesses in the property component of the payment methodology.
    • Dissemination of Limited Capital: Equitably distribute available funds to all nursing home providers.
    • Fund costs before allocating dollars for payments above costs.
    • Ramp Up: Phase in over a period of time, ideally five years.
    • Seat at the Table: Include input from relevant stakeholders.
LeadingAge Florida vigorously opposes any plan that would exacerbate the current, significant underpayment of many of our high-quality nursing home members.

Legislative Strategy/Engagement of LeadingAge Florida Advocacy Team & Lobbyists

Part of LeadingAge Florida’s multi-faceted approach to addressing this issue is to advise key legislators of the FHCA’s development of the OFP prospective payment plan and educate them on the devastating effect it would have on quality nursing home care provided at not-for-profit communities.
  • Members should contact key legislators with whom you have established relationships (see the list of key legislators below).
  • LeadingAge Florida continues to meet with and inform legislators and legislative staff in Tallahassee.
The following key legislators will be influential in shaping the direction taken in developing a new Medicaid prospective payment plan. If you have a relationship with any of these members, or if you are a constituent of theirs, please reach out to them while they are in their districts this week to express your concerns with FHCA’s payment models.
  • Senate President Andy Gardiner (R-Orlando) - (407) 428-5800
  • Senate President-Elect Joe Negron (R-Palm City) – (772) 219-1665
  • Senate Appropriations Chairman Tom Lee (R-Brandon) – (813) 653-7061
  • Senate Appropriations Subcommittee on Health & Human Services Rene Garcia (R-Hialeah) – (305) 364-3100
  • Senator Jack Latvala (R-Clearwater) – (727) 793-2797
  • House Speaker Steve Crisafulli (R-Merritt Island) – (321) 449-5111
  • House Speaker-Designate & Appropriations Committee Chairman Richard Corcoran (R-Lutz) – (813) 792-5177
  • House Health Care Appropriations Subcommittee Chair Matt Hudson (R-Naples) – (239) 417-6270
  • House Health & Human Services Committee Chairman Jason Brodeur (R-Sanford) – (407) 302-4800

Nursing Home 5-Star Analysis Report Webinar Training Scheduled – LeadingAge Florida, along with LeadingAge national and the state affiliates rolled out the Nursing Home 5-Star Analysis Report in September. You should have received your report via email and you will continue to receive an updated analysis on a quarterly basis as a free LeadingAge Florida member benefit. The report includes a comprehensive analysis of your Centers for Medicare and Medicaid (CMS) 5-star rating, highlighting areas to focus improvement efforts to increase your star rating.

If you missed the webinars that were offered a few weeks ago, LeadingAge offers recorded training sessions. The webinar will review the Nursing Home 5-Star Analysis report and show you how to best use the report in conjunction with Nursing Home Quality Metrics to track trends, identify areas of success, analyze areas for improvement, and demonstrate value to potential health care partners. Click here for recorded training sessions and upcoming training dates.

If you have any questions, please contact Steve Bahmer at the LeadingAge Florida office.

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