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130+ Members of FHCA to Gather at Capitol, Address in Support of Senate PPS Plan

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MEDIA ADVISORY

Members of the Florida Health Care Association (FHCA) will hold a media availability tomorrow morning to support the Senate’s plan for a Prospective Payment Plan for nursing center reimbursement. The event will be held Wednesday, April 5, at 9:00 a.m. on the 4th floor of the Capitol. FHCA represents 82 percent of Florida skilled nursing centers, and up to 130 long term caregivers will be in the Capitol to explain how the Senate PPS plan will encourage quality care and promote improvement. Speakers at the media availability will include Sen. Rene Garcia, FHCA Executive Director Emmett Reed, Cliff Bauer of Miami Jewish Health Systems, and Jamey Richardson of Gulf Coast Health Care. For interview opportunities and more information regarding the meeting, please contact Herbie Thiele.

What: Florida Health Care Association media availability regarding Senate PPS plan
Who: Sen. Rene Garcia
Emmett Reed, FHCA Executive Director
Cliff Bauer, Miami Jewish Health Systems
Jamey Richardson, Gulf Coast Health Care
When: Wednesday, April 5, at 9:00 a.m.
Where: 4th Floor of the Capitol

CONTACT:
Herbie Thiele
[email protected]
(850) 222-1996

FHCA: Managed Care Exemption Will Save Taxpayers Millions, Not Carry High Cost Projected by State

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The Florida Health Care Association today rejected figures developed by the state that suggest a proposal to remove skilled nursing centers from managed care would carry an extreme cost. The state’s calculations are seriously flawed, FHCA told a Senate committee, and instead of the $200 million cost identified by the state, the carve-out would actually save taxpayers $68.2 million per year. 

The state Agency for Health Care Administration has shared its estimate of the impact of excluding nursing centers from the managed long term care component of the Statewide Medicaid Managed Care system. However, FHCA told members of the Senate Health and Human Services Appropriations Subcommittee that the state agency’s numbers were based on incorrect assumptions.

Tom Parker, FHCA’s Director of Reimbursement, testified that the state figures are based on an assumption of what it would cost the state IF individuals who received home- and community-based services during certain times had instead been cared for in a nursing center. “But that’s not how the system works, and it’s not what this bill does,” Parker said. “Rather, this bill focuses solely on exempting long-stay nursing center residents. There are no savings to be realized for these individuals, because their health and medical needs can only be addressed in a nursing center. They cannot be safely cared for in a home or a community setting.” 

Florida’s system of managed care does not work effectively for long-stay nursing center residents who can’t take care of themselves or be safely cared for in the community. Parker cited data previously announced by FHCA showing that the system is costing taxpayers approximately $68.2 million in unnecessary fees each year by charging for management services that are not needed. 

More than 47,000 Floridians live in nursing centers and are enrolled in the long term managed care program, a 25 percent increase since 2014. Parker said managed care ensures that only those who truly need nursing home care are admitted into nursing centers – but that amounts to less than 2 percent of Florida seniors over the age of 65, well below the national average is 5 percent.

“Florida is doing a much better job than other states and the nation at ensuring seniors are receiving care in the most appropriate place and the least restrictive setting,” Parker told senators. 

Managed care does not work well, however, for long term stay residents, those who are in nursing homes for more than 60 days. Parker pointed to state data showing that managed care companies transition only about 4 percent of the nursing home Medicaid population into community care, leaving the remaining 96 percent continuing to receive their care in skilled nursing centers. 

“For those individuals, we believe that the state and the nursing home can save money if they returned to a straight fee for service,” Parker said. “Florida has a long-standing commitment to help elders stay in their homes or community settings for as long as possible. But we must also recognize that for more and more of the frailest residents, a nursing home is the best – and perhaps only – realistic option.”

Additional FHCA witness reinforced the benefits to both residents and the nursing centers from excluding them from the managed care system

For more information about Florida Health Care Association and their legislative initiative to exempt long-stay nursing residents from Florida’s Medicaid Managed Care System, visit http://tinyurl.com/FHCAMgdCare17.

FHCA Statement on House Budget Exercise

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Protect Medicaid Funding for Nursing Center Care

FHCA Executive Director Emmett Reed issued the following statement regarding the House Health Care Appropriations Subcommittee budget exercise which, in the first scenario, held nursing centers harmless from Medicaid funding cuts. The second scenario proposed a $75 million funding cut to nursing center care.

“We appreciate that Chairman Brodeur didn’t include us in their first tier of budget cuts; however, a $75 million reduction to nursing centers’ Medicaid reimbursement represents a significant threat to Florida’s long term care sector. Medicaid already underfunds our state’s nursing centers by $14 per patient per day, or almost $325,000 per center annually. High quality care and adequate funding go hand in hand, and with nearly 60 percent of the residents in our centers depending on Medicaid to cover their long term care needs, our state’s nursing centers simply can’t sustain any more reductions. We hope the House recognizes the importance of preserving Medicaid funding for nursing center care and keeps our funding intact when the final budget is released.” 

ABOUT FLORIDA HEALTH CARE ASSOCIATION 
Florida Health Care Association (FHCA) is a federation that serves almost 1,000 members and represents more than 500 long term care centers that provide skilled nursing, post-acute and sub-acute care, short-term rehab, assisted living and other services to the frail elderly and individuals with disabilities in Florida. The mission of FHCA is to advance the quality of services, image, professional development and financial stability of its members. As Florida’s first and largest advocacy organization for long term care providers and the elderly they serve, the Association has worked diligently since 1954 to assist its members with continuously improving quality of care and quality of life for the state’s growing elder care population. For more information about Florida Health Care Association, visit http://www.fhca.org.

Florida Health Care Association to Detail Legislative Priorities at Media Roundtable

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The Florida Health Care Association (FHCA) will hold a media roundtable TODAY, February 20, at 10:30am. Officials from FHCA, the largest advocacy organization in the state for nursing centers and the residents under their care, will discuss its priorities for the upcoming legislative session, including Certificate of Need, Managed Care, and Prospective Payment System legislation.
What: Media roundtable on legislative priorities
When: Today, February 20
10:30am
Where: Florida Health Care Association
307 W. Park Avenue
Tallahassee

Call-in Info: 1-866-951-1151
Room # 7059080

Florida Health Care Association to Detail Legislative Priorities at Media Roundtable

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The Florida Health Care Association (FHCA) will hold a media roundtable on Monday, February 20, at 10:30am. Officials from FHCA, the largest advocacy organization in the state for nursing centers and the residents under their care, will discuss its priorities for the upcoming legislative session, including Certificate of Need, Managed Care, and Prospective Payment System legislation. 

What: Media roundtable on legislative priorities
When: Monday, February 20
10:30am
Where: Florida Health Care Association
307 W. Park Avenue
Tallahassee

FHCA: Legislators Should Act Carefully on Changes Affecting Care Options for Frail Elders

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The Florida Health Care Association (FHCA) today provided legislators with invaluable information and insights to help shape crucial policy discussions affecting the care of Florida’s most frail residents.  In presentations to two House panels, the association detailed why nursing centers should be removed from any repeal of the Certificate of Need process and offered recommendations on the state’s proposal for a Prospective Payment System for nursing center reimbursement.

FHCA, Florida’s largest advocacy organization representing 82% of Florida nursing centers and the elderly they serve, told House members that both the quality of care for the state’s seniors and the health of the nursing centers that care for them could be significantly impacted by proposals under consideration. The association is advocating for an exemption from any proposal that eliminates the Certificate of Need (CON) process and supports efforts to move to a Prospective Payment System (PPS) for delivery of nursing center care. 

“Repealing nursing home Certificate of Need will most certainly result in unmanaged growth, low occupancy rates, inefficiencies in how buildings operate and a reduction in the value of our state’s nursing centers. All of this will greatly impact how quality care is provided to our state’s seniors,” Emmett Reed, FHCA’s executive director, told members of the House Health Innovations Subcommittee.

CON repeal has affected elder care in other states, Reed noted. For example, Texas operates twice as many nursing centers as Florida but is plagued by facilities that have beds that remain empty and deliver a poor quality of care. Indiana was forced to impose a moratorium on building nursing centers due to unmanaged growth 16 years after it repealed it CON process. 

FHCA speakers also noted that by promoting an environment in which new nursing centers must lure elders to fill costly beds, repeal of CON for nursing centers would run contrary to Florida’s long-standing commitment to enabling elders to remain in their homes or in community-based care for as long as possible.

“Florida has attained a system that strikes the right balance. Those who can be cared for in a home and community-based setting are receiving it there – and those who come to my nursing center and others around the state do so because that is the only place they can safely receive the more specialized care they need,” said Ari Hollander, CFO of small nursing center operator Stirling Long Term Care.

The House Heath Care Appropriations Subcommittee received a report on the Navigant model for a Prospective Payment System for nursing center reimbursement, developed for the Agency for Health Care Administration. FHCA representatives supported the concept of a PPS approach to foster higher quality with reasonable Medicaid reimbursement rates, but offered recommended changes to that approach to avoid placing undue financial burdens on nursing centers as they transition to the new system. 

“The current cost-based system is antiquated. It involves multiple audits, with some of those audits looking at books dating back several years and resulting in underpayments with no ability to financially recoup those monies paid out to cover resident care costs. We support a prospective payment system, where we will know the amount of our payment to cover the cost of care – and the state will have budget predictability, as well,” said Andy Weisman, president of NuVision Management which operates six nursing centers in Florida. 

James Aschenbeck of Signature HealthCARE, who is chair of FHCA’s Reimbursement Committee, warned that any transition to a PPS system should include a three-year transition period and additional funding to pay for the nursing staff who provide hands-on care. “We believe any reimbursement system must take into consideration the current financial landscape of nursing center care in order to achieve its goals and become the payment norm of the future,” he said. 

Jamey Richardson, president of Gulf Coast Health Care which operates 33 nursing centers in Florida, shared how their support of the Navigant model will come at a cost of Medicaid rate reductions amounting to $6.7 million once the PPS is fully implemented. “Despite this short-term revenue loss, we support the Navigant model because it recognizes and rewards both efficiency and high-quality outcomes…and we know we will be able to adjust to remain successful in how we deliver quality care to our residents with the recommendations put forth by Florida Health Care Association.” 

More information on how the Certificate of Need issue may affect the care of Floridians in skilled nursing centers can be found at http://cqrcengage.com/ahcafl/CONProcess. To learn more about the Prospective Payment System and FHCA’s recommended changes to the Navigant PPS model, visit http://cqrcengage.com/ahcafl/SupportPPS.

ABOUT THE FLORIDA HEALTH CARE ASSOCIATION
The Florida Health Care Association (FHCA) is a federation that serves nearly 1,000 members and represents over 500 long term care facilities that provide skilled nursing, post-acute and sub-acute care, short-term rehab, assisted living, and other services to the frail elderly and individuals with disabilities in Florida. The mission of FHCA is to advance the quality of services, image, professional development, and financial stability of its members. As Florida’s first and largest advocacy organization for long term care providers and the elderly they serve, the Association has worked diligently since 1954 to assist its members with continuously improving quality of care and quality of life for the state’s growing elder care population. For more information about the Florida Health Care Association, visit www.fhca.org.

FHCA: Managed Care Not Best Option for Frail Floridians, Needlessly Costs Taxpayers $68+ Million

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Florida’s system of managed care does not work effectively for long-stay nursing center residents who can’t take care of themselves or be safely cared for in the community – and the system is costing taxpayers approximately $68.2 million in unnecessary fees each year, the Florida Health Care Association (FHCA) told a state Senate committee today. 

More than 47,000 Floridians live in nursing centers and are enrolled in the long term managed care program. FHCA representatives told senators the program achieves cost savings when residents are either delayed from entering or transitioned out of nursing centers and into lower-cost settings – but those are not options for the many residents who need long term nursing center care lasting more than 60 days.

“Florida has a long-standing commitment to help elders remain in their homes or community settings for as long as possible. But we also must recognize that for more and more of the frailest residents, a nursing center is the best – perhaps only – realistic option,” Bob Asztalos, who manages FHCA’s Government Affairs Department, told members of the Senate Appropriations Subcommittee on Health and Human Services. 

A series of experts presented testimony during the subcommittee’s discussion of the managed long term care component of the Statewide Medicaid Managed Care system. They detailed how managed care is not an effective approach for many skilled nursing care centers, which care for nearly 73,000 frail elders and individuals with disabilities – most of whom require 24-hour complex medical care and have cognitive impairments, such as Alzheimer’s disease or other dementias. 

Asztalos said Florida uses home and community-based care effectively to ensure that seniors receive care in the most appropriate place and the least restrictive setting. Less than 2 percent of Florida seniors over the age of 65 are living in nursing homes, less than half the national average of 5 percent.

The managed care program was designed to reduce the cost of providing health benefits, but FHCA presented several reasons why it is not effective for long-stay residents. Steve Jones, an accountant with the Moore Stephens Lovelace CPA firm that conducted a study of the system, testified that the state could save more than $68 million by exempting long-stay residents from managed care. 

Jones noted that the number of enrollees in the program who receive care at nursing centers grew by 2.6 percent in the two years ending in July. He said by eliminating the need to contract with managed care organizations, the program would realize savings by eliminating $36.5 million in administrative fees and another $31.7 million in case management fees – expenditures that are not necessary for residents who remain in long-stay care. 

“These numbers will only continue to grow as Baby Boomers age. This is money the state could instead be putting into direct resident care, to improve the lives of those who rely on quality care in the later portion of their lives,” Jones told senators. 

By utilizing traditional Medicaid, case management costs would be cut by about 72 percent while administrative costs would be reduced by approximately 54 percent, he said.

The Managed Care system complicates the Medicaid process for long-stay residents who need consistent care. It places a barrier in the efficiency of the health services of these facilities and drives up unnecessary costs.

Patti Spears, administrator at Oakbrook Health and Rehabilitation in the rural Hendry County community of LaBelle, described some of the challenges faced by long term care residents at her skilled nursing center. Because many managed care companies will not authorize services across county lines, seniors who live in LaBelle but are treated at the nearest hospital in Lee County are then required to be placed in a nursing center in that distant county.

“The transition from a hospital to a nursing center is already a difficult experience, for the patient as well as the family members. Imagine the additional burdens of being placed in an environment that is far from home and unfamiliar. Your loved ones now have a 45-minute commute, on a busy interstate, to visit you,” Spears said. “These residents deserve better; this is not quality of life.” 

Kristina Robinson, a case manager for Opis Senior Services Group, serves as a liaison between 11 skilled nursing centers and an assisted living facility, and the managed care staff they work with. She told senators that managed care case managers typically direct any issues or concerns back to the nursing staff – something the facilities could do themselves.

“Managed care case managers don’t bring any added service to those residents whose health and care needs prevent them from moving to a setting outside the nursing center. Their medical needs are simply too complex, and typically their families believe they are better served in the nursing center where 24-hour care is provided,” she said. “I believe the managed care system is simply duplicating the services we already have in place.”

For more information about Florida Health Care Association and their legislative initiative to exempt long-stay nursing residents from Florida’s Medicaid Managed Care System, visit http://tinyurl.com/FHCAMgdCare17. A copy of the Moore Stephens Lovelace report can also be found at that location online.