“LeadingAge Florida applauds the Florida Senate and House of Representatives for recognizing that the proposed Prospective Payment System (PPS) plan needs more study, and for creating a workgroup to develop recommendations for the plan,” said Steve Bahmer, President & CEO of LeadingAge Florida. “LeadingAge Florida looks forward to working with the Agency for Health Care Administration, the Legislature, and other stakeholders to produce a fair and equitable PPS plan, one that ensures resident care dollars are spent on care rather than property, that guarantees accountability for how any new tax dollars are spent, and which ensures that the rate setting approach is reasonable in terms of how it treats nursing homes of various sizes and the different regions of the state, among other items.”
“LeadingAge Florida appreciates all of the hard work and effort put into creating a PPS for Medicaid nursing home residents. Over the past 10 months, our members have advocated vigorously for a payment system that is fair and equitable for all providers. LeadingAge Florida appreciates the steps taken by the Florida Legislature to further study this important issue,” Bahmer said.
About LeadingAge Florida
For 54 years, LeadingAge Florida has served as an association of more than 250 mission-driven communities, including many of the highest rated nursing homes affected by the plan inserted into the Senate budget. LeadingAge Florida is proud to serve quality leaders who devote themselves to creating a culture of excellence that motivates and inspires others throughout the aging continuum. LeadingAge Florida’s members are trusted with providing quality care and services to Florida’s seniors. LeadingAge Florida promotes practices that support, enable and empower people to live fully as they age.
LeadingAge Florida
ICYMI: Florida Politics: Proposed Nursing Home Payment System Raises Serious Concern
Proposed Nursing Home Payment System Raises Serious Concern
By Brian Robare
I wanted to take a moment to alert Floridians to The Estates’, a Lakeland-based nursing home, significant concerns with the Florida Health Care Association’s (FHCA) plan, which would change the way nursing homes are paid, under consideration in the Florida Legislature.
The FHCA is asserting that this prospective payment system (PPS) plan will incentivize nursing homes to make renovations and improvements that will improve and enhance the resident’s quality of life. As a longtime member of FHCA, we are disappointed that they would place a higher priority on the building than on resident care.
At the Estates, we have long prided ourselves on our high staffing ratios, and with the care provided to the residents and families, we are privileged to serve. A “modernized dining room” does not improve that quality of care, and I consider it shameful that they would propose the redistribution of money from communities that have continually invested the money needed to make renovations and improvements to communities that have shirked this responsibility.
If passed, this plan will financially hurt our nursing home and Florida Presbyterian Homes.
To illustrate, our nursing home stands to lose $166,000 under this proposed plan. Frankly, I am stunned that the Florida House or Senate would even consider a plan that provides an additional $26 million to a nursing home chain that just had a $374 million judgment for Medicare and Medicaid fraud. Consulate Healthcare’s 79 nursing homes in the state have an average star rating of 2.3 out of 5, and yet the plan is to reward their efforts with an additional $26 million to modernize dining rooms and improve the look of their buildings.
It’s imperative that any changes to the payment model for nursing homes are accomplished when all of the stakeholders are offered a seat at the table to develop a plan that advances the goal of providing quality care. At The Estates, we believe in the adage of slow and right versus fast and wrong.
This plan is the epitome of fast, and wrong.
On behalf of residents, families and staff at The Estates, I am asking that lawmakers reject the plan proposed by the FHCA and remain resolute that any PPS plan for nursing homes must include an open discussion by all of the stakeholders and must require that any additional funds to go improving the quality of care for the residents.
Finally, we ask that lawmakers advocate for slow and right versus fast and wrong and insist that any additional money advances the quality of care and does not further inflate the bottom line of companies that seem to focus on what is best for them and not on what is best for the residents and families they serve.
Brian L. Robare is CEO and Executive Director at the Estates at Carpenters, located in Lakeland.
LeadingAge Florida Offers Alternative PPS Plan that Protects Seniors
Plan Preserves Funding for Highly Rated Nursing Homes
As the Florida Senate and House of Representatives begin budget conference, LeadingAge Florida today offered an alternative Prospective Payment System (PPS) plan, that was delivered to Representative Jason Brodeur (R-Sanford), chair of the House health care budget subcommittee, along with other House members serving on the budget subcommittee, that would protect Florida seniors and preserve funding to highly rated nursing homes. To view the cover letter and plan, please click here or visit http://bit.ly/2pF7PjO.
The current PPS plan, which was included in the Florida Senate budget and LeadingAge Florida continues to oppose, would make significant funding cuts to 152 four- and five-star nursing homes, while 97 one- and two-star nursing home facilities would receive substantial additional funding.
LeadingAge Florida’s proposed alternative PPS plan, however, minimizes losses and gains, is not dependent on $57 million in new funding and does not shift $44 million from direct care to property.
“We wanted to offer an alternative PPS plan to demonstrate that we are ready, willing and able to work with lawmakers and other stakeholders to develop a plan that holds highly rated nursing homes harmless, directs money to care rather than property, and protects our seniors, while still moving toward a prospective payment model,” said Steve Bahmer, president & CEO of LeadingAge Florida. “The reality is, under the Florida Senate’s proposed PPS plan, 312 of our state’s nursing homes would lose upwards of $90 million. Worse, 97 poorly rated homes would gain $29 million. We don’t believe this is good public policy and we believe our plan is a better alternative that merits consideration as the legislature begins budget conference.”
The alternative plan LeadingAge Florida developed would address a number of policy concerns, including the following:
• Recognizing size and geographic location variations in staffing and operating costs;
• Establishing reasonable payment limits and incorporating quality incentives;
• Eliminating the concern that the Senate plan does not require one- and two-star
nursing homes to spend new funding on quality; and,
• Is not dependent on a 5-year transition period.
“We respectfully ask that lawmakers in both the Senate and the House take a moment to consider the real and damaging effects that the Senate’s PPS plan will have on our seniors, and consider an alternative – or delay implementation of a PPS plan until all parties come to a fair and equitable solution that holds our seniors and high-quality nursing homes harmless,” concluded Bahmer.
To learn more about LeadingAge Florida, please visit LeadingAgeFlorida.org, FB.com/LeadingAgeFlorida and @LeadingAgeFL.
LeadingAge Florida
For 54 years, LeadingAge Florida has served as an association of more than 250 mission-driven communities, including many of the highest rated nursing homes affected by the plan inserted into the Senate budget. LeadingAge Florida is proud to serve quality leaders who devote themselves to creating a culture of excellence that motivates and inspires others throughout the aging continuum. LeadingAge Florida’s members are trusted with providing quality care and services to Florida’s seniors. LeadingAge Florida promotes practices that support, enable and empower people to live fully as they age.
LeadingAge Florida statement on meeting with Senate Democrats on PPS
LeadingAge Florida released the following statement today, attributable to President and CEO Steve Bahmer, regarding a meeting with the Senate Minority Leader to discuss the proposed Prospective Payment System (PPS) plan for nursing homes that is currently included in the Senate budget.
“On behalf of LeadingAge Florida and the high-quality nursing homes that are our members, I want to thank Leader Oscar Braynon for arranging this morning’s meeting to discuss the Medicaid payment plan included in the Florida Senate’s budget. An open discussion of the proposal and its many flaws was long overdue, and we appreciate Leader Braynon’s willingness to have that discussion.
“Leader Braynon and other Senate Democrats asked a number of important questions about how the plan shifts dollars from high-quality nursing homes to lower-quality nursing homes, how payments to nursing homes would be calculated, and what kind of accountability should be required if nursing homes receive additional taxpayer dollars under the plan. These and other critical issues are precisely the questions LeadingAge Florida has been raising about the plan since it first appeared just one month ago.
“An important issue raised during the meeting focused on the lack of transparency and absence of public vetting of this plan, which would institute major policy changes – in the budget – to the way nursing homes are paid for caring for Medicaid residents.
“This meeting demonstrated that there are still major holes in the plan that must be addressed. Chief among them is its complete lack of accountability with taxpayer dollars – there is no requirement in the plan that nursing homes that gain additional dollars have to spend even one dime of that new money on resident care. Because of that, the plan simply does not create an incentive to improve nursing quality.
“This is a concern that LeadingAge Florida has been expressing for months and we appreciate Leader Braynon’s draft amendment, which is an important step toward solving this specific problem with the plan. We also applaud the Florida Health Care Association for finally agreeing include an accountability component in their plan. This has been one of the many major flaws in their plan from the beginning. It won’t entirely fix the proposal, but it’s a step in the right direction.
“We look forward to continuing to work with members of the Florida Senate and House, as well as fellow stakeholders, on a PPS plan that meets our collective goals of ensuring accountability of taxpayer dollars and providing the highest standard of care for our state’s seniors.”
LeadingAge Florida, FLiCRA, & Nursing Home Advocates Urge Caution with Proposed PPS Plan
LeadingAge Florida and Florida Life Care Residents Association (FLiCRA) were joined by advocates of nursing homes from around the state today at a press conference to voice concern over a prospective payment system (PPS) plan that is being considered by the Florida Senate.
“LeadingAge Florida is focused on the delivery of high-quality nursing home care and we oppose the proposed PPS plan, as it will have a negative impact on the nursing homes in our state that are providing the highest-quality care to Florida seniors,” said Steve Bahmer, president & CEO of LeadingAge Florida. “LeadingAge Florida supports the transition to a prospective payment system, but we simply can’t support this one. If it is approved, it will have the very real effect of four- and five-star nursing homes losing substantial amounts of money, while lower-performing facilities will see windfall gains – one to the tune of more than $15 million.”
“Additionally, it is important to point out that the vast majority of the increase contemplated in this budget recommendation goes to facility and property improvements, not toward the care of our state’s seniors,” continued Bahmer. “For these reasons, I am joined here today by representatives from some of Florida’s best nursing homes, as well as residents and FLiCRA, and, together, we respectfully call on lawmakers to send this proposed plan back to the drawing board, in order for all groups to come to an equitable, fair solution that doesn’t punish the highest-quality nursing homes in the state.”
LeadingAge Florida, FLiCRA, and nursing home advocates oppose the PPS model that was included in the budget recommendation adopted by the Senate Appropriations Subcommittee on Health and Human Services and will be taken up by the full Senate Appropriations Committee on Wednesday, April 5, 2017, as it would negatively affect high-quality nursing homes by shifting resources from high-quality nursing home communities to primarily lower-quality facilities.
“On average, our facility has a Medicaid census of close to 70 percent, which translates into 172 seniors, and under the proposed PPS system, we would lose $1.7 million – $200,000 more than we would have lost under the shelved Navigant plan; this is a cost we simply cannot afford and one that would be devastating to our core mission of caring for the sick and dying,” said Kip Corriveau, director of Mission at Bon Secours St. Petersburg Health System. “I ask lawmakers prioritize quality care for our state’s most vulnerable and fragile seniors, whose families have entrusted their care to us, by deferring the proposed PPS system until a fair solution that truly cares for seniors can be reached.”
The proposed PPS plan would make funding cuts to 152 four- and five-star nursing homes, while 97 one- and two-star nursing home facilities would receive additional funding.
“Menorah Manor is a mission-driven, charitable, nonprofit, faith-based organization that strives to provide the highest standards of care, and our doors are open to everyone – regardless of ability to pay, which means our Medicaid census on average is roughly 65 percent,” said Rob Goldstein, CEO of Menorah Manor. “Yet, under the PPS plan included in the Senate Appropriations Subcommittee on Health and Human Services budget recommendations, our facility, along with other high-quality providers, would lose significant funding if the legislature cannot guarantee new funding for Medicaid reimbursement for the next three years. Moreover, this proposed PPS plan lacks any requirement that providers who receive new money under the plan have to spend it on care, programs or services. I respectfully ask, on behalf of the residents we are committed to caring for, the legislature rejects this plan.”
“As a resident of Westminster Woods, a continuing care retirement community in Julington Creek, Fla., and an executive committee officer with FLiCRA, I stand in opposition to the current proposed PPS plan,” said Ramsey Geyer, Westminster Woods resident, FLiCRA executive committee member. “This plan, as currently constructed, will almost certainly result in a Medicaid funding shortfall, which puts continuing care retirement community residents at risk, including those residents who are Medicaid recipients. I ask the legislature to consider alternative solutions that would provide fair funding across the board and not shift costs burdens on the backs of high-quality nursing home providers, and thus the residents they serve.”
ABOUT LEADINGAGE FLORIDA
For 54 years, LeadingAge Florida has served as an association of more than 250 mission-driven communities, including many of the highest rated nursing homes affected by the plan inserted into the Senate budget. LeadingAge Florida is proud to serve quality leaders who devote themselves to creating a culture of excellence that motivates and inspires others throughout the aging continuum. LeadingAge Florida’s members are trusted with providing quality care and services to Florida’s seniors. LeadingAge Florida promotes practices that support, enable and empower people to live fully as they age.
ABOUT FLiCRA
Florida Life Care Residents Association (FLiCRA) is a statewide non-profit association of residents living in Continuing Care Retirement Communities (CCRCs). Under the leadership of volunteer residents and a dedicated staff in Tallahassee, FLiCRA is a recognized voice before the legislature and state regulatory agencies. The mission of FLiCRA is to promote and protect the rights of the 30,000 residents who live in CCRC’s. FLiCRA accomplishes its mission through its relationship with legislators and state agencies.
LeadingAge Florida, FLiCRA, and Nursing Home Advocates to Gather to Urge Caution with Proposed PPS Plan
MEDIA ADVISORY:
WHO: Steve Bahmer, President & CEO of LeadingAge Florida
Kip Corriveau, Director of Mission at Bon Secours
St. Petersburg Health System
Rob Goldstein, Chief Executive Officer of Menorah Manor
Ramsey Geyer, Westminster Woods resident,
FLiCRA Executive Committee member
WHAT: LeadingAge Florida, FLiCRA, & Nursing Home Advocates to Gather to Urge Caution with Proposed PPS Plan
WHERE: Room 333, The Capitol
400 South Monroe Street
Tallahassee, FL 32399
WHEN: Wednesday, April 5, 2017
8:30 a.m. EDT
WHY: LeadingAge Florida, FLiCRA, and nursing home advocates oppose the Prospective Payment System model that was included in the budget recommendation adopted by the Senate Appropriations Subcommittee on Health and Human Services, which will be taken up by the full Senate Appropriations Committee on Wednesday, April 5, 2017.
This would negatively affect high-quality nursing homes, threatening the quality of care that is currently delivered by Florida’s nursing homes and devastating many of the state’s four- and five-star providers. This proposal directly impacts Florida’s seniors and could adversely affect the quality of life of residents. The funding in the Senate budget shifts resources from high-quality nursing home communities to primarily lower-quality facilities; under the plan 152 four and five star nursing homes take drastic funding hits while 97 one and two star facilities receive additional funding. This proposal would shift $44 million from care to property.
ABOUT LEADINGAGE FLORIDA
For 54 years, LeadingAge Florida has served as an association of more than 250 mission-driven communities, including many of the highest rated nursing homes affected by the plan inserted into the Senate budget. LeadingAge Florida is proud to serve quality leaders who devote themselves to creating a culture of excellence that motivates and inspires others throughout the aging continuum. LeadingAge Florida’s members are trusted with providing quality care and services to Florida’s seniors. LeadingAge Florida promotes practices that support, enable and empower people to live fully as they age.
ABOUT FLiCRA
Florida Life Care Residents Association (FLiCRA) is a statewide non-profit association of residents living in Continuing Care Retirement Communities (CCRCs). Under the leadership of volunteer residents and a dedicated staff in Tallahassee, FLiCRA is a recognized voice before the legislature and state regulatory agencies. The mission of FLiCRA is to promote and protect the rights of the 30,000 residents who live in CCRC’s. FLiCRA accomplishes its mission through its relationship with legislators and state agencies.
LeadingAge Florida Hosts Legislative Days: Advocacy In Action
MEDIA ADVISORY
WHO: LeadingAge Florida
WHAT: Media Availability to discuss LeadingAge Florida’s Legislative Agenda:
• A major reform of CCRC regulation – Chapter 651 FS
• Elimination of Certificate of Need for Nursing Homes
• The effort to preserve and ensure proper usage of the Sadowski funds
• The systematic overhaul of Medicaid reimbursement for nursing homes
WHERE: Governors Club, 202 S. Adams St, Tallahassee, FL 32301, (850) 224-0650
WHEN: Wednesday, March 8, 2017
• 11:15 AM – NOON
Thursday, March 9, 2017
• 8:30 – 9:00 AM
WHY: Legislative Days: Advocacy In Action is a unique opportunity to
demonstrate to lawmakers the strength of LeadingAge Florida’s
grassroots advocacy efforts. LeadingAge Florida is sending a
clear message to elected officials on the importance and urgency
of any action taken on these issues.
For 54 years, LeadingAge Florida has been the only statewide association representing the full continuum of care and advocating for seniors, caregivers, and providers who serve seniors in all of the places they call home. LeadingAge Florida is an association of more than 250 mission-driven communities. We are proud to serve quality leaders who devote themselves to creating a culture of excellence that motivates and inspires others throughout the aging continuum. Our members are trusted with providing quality care and services to Florida’s seniors. We promote practices that support, enable, and empower people to live fully as they age.
LeadingAge Florida Statement Regarding Actions Taken by House Health Care Appropriations Subcommittee
“LeadingAge Florida applauds Chairman Jason Brodeur and the Florida House of Representatives for their decision not to pursue the Navigant plan for nursing home reimbursement,” said LeadingAge Florida President & CEO Steve Bahmer. “The House Health Care Appropriations Subcommittee listened to our members’ concerns and decided that a change this significant deserves additional thoughtful deliberation and further study to prevent unnecessary disruptions in nursing home care. High-quality care for Florida’s seniors was at stake, and the Committee recognized the complexities of the system and the careful balance needed to provide the highest quality of care across a state as diverse as Florida.
LeadingAge Florida looks forward to working with AHCA, the Florida Legislature, and other key stakeholders to develop a fair and equitable reimbursement system focused on quality care. I want to personally thank our members for their hard work in contacting legislators and explaining the potential impact of the Navigant plan on nursing homes, their residents, and their families.”
ICYMI: Tampa Bay Times: A bad Medicaid plan for nursing homes
By Steve Bahmer
Since the early 1980s, when the state Agency for Health Care Administration conducted its last major overhaul of the Medicaid payment system for nursing homes, the quality of care in Florida nursing homes has vastly improved.
Although there are still exceptions, Florida is no longer home to the flood of nursing home horror stories that Sunshine State residents heard so frequently, and from so many homes, in the early ’80s.
Improved regulatory oversight at AHCA and a payment system that rewarded nursing homes for providing high-quality care, among other factors, combined to slowly move Florida into the top tier of states in terms of nursing home quality.
In 2014, the organization Families for Better Care gave Florida nursing homes an A, one of only 10 states to receive that grade. It rated Florida fifth in the nation in terms of care quality. In its 2015 rankings of the nation’s best nursing homes, U.S. News & World Report listed Florida behind only California and Ohio for the number of 5-star nursing homes in the state.
This may all be about to change.
Earlier this month, AHCA submitted a plan to the governor and the Legislature for a new approach to nursing home Medicaid payments. The plan is intended to establish an equitable payment system that includes incentives for high-quality care, simplifies the payment process, controls costs and makes legislators’ budgeting for Medicaid spending on nursing homes more predictable.
What the plan will actually do is penalize the nursing homes that for the last three decades have invested in delivering the highest quality of care possible, while rewarding homes that have remained at the bottom of the quality barrel.
Under AHCA’s proposal, 143 nursing homes that are rated as 4- or 5-star homes would lose significant funding. Meanwhile, 86 nursing homes that received a 1- or 2-star rating would receive additional funding. In fact, a single nursing home chain would reap $16.5 million of that unearned windfall.
Clearly, this is neither equitable nor fair. Moreover, the proposal does nothing to control Medicaid spending on long-term care, or even to make budgeting meaningfully more predictable. The Legislature decides when to fund a rate increase for nursing homes, something it has not done since 2011, and the current payment system includes caps and limits on payments.
Quality care costs money, and those costs are largely driven by staffing levels — the number of nurses and nursing assistants who are available at any given time to care for a frail senior in a nursing home. The best way to ensure that nursing home residents receive quick, consistent, quality care is to ensure a sufficient number of skilled, caring, long-tenured staff to provide that care.
Under the AHCA proposal, however, nursing homes with the highest staffing levels would lose funding, while those with the lowest staffing would gain dollars.
Nursing home care is not improved, or even sustained, by stripping funding from those that have invested in delivering high quality and shifting it to those that, for whatever reason, have not chosen to make that investment. Despite claims in earlier news reports, the plan does not require that the low performers spend any of their new money on care, nor is there any mechanism in the plan to ensure that quality improves.
AHCA’s proposal is not likely to achieve any of the agency’s stated goals.
It is likely, however, to reverse 30 years of progress in improving quality in the homes that care for Florida’s most vulnerable seniors, and the Legislature simply must reject it.
Steve Bahmer is president and CEO of LeadingAge Florida, a nonprofit statewide association representing the full continuum of care for seniors with members ranging from nursing homes to assisted living facilities to continuing care retirement communities.
