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FHCA 2024 Legislative Wrap Up Report
March 8, 2024
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Overview
The Legislature officially adjourned today, March 8, to pass the final $117.46 billion budget for the 2024-2025 state fiscal year.
This year's state budget includes funding for Florida's infrastructure and public schools, authorizes paying off $500 million in state debt, accounts for tax relief and sets aside record state revenues. Additional legislation passed by both Chambers also includes funding to grow Florida’s health care workforce and new, dedicated investments in Florida’s environment & clean water resiliency.
With nursing centers still grappling with a severe workforce shortage and the demand for a skilled workforce on the rise, the priority focus this session was on the need for increased Medicaid funding for nursing center care. Despite recent investments in the sector, providers were still lacking adequate resources to build a pipeline of skilled caregivers to answer the call of who will care for our aging population.
Thus, FHCA set out with a single-focused priority of increasing Medicaid funding for nursing center care.
Efforts to secure a funding increase began with members hosting legislators in their care centers to educate lawmakers about the need to strengthen the workforce to ensure high-quality care. FHCA's government affairs team and members of Our Florida Promise also held one-on-one meetings with House and Senate leaders to discuss the financial demands of increasing labor costs and inflation, which have left centers with limited resources to compete against hospitals and other health care providers when it comes to attracting workers.
Throughout the session, over 400 members traveled to Tallahassee for Lobby Wednesdays to speak with a united voice during meeting with legislators and their aides. Sharing stories about the positive impact that staff are making on residents’ lives resonated with lawmakers, who recognized that bold investments and policy solutions were needed if Florida is going to remain a leader in quality care for our elder population.
In the end, FHCA was successful in securing an 8%, $247.8 million increase to Medicaid funding for nursing centers. This amounts to an approximate $470,000 increase per center per year.
Below you'll find additional details about the Medicaid funding priority and other legislation with an impact on long term care.
*Please note that although these legislative measures have been approved by both chambers, the governor must take action for final approval (sign the bill, allow it to become law without his signature or veto the bill). Watch your weekly Focus on Florida e-newsletter for updates on the governor's action and effective dates on the bills we've reported on below.
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Medicaid Funding & Budget Highlights
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In December, Governor Ron DeSantis released his proposed “Focus on Florida’s Future” $114.4 billion budget, which included a 1% increase in Medicaid reimbursement for nursing centers. The Governor’s recommended budget set the stage for FHCA’s work with the Legislature to ensure members have the necessary funding to compete for health care workers in the midst of an ongoing labor shortage and continue providing high-quality care.
In late January, the House and Senate released their respective budgets, which were significantly different when it came to base funding for nursing center Medicaid rates. The House proposed budget, thanks to the leadership of Health Care Appropriations Chairman Rep. Sam Garrison (R-Fleming Island), included $123.9 million in Medicaid funding (4% increase) for nursing centers. The Senate budget fully funded nursing center Medicaid rates; however, the Senate proposal did not include a rate increase.
This was a positive start for budget discussions, and through the remainder of session, FHCA worked to secure stronger investments for nursing centers in the final budget. Ultimately, FHCA was successful in our efforts, with the final 2024-2025 Fiscal Year (FY) budget including a historic Medicaid rate increase of $247.8 million for nursing center care. On average, this represents a more than $21 per patient day Medicaid rate increase over the base spending allocation. Funds will take effect on October 1, 2024, with the next annual rate setting. Please note that individual provider rate increases will vary greatly, dependent on factors such as quality scores, location and FRVS submissions.
This bold budget increase was thanks to the leadership of Appropriations Subcommittee on Health and Human Services Chair Sen. Gayle Harrell (R-Stuart), Appropriations Chair Sen. Doug Broxson (R-Pensacola) Health Care Appropriations Subcommittee Chair Rep. Sam Garrison (R-Fleming Island), and Appropriations Chair Rep. Tom Leek (R- Daytona Beach). A special thank you to House Speaker Paul Renner (R-Palm Coast) and Senate President Kathleen Passidomo (R-Naples), who both made nursing center funding a significant factor during budget negotiations.
Additional items in the state budget that will impact long term care providers include:
- The Agency for Health Care Administration (AHCA) received additional staffing resources for FNHURS data collection and analysis, as well as additional staff in the Background Screening unit to process requests more quickly.
- AHCA received funding to implement a texting service connected to the Health Facility Reporting System (HFRS) to better communicate with providers during a declared emergency, along with funding for a mobile response trailer to better respond to impacted areas.
- Funding was allocated for the construction of the next State Veteran’s Nursing Home in Collier County.
The Home and Community-Based Services section of the budget included the following increases:
- A personal needs allowance increase from $54 to $160 for individuals in the Optional State Supplementation Program.
- A $1.26 million dollar rate increase for the assistive care services fee schedule rate, with a requirement for Medicaid plans to pass through the increase to providers.
- Additional funding for PACE slots and Medicaid Long Term Care HCBS waiver slots.
| "Live Healthy" Package
Addressing the Shortage of Health Care Providers
| Senate President Kathleen Passidomo (R-Naples) was successful in achieving passage of her priority legislative initiative, "Live Healthy." Live Healthy follows last year's passage of Live Local, which addressed attainable housing options for Floridians, and completes Passidomo’s signature priorities as Senate President. The Live Healthy package of legislation aims to address the shortage of health care providers among Florida's growing population and support innovation in the health care marketplace.
The two primary bills that make up the Live Healthy package include SB 7016 by Sen. Colleen Burton (R-Lakeland) and SB 7018 by Sen. Gayle Harrell (R- Stuart). These bills focus on developing the pipeline of health care workers in the state, removing regulations to increase workforce mobility, expanding access to quality and efficient health care, and incentivizing innovation in the health care industry through investments in technology. In addition to addressing care needs and training in primary care, dental, and mental health, the bills contain provisions that may impact long term care as follows:
Revises the purpose and eligibility for the Florida Reimbursement Assistance for Medical Education (FRAME) Program.
- Purpose is to support the state Medicaid program
- Expands eligible practitioners to include licensed clinical social workers
- Lengthens the amount of time over which student loan reimbursements may be given and increases the maximum total award amounts for qualified health care professionals:
- Up to $90,000 for autonomous practicing APRNs
- Up to $75,000 for non-autonomous APRNs and PAs
- Up to $75,000 for mental health professionals, including LCSWs
- Up to $45,000 for RNs and LPNs
- Adds nursing centers to the list of eligible health care settings where practitioners can practice and qualify for FRAME awards. The nursing center must be located in, or serve residents in, an underserved area as designated by the Department of Health and must provide services to Medicaid recipients.
Enters Florida into the Physical Therapy Licensure Compact, the Audiology and Speech-Language Pathology Interstate Compact, and the Interstate Medical Licensure Compact.
Requires AHCA to report annually on potentially preventable health care events.
- The report must include an analysis of potentially preventable hospital emergency department visits, admissions, and readmissions reported by age, managed care plan, regions, and contributing conditions.
Creates emergency department diversion requirements for hospitals and Medicaid managed care plans.
Requires the Agency for Health Care Administration (AHCA) to seek federal approval to implement an acute hospital care at home program in Florida Medicaid.
Creates the “Health Care Innovation Council” within the Department of Health composed of 15 members including a representative of the long term care facility industry to:
- Facilitate public meetings for presentations on technology, workforce pathways, service delivery models, and other innovations
- Provide recognition for the most impactful concepts, projects, and initiatives that have the capability to accelerate transformation of health care in Florida
- Develop and update best practice recommendations by practice setting
Creates a low-interest loan program for applicants seeking to implement innovative health care technology solutions.
These bills will take effect upon signing by the Governor.
| MOBILE Act
Streamlining licensure for out-of-state practitioners
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The “Mobile Opportunity by Interstate Licensure Endorsement” (MOBILE) Act is a part of the overall Live Healthy legislative package and is intended to create a streamlined licensure pathway for out-of-state practitioners moving to Florida. The bill, SB 1600 by Senator Jay Collins (R-Tampa), applies to most health professionals licensed by the Department of Health including Nursing Home Administrators, RNs, LPNs, CNAs, OT, PT, Dietitians, and Clinical Social Workers.
An applicant for licensure by endorsement must:
- Hold an active, unencumbered license issued by another state with a similar scope of practice
- Have a passing score on a national licensure examination, hold a recognized national certification, or have obtained minimum education requirements
- Have actively practiced for 3 of the 4 years immediately preceding the application
- Attest to not being subject to an active disciplinary proceeding and has not been subject to a disciplinary action in the preceding 5 years
- Complete a level 2 background screening
- Successfully complete a state examination on laws and rule that regulate the profession
The Department of Health (Department) must issue a license within seven (7) days of receipt of all required documentation. The bill will take effect on July 1, 2024, after signed into law by the Governor. However, the Department may continue processing applications under the 2023 statutes until rules are adopted to implement the changes or until six months after the bill’s effective date, whichever occurs first.
| Spouses in State Veterans' Long Term Care Facilities
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The Veteran’s Long-term Care Facilities Admissions, HB 725, by Rep. Marie Woodson (D-Pembroke Pines), Rep. John Snyder (R-Palm City), and Sen. Danny Burgess (R-Zephyrhills) expands eligibility for residency and prioritizes admittance in Veteran’s long term care centers to include spouses and surviving spouses of Veterans.
This bill will:
- Revise definitions to include spouses and surviving spouses of Veterans as applicants eligible for domiciliary and nursing home care within Florida’s Veterans' nursing homes;
- Adjust eligibility requirements for residency in Veterans’ nursing homes to include spouses and surviving spouses of Veterans;
- Add spouses and surviving spouses of Veterans to the priority of admittance schedule for Veterans' nursing homes; and
- Ensure that admittance priority in Veterans' nursing homes includes the spouses or surviving spouses of Veterans, following eligible Veterans with service-connected disabilities and those unable to afford nursing home care.
HB 725 received unanimous support from both Democrats and Republicans throughout the committee process and is soon expected to be sent to the Governor for signature. Once signed, this bill takes effect on July 1, 2024.
| Tort Reform
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Several bills addressing general tort and medical negligence were introduced, along with legislation to give assisted living facilities litigation protections. None, however, successfully navigated the legislative process.
Litigation Financing
The litigation financing disclosure bills, SB 1276 by Sen. Jay Collins (R-Tampa) and HB 1179 by Rep. Tommy Gregory (R-Lakewood Ranch), made it through almost all of their assigned committees before eventually dying. The bills would have required disclosure of entities that finance a civil litigation action.
Adult Child Recovery
These medical negligence bills would have repealed tort protections currently enjoyed by health care providers.
SB 310 by Sen. Jonathan Martin (R-Fort Myers) and HB 77 by Rep. Spencer Roach (R-North Fort Myers) proposed to remove the provision that prohibits parents of an adult child from recovering pain and suffering damages. HB 129 filed by Rep. Mike Beltran (R-Apollo Beach) and Rep. Johanna Lopez (D-Orlando) also removed the prohibition on recovery by adult children.
SB 248 by Sen. Clay Yarborough (R-Jacksonville) would have created an administrative process to determine probable cause or a breach of the standard of care for practitioners and health care facilities determined by the Department of Health or the Agency for Health Care Administration, respectively. The determination of causation by the administrative agencies would take the place of the pre-suit procedures for investigation and evaluation of the claim, notice to prospective defendants, and informal discovery. The prohibitions on recovery of damages by parents of adult children and by adult children would have also been removed by the bill.
Sen. Lauren Book (D-Plantation) filed SB 442, a fifth bill that addressed the repeal of the prohibition in medical negligence statutes that prevents independent adult children and parents of adult children from recovering non-economic damages from hospitals and health care practitioners.
ALF Litigation Reform
Claims Against Assisted Living Facilities, SB 238 by Sen. Colleen Burton (R-Lakeland) and its counterpart in the House, HB 995 by Rep. Ryan Chamberlin (R-Ocala), would have given ALFs similar litigation protections to those of nursing centers, including protecting passive investors from being targets of lawsuits and revising punitive damages claims procedures. The bill passed two committees in the Senate and one committee in the House before stalling.
| Health Care Legislation
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The following health care bills failed to pass this session.
Health Care Provider Accountability
Senator Gayle Harrell (R-Stuart) and Rep. Mike Giallombardo (R-Cape Coral) filed companion bills addressing nursing center accountability and transparency. The bills, SB 952 and HB 891, sought a requirement for providers to report common ownership between the nursing center or its parent company and any other companies it contracts with to provide services in the facility, including staffing companies and physical therapy companies. The bills also sought data related to personal care attendants including adverse incidents.
The House bill was only heard in two committees, during which FHCA was successful in having a provision removed that proposed a 5% increase to the rate setting floor for the direct care component (95% to 100%). The Senate bill was never heard in committee.
Medicaid Managed Care Plan Performance Metrics
HB 783, Medicaid Managed Care Plan Performance Metrics by Rep. Kimberly Berfield (R-Clearwater) and the Senate companion, SB 794 by Sen. Gayle Harrell (R-Stuart), would have required Medicaid managed care plans to submit performance metrics on a monthly basis to the Agency for Health Care Administration (AHCA), including data on provider credentialing for billing, prior authorization requests, and payment of claims.
Priority Enrollment for Medicaid Home and Community-Based Services (HCBS)
SB 726 by Senator Ileana Garcia (R-Miami) and HB 949 by Rep. Dean Black (R-Jacksonville) granted priority enrollment to Medicaid HCBS for nursing center residents seeking community transition after a 60-day residency, and to assisted living facility residents if they resided in an ALF for at least six months and needed assistance with two or more activities of daily living. These bills were never heard in committee.
Health Care Patient Protection
SB 798 by Sen. Gayle Harrell (R-Port St. Lucie) and HB 1343 by Rep. Thad Altman (R-Indian Harbour Beach) added additional disqualifying offenses to background screening requirements and defined a memory care provider in the context of assisted living facilities, requiring minimum staffing of 1 person for every 5 memory care residents. The House bill was amended to remove these provisions before stalling, and the Senate bill was never heard in committee.
Patient-directed Doctors Orders
SB 390 by Sen. Joe Gruters (R-Sarasota) and HB 219 by Rep. Susan Plascencia (R-Winter Park) addressed end-of-life care in a manner that is similar to the living will, health care surrogate, and do not resuscitate order processes that are already in law. These bills, however, added a requirement that the order be stored electronically by the Agency for Health Care Administration (AHCA). Neither bill was heard in committee.
Digital Voyeurism
SB 1604 by Sen. Lauren Book (D-Davie) and HB 1389 by Rep. Hillary Cassel (D-Hollywood) would have redefined the crimes of digital and video voyeurism and included enhanced penalties for persons who commit the offense. The bills also included a definition for persons in a position of authority or trust to specifically include caregivers, which could be staff of nursing centers and assisted living facilities.
Commercial Self-Insurance Fund
In the last two weeks of session, an amendment was filed for HB 1611, the Office of Insurance Regulation reform bill by Rep. Cyndi Stevenson (R-St. Augustine), to expand the definition of “commercial self-insurance fund” to include a group of nursing centers, assisted living facilities, or any combination thereof, provided the group maintains at least $10 million in annual imputed premiums. The amendment would have allowed for a self-insurance fund to be formed by a group for the purpose of pooling and spreading liabilities of its members as related commercial property, casualty risk, or surety insurance. Participating nursing centers would have been required to report their insurance costs as part of the data collected under the Florida Nursing Home Uniform Reporting System (FNHURS). In the final hours of session, however, the Senate removed this amendment provision from the final bill that was ultimately passed by the House after being sent back to that chamber.
| Thank You
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FHCA wants to thank you again for your continued trust in our team. We achieved what was seemingly impossible, given that Florida's Legislature has already delivered more than $660 million in funding increases to nursing centers over the past four years. FHCA worked hard every single day to achieve the objective, and this bold investment from lawmakers is a result of the combined efforts of our internal team and external lobbyists, conversations with legislators well before session began and your active involvement in our grassroots advocacy through Lobby Wednesdays.
We also want to thank our legislative initiative sponsors, Marsh McLennan Agency, Medline Industries and Health Care Professional Consulting Services, Inc. These long-time sponsors joined us for many Lobby Wednesdays, as did several business partners. Their perspectives on our members’ commitment to quality care despite labor challenges aided in our messaging.
Now that session has ended, we want to remind you that relationship building outside of Tallahassee will be key to our future success. Lawmakers will now return to their districts, so please consider inviting them into your center to learn about your care and operations, meet your dedicated team members and interact with your residents. We are always more successful when our members are engaged in our legislative initiatives throughout the year.
In the meantime, thank you for the honor of representing you. Our team works hard because of the confidence you have placed in us.
Sincerely,
J. Emmett Reed, CAE
FHCA/OFP Chief Executive Officer
| Watch Highlights from Our Lobby Wednesdays
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