Michael Moline
The top legislative priority for Florida’s nursing homes this year is to kill a proposal, backed by Gov. Rick Scott, to repeal a requirement that they demonstrate a demand for new beds before they can expand or build new facilities.
SB 676, by Rob Bradley, and CS/HB 7 by Alex Miller, and would eliminate the certificate of need program at the Agency for Health Care Administration for all health care facilities.
Eliminating the requirement for nursing homes “would be extremely disruptive,” Florida Health Care Association chief lobbyist Bob Asztalos told reporters during a briefing Monday.
The association, which represents 82 percent of the skilled nursing facilities in Florida, fears competition from newer, shinier “Taj Mahal” facilities would drive down occupancy rates.
That’s what happened in Texas, where the occupancy rate hit 70 percent after the state scrapped its certificate of occupancy requirement, Asztalos said.
In Indiana, eliminating the requirement led to the construction of “so many buildings that they were looking at taxpayer money to buy buildings to take them off line,” he said.
“We don’t want to see Florida make the same mistakes,” Asztalos said.
Staffing levels would be “watered down,” said Rob Greene, CEO of Palm Garden Healthcare, which operates a network of facilities.
The association would like to see expansion limited to about 3,750 beds through July 2017, targeted to areas where they’re needed.
Free-market advocates, including Scott, argue an open marketplace would lower costs and increase quality.
“The government sets our rates. If there were a true free market, we would set our rates that the state would pay us for our care. But how do you have a free market where they set our rates?” Asztalos said.
The existing system is in the best interests of nursing homes, he conceded, but it also serves the state’s policy of placing patients in home- or community-based care.
“It’s not like nursing home A is going to steal beds from nursing home B. You’re going to look for people with high acuity who are in assisted living facilities, who are eligible for nursing home care or in home- or community-based care.”
“It’s really a bad idea,” said Emmett Reed, executive director of the association.
“I understand the free-market concept. But this is a public-private partnership. This is not a true free-market business we’re in.
He added: “I think that, philosophically, the governor wants to get it all on the table, to have the discussion. At the end of day, I think, he may have a reasonable ear for nursing homes when we discuss it with him.”
In other priorities, the association supports a proposed prospective payment reimbursement system — paying facilities on a per diem basis tied to factors including patient care and quality.
But it would like a three-year phase-in and more incentives to increase room size and build other improvements.
Additionally, representatives of the organization said, the state could save $68.2 million by exempting long-stay nursing home residents from Florida’s managed care system when it is demonstrated they can’t be moved to less intensive care settings.
