Go big or go home: FHCA releases ambitious legislative wish list

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The Florida Health Care Association has released an ambitious legislative wish list for the 2022 Session that includes a request for hundreds of millions in additional funding, lawsuit protections, and changes to mandatory nursing home staffing requirements.

FHCA spokesperson Kristen Knapp said the agenda reflects the current state of the industry.

“We are operating in the midst of a pandemic still,” Knapp said, noting that the fast-spreading omicron variant has caused infection increases among nursing home staff and residents.

The FHCA, which represents the majority of the 690 skilled nursing facilities in the state, did not disclose in Monday’s press release how much money it would like the Legislature to direct to the industry.

However, the association has previously released budget documents that show it wants lawmakers to pump an additional $469 million ($184 million coming from general revenue) to boost the Medicaid rates in the fiscal year 2022-2023 budget.

Similar to Medicare, Florida Medicaid relies on a “prospective payment system” to reimburse nursing homes for providing care. Under a PPS system, nursing homes are paid a predetermined rate based on a formula.  The association wants legislators to target $96 million to increase funding for quality initiatives and another $88 million for increases in direct care services.

According to the FHCA, skilled nursing facilities have seen a 20.1% increase in direct-care staffing costs during the COVID-19 pandemic. The increases are due to staffing crunches that have forced nursing centers to hire additional in-house staff and to pay nurses overtime to meet mandated staffing requirements.

Gov. Ron DeSantis included $185 million in his proposed “Freedom First” budget he submitted to the Florida Legislature for consideration. The Governor’s recommendation, if accepted by lawmakers, would increase Medicaid reimbursement by $270,000 annually per facility, Knapp said.

Meanwhile, the FHCA also is lobbying the Legislature to “modernize” the state’s nursing home staffing requirements and supports SB 804 by Sen. Ben Albritton, R-Bartow, and  HB 1239 by Rep. Lauren Melo, R-Naples.

The bills are not identical but both will face opposition from AARP Florida.

Florida law requires nursing facilities to provide 3.6 hours of direct nursing care to residents, of which 2.5 hours can be provided by a certified nursing assistant or CNA. Melo’s bill bumps the 3.6-hour requirement to 3.8 hours instead. However, Melo’s bill allows a portion of the other 2.5 hours of care be provided by “non-nursing” direct care staff. For that to occur, though, the nursing home must provide at least 1.8 hours of certified nursing assistant care.

The bill defines direct care staff as licensed nurses, certified nursing assistants, physical therapy staff, occupational therapy staff, speech therapy staff, respiratory therapy staff, activities staff, social services staff, and mental health service staff.

The current requirement that residents receive 1 hour of direct care by licensed nurses per resident per day is maintained in the House bill. Moreover, Melo’s bill does not change the requirement that nursing facilities have at least one licensed nurse for every 40 residents and at least one licensed CNA for every 20 residents.

Albritton’s bill is similar to Melo’s, but his bill doesn’t increase the current mandated nursing hours from 3.6 hours to 3.8.

The staffing requirements were passed 20 years ago as part of a larger package of nursing home changes that included liability protections. Knapp said nursing home residents have much different needs today than they did 20 years ago.

Though not specific to staffing requirements the FHCA also wants the Legislature to take steps to increase the long-term care workforce.

Another closely watched issue the FHCA will lobby for is the extension of the 2021 law that protected nursing homes, hospitals, and physicians from COVID-19 lawsuits. While the law gave businesses permanent protections from COVID-19 lawsuits, at the behest of House Speaker Chris Sprowls the protections granted to health care providers in the law expired after a year, or in March 2022. Now nursing homes and other providers want the protections extended.

The Senate Judiciary Committee already has moved a bill to extend the protections for health care providers. It’s filed by Sen. Danny Burgess, Chair of the committee.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


One comment

  • Alex

    January 11, 2022 at 10:48 am

    If at-home care was affordable (and is clearly preferable to most folks), this would be a much smaller issue.

    But that would require Federal help, and the Republicans are hostile to all forms of healthcare as evidenced by the way they bungled the pandemic, and continue to do so.

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