Legislative Updates

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  • March 03, 2017 11:18 AM | Anonymous

    Florida's Republican leaders are moving ahead with a controversial plan to create Medicaid vouchers, which critics warn could leave tens of thousands of low-income Floridians without adequate health care:

  • February 18, 2017 4:46 PM | Anonymous

    FHCA is asking legislators to remove nursing centers from Senate Bill 676 by Sen. Rob Bradley (R-5 ) and House Bill 7 by Rep. Alex Miller (R-72),which deregulates Certificate of Need process for nursing centers and hospices, as well as other health care providers.

    The current nursing center CON process, reformed in 2014,  is working well to ensure managed growth where there is a demonstrated need for nursing center beds in areas that are underserved. Seniors now have access to 30 new nursing centers and almost 4,000 beds.

    The current CON process helps preserve nursing center occupancy rates, which delivers cost savings to Florida’s Medicaid program. *A 1% drop in Florida’s nursing center occupancy rate results in an $11 million increase in the Nursing Center Medicaid line item.

    Operating a nursing center with empty beds is inefficient; this leads to reduced investments which are needed to renovate buildings, upgrade medical technologies and modernize services to enhance resident quality care.

    Florida’s nursing centers are facing a shortage of nurses and certified nursing assistants to meet the state’s future elder care demands. Without CON, unmanaged growth would lead to more beds than there are qualified staff available to care for residents. This would cause quality care to decline, putting Florida’s seniors at greater risk.

    Florida has a long-standing commitment to helping elders remain in their own home environments as long as possible. The current CON process helps the state achieve that commitment.

    Florida Health Care Association is asking the Legislature to remove nursing centers from being included in Senate Bill 676 and House Bill 7 and preserve the effective Certificate of Need process for nursing centers.

  • February 18, 2017 4:43 PM | Anonymous

    Going into the hospital is stressful enough. But if you’re a senior on Medicare, and you stay at a hospital under “observation status,” you may end up with serious financial pain, too.

    Medicare Part A, which pays hospital costs, requires beneficiaries to have three consecutive inpatient hospital days to qualify for nursing home care. Observation days don’t count toward that total.

    It’s a big concern in Florida, where state advocacy groups and health coalitions have pushed for observation status reform. They joined the efforts of federal nonprofits, too, like the Washington, D.C.-based Center for Medicare Advocacy.

    The designation, however, has increased in popularity in recent years. A federal analysis showed the number of observation days doubled in eight years, from 932,000 in 2006 to almost 1.9 million in 2014. 

    One reason is Medicare’s “two-midnight” rule, implemented in October 2013, that stated many patients expected to stay in the hospital fewer than two nights should be under observation instead of admitted as inpatients, according to Monica Corbett, spokeswoman for the Florida Hospital Association. The rule came from the Centers for Medicare and Medicaid Services’ (CMS) audits that showed some inpatients were receiving care that was not medically necessary, driving up costs.

  • February 18, 2017 4:42 PM | Anonymous

    Despite the lip service, there is scant little affordable seniors housing being built right now. To be sure, there are some notable exceptions. But the reality is that most builders are anticipating monthly per-unit payments that test the limits of what's affordable.

    But don't take our word for it. According to Genworth Financial's most recent Cost of Care Survey, monthly costs for assisted living are $3,628 a month on average, or $43,539 a year. Yet the median income in our nation was not terribly better than that in 2015: $56,516. Can you see why we might have a math problem on our hands?

    Which leads us to problem number two: Simply put, too many assisted living communities are being built. Already, NIC and others are reporting that occupancy levels are trending south.

    At this point, we are not nearing a catastrophe. But you don't have to be an expert to realize that many operators are not listening to the market. And as long-term strategies go, that's probably not a good one.

  • February 13, 2017 6:32 PM | Anonymous

    A solution to the Medicaid cost quandary favored by Trump, Vice President Mike Pence, and Seema Verma, the incoming administrator of the Centers for Medicare and Medicaid Services, is a block grant approach designed to limit funding while providing states with more flexibility.

    When the federal government provides a Medicaid block grant, it gives a state a fixed sum and the state must figure out how to cover all of its Medicaid members with that allotment. Currently, states share the cost of Medicaid with the federal government. Poorer states pay less than richer states. In Mississippi, for instance, the federal government pays about 75 percent of the cost of Medicaid, compared to 50 percent in Massachusetts.

    It has often been said that there are two ways to lower Medicaid costs: reduce eligibility to the program or cut the services provided. Neither are attractive options. Turning the program into block grants firmly delegates decisions on that dilemma to the states.

    A minority of members comprise a majority of the cost. According to the Kaiser Family Foundation, in 2011 more than half of the program’s expenses went to pay for just 5 percent of Medicaid enrollees. Nationally, the elderly and people with disabilities account for just 21 percent of those covered by Medicaid but 48 percent of Medicaid spending. For this population, nursing home care is a major driver of Medicaid costs. Those numbers are significant because any reduction in the covered population that is not elderly or disabled will yield a smaller share of savings.

    A majority of those covered by Medicaid are already in managed care.Many people on Medicaid are on managed care plans, in which case Medicaid pays a fixed fee to a health plan and the plan provides all of the care the member needs, even if the cost of care exceeds the Medicaid payment. That limits how much additional savings states can capture because they are already controlling risk by delegating it, in essence, to health plans.

    Click the link to learn more:

  • February 13, 2017 6:25 PM | Anonymous

    Governor Rick Scott proposed a $83.5 billion state budget for Fiscal Year 2017-18. The Governor’s budget provides full funding for nursing center Medicaid rates as projected by the 2016 Social Services Estimating Conference. The budget also directs AHCA to implement the Nursing Center Prospective Payment System as recommended by the Agency/Navigant.  

    The budget also includes additional funds for AHCA to improve the Background Screening Clearinghouse, which will speed up the hiring process for new employees.

    It's important to note that hospitals are subject to over $929 million in cuts to Medicaid rates under the proposed budget as a result of the removal of inflationary adjustments, the elimination of supplemental payments for charity care to not-for-profit hospitals and by allowing Medicaid managed care plans to negotiate lower rates for hospitals.

    Learn more here:

  • February 13, 2017 5:49 PM | Anonymous

    Early this month, AHCA submitted a plan to Governor Rick Scott and the Legislature for a new approach to nursing home Medicaid payments. The plan was intended to establish an equitable payment system that includes incentives for high-quality care, that simplifies the payment process, and that ultimately controls costs and makes legislators' budgeting for Medicaid spending on nursing homes more predictable. 

    Under the AHCA proposal, however, nursing homes with the highest staffing levels would lose funding, while those with the lowest staffing would gain dollars. 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.

    Learn more here:

  • December 31, 2015 8:00 AM | Deleted user
  • December 29, 2015 8:00 AM | Deleted user
  • December 16, 2015 8:00 AM | Deleted user

    House and Senate Release Final FY 2016 Funding Bill 
    Few Increases for OAA Programs But No Cuts
    December 16, 2015

    In the early hours of this morning, House and Senate leaders released details of the negotiated final FY 2016 federal spending bill. The $1.15 trillion spending package, once passed in the next few days by Congress and signed into law, would ensure consistent funding flowing to federal discretionary programs for the rest of this fiscal year and marks the end of the FY 2016 budget process.
    The measure rolls all 12 appropriations bills into one massive spending package, which is why it is called an omnibus. The compromise includes FY 2016 discretionary funding levels for the often-contentious Labor, Health and Human Services and Education (Labor/HHS), which funds the bulk of federal workforce, education, health and social services programs—including the Older Americans Act and other aging programs.
    The spending bill is a direct result of the bipartisan budget negotiations that took place in the fall, which raised overall funding levels for discretionary programs for FY16 and FY17 by $80 billion. With the top-line funding levels established in October, lawmakers have spent the past few months hammering out funding levels for the thousands of individual programs on the federal discretionary ledger, while also negotiating contentious policy issues that are attached to the spending measure as “riders.” More details about the fall budget agreement are available in our October 28 Legislative Update
    The spending bill, which still must pass the House and Senate and be signed into law by President Obama, does contain some good news for aging advocates, although it’s certainly not all we wanted: most OAA programs included some much-needed funding increases or were level funded at FY15 amounts. See n4a’s appropriations chart and read on for more details.
    Funding for OAA and Other Key Aging Programs
    The fact that any OAA increases are in this final bill is in itself a victory because, as we reported this summer, both the House and the Senate proposed sweeping cuts to Labor/HHS programs overall and further squeezed funding available for these programs by proposing huge increases for NIH and CDC, including major new investments in Alzheimer’s research. While the October budget deal gave appropriators more dollars to work with, the percentage increase for Labor/HHS’s piece of the pie was far lower than the overall increase, even with the continued interest of lawmakers in boosting NIH and CDC funding.
    The largest increase in terms of dollars for OAA programs is the $20 million (3 percent) boost to Title III C nutrition programs, split roughly evenly between the C1 Congregate and C2 Home-Delivered subtitles.
    Appropriators also included a $5 million (3.4 percent) increase for Title III E Family Caregiver Support, as well as a $1 million (42 percent) increase for the non-OAA Lifespan Respite program, also administered by the Administration for Community Living (ACL).
    One of n4a’s perennial top priorities is to boost funding for the Title VI Native American aging programs, therefore, we are thrilled to report that thanks to the leadership of House Labor/HHS Chairman Tom Cole (R-OK), these much-needed, long-overdue increases were included in the final bill. Specifically, Title VI Part A (nutrition and other aging services) will increase by $5 million (19 percent) and Part C (caregiver supports) will increase $1.5 million (25 percent)!
    In a big win for the elder justice efforts at ACL, appropriators boosted funding for Adult Protective Services (APS) by $4 million, doubling the current level of federal investment in these vital elder abuse prevention and remediation activities. As you may recall, the Elder Justice Initiative made a repeat appearance in the President’s budget this year, proposing federal support of APS to the tune of $25 million. In FY 2015, advocates secured first-time funding from Congress for Elder Justice Act–related activities included under this request, but that appropriation only totaled $4 million. With $8 million in FY 2016, it will be exciting to see the work advance in a larger way than has previously been possible.
    One surprising victory in the bill is the boosting of the Community Services Block Grant(CSBG), which received a $41 million increase for a final funding level of $715 million.
    Unfortunately, this trend of increases did not carry across all the vital OAA core programs.Title III B Supportive Services and Title VII Ombudsman programs were both level funded, as was the Title V Senior Community Service Employment Program.
    In the “level funding is a victory” category, n4a is especially pleased that lawmakers rejected the massive Senate-proposed cut to the State Health Insurance Assistance Program (SHIP), and level funded SHIP activities at $54.1 million. 
    Also of note in the level-funded category, the evidence-based programs focused on Chronic Disease Self-Management ($8 million) and falls prevention ($5 million) will continue to be funded at last year’s level under the Prevention and Public Health Fund (PPHF). The PPHF is an ACA fund which has provided a major new source of mandatory funding for activities devoted to boosting public health and using proven prevention strategies to reduce Americans’ rates of illness and disability. What is unique about the PPHF, however, is that while the funding is set statutorily by ACA, the determination on which programs it will be spent on in any given year is up to Congress. So appropriators don’t have to “find” the money, but they do get to divvy it up, which is slightly different than regular appropriations. It should be noted, however, that n4a has reported on the proposed elimination of the PPHF via the reconciliation bill moving through Congress—as we expect the President to veto that measure, we believe these PPHF funding levels will proceed as directed this year.
    Unfortunately, the bill failed to provide additional funding for Aging and Disability Resource Center (ADRC) activities beyond last year’s $6.1 million, to fill the $10 million shortfall after mandatory program dollars included in the Affordable Care Act expired in September 2014.
    Level funding was also included for other HHS programs such as the Social Services Block Grant (SSBG) at $1.7 billion, Senior Corps at $202 million and Low-Income Home Energy Assistance Program (LIHEAP) at $3.39 billion.
    While we are happy to see critical increases included for some of the most important core OAA programs (and no cuts!), we must keep up the drumbeat about the need for funding increases for OAA into 2017. These funding levels still are not adequate to either meet the need or make up for federal and state funding cuts over the last several years, and we will stay heavily focused on that message when the FY 2017 budget process begins in just a few short months.
    What’s Next?
    Lawmakers will have to pass another short-term funding bill to keep the government running beyond tonight while the omnibus makes it through the legislative process. Both chambers are expected to move to vote on this measure this week, with the House expected to pass it easily by Friday and the Senate possibly following suit. However, the Senate passage could be complicated by debates over the bill’s riders or the tax break legislation that is moving hand-in-hand with the spending bill, so it could be a long weekend for the Senate. But ultimately, we expect the President to receive the legislation early next week and the White House had indicated he will sign the measure.


    This Legislative Update is an n4a membership benefit. For more information about these and other federal aging policy issues, please contact n4a’s policy team: Amy Gotwals ( and Autumn Campbell (, 202.872.0888.

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