Wins and Losses for Home Care in 2012 Legislative Session, But Industry Dodges Provider Cuts

The 2012 Florida Legislative Session concluded last Friday with the legislature passing a $70 billion budget that doesn’t raise taxes, slashes money going to hospitals and universities, raises college tuition rates and eliminates thousands of state jobs. The legislature’s ability to pass a budget with no new taxes is significant considering the fragile state of the economy and a $1.4 billion budget shortfall.

One of the major highlights for Gov. Rick Scott and the Republican-controlled legislature this session was sweeping changes to the state’s personal injury protection (PIP) law, which has been wrought with fraud and abuse, and has caused auto insurance premiums to skyrocket. Earlier this spring, HCAF joined a coalition with more than 20 consumer advocacy groups and trade associations in support of PIP reform. The bill passed along party lines on the last day of session.

Several health care bills that saw weeks of lobbying and extensive debate failed to pass, including legislation impacting home health agencies and assisted living facilities. Surprisingly, the House and Senate failed to agree on regulatory changes affecting ALFs after a series of damaging exposés in the Miami Herald last year. In addition, the Senate did not take up Senate Bill 1884, also referred to as the Agency for Health Care Administration’s (AHCA) core bill that included changes affecting several types of health care providers. SB 1884 included HCAF’s proposal to reform AHCA’s one-time $5,000 quarterly report fine for home health agencies that do not submit timely reports. HCAF proposed reducing the fines to $200 per day up to $5,000 per quarter, which was included in the successful Senate version of the core bill. Ultimately, many other issues divided the House and Senate, who in the end could not agree on a final bill to be voted on. HCAF remains committed to reducing the quarterly report fines and will attempt to do so administratively through AHCA, and if that is not possible, HCAF will seek legislative action again next session.

Health care spending for 2012-13 totaled $29.9 billion, which is a $67.8 million (0.23%) increase from the 2011-12 fiscal year. Hospitals and nursing homes were cut, while home health saw a $28.9 million increase in funding for Medicaid waiver slots, including:

  • 1,896 new slots in the Nursing Home Diversion waiver program;
  • 250 slots for the Program of All-Inclusive Care for the Elderly (PACE) in Lee and Collier counties and 100 new slots in Miami-Dade County;
  • 207 slots in the Assisted Living Waiver program;
  • 298 slots in the Aged and Disabled Waiver program; and,
  • 187 slots in the Community Care for the Elderly program.

House Bill 5301, passed into law, will also create PACE programs in select counties to help keep seniors at home and avoid institutionalization. The new program in Broward County calls for up to 150 slots for seniors who qualify, and up to 150 slots for seniors in Manatee, Sarasota and DeSoto counties.

Additionally, the legislature provided $65.1 million to increase the Medicaid Home and Community Based Services waiver for the developmentally disabled. This increase brings total HSBS waiver funding to $877 million, an increase of 8.2% over 2011-12 spending. An additional $46.5 million was also provided for the 2011-12 fiscal year to cover an anticipated deficit in the waiver program.

The legislature also expanded two Medicaid home health pilot projects in an attempt to curb ongoing fraud and abuse in the Medicaid system. The Telephonic Home Health Services Delivery Monitoring and Verification Project and the Comprehensive Care Management Pilot Project, both of which were implemented in Miami-Dade County in 2009 when the county was deemed a health care fraud crisis area in by the legislature, will both be expanded statewide effective July 1, 2012. The comprehensive care pilot will now also include private duty nursing and personal care services paid for by Medicaid.

When the session kicked off in January, more than a dozen bills were filed that impacted home care, and just a few will now be sent to the governor to be signed into law. Here is a look at the bills that passed:

  • Background Screening (HB 943/SB 320)– Representative Doug Holder (R-Sarasota) and Senator Ronda Storms (R-Brandon) introduced legislation that will make major changes to current background screening requirements for health care providers:
    • Employers will now be able to hire an employee for training and orientation before the screening is complete, provided the employee does not have any contact with clients until successful completion of the screening.
    • The bill creates a clearinghouse that will streamline the background screening system so that a screening result can be shared among all state agencies, which will avoid the need for many future screens and related fees.
    • The bill establishes the rescreening schedule for persons screened under AHCA, who are required to be rescreened every five years. This schedule applies to all persons who have a controlling interest in, are employed by, or contract with a licensee on July 31, 2010. All such persons must be rescreened by July 31, 2015. The rescreening schedule is as follows:
      • Individuals screened on or before 12/31/04 must be rescreened by 7/31/13
      • Individuals screened between 1/1/05 and 12/31/08 must be rescreened by 7/31/14
      • Individuals screened between 1/1/09 and 7/31/11 must be rescreened by 7/31/15
      • The bill provides an exemption from additional background screening for an individual who becomes a direct care provider and provides services within the scope of his or her license. The exemption applies to a person who was previously screened by the Agency for Health Care Administration as a condition of licensure or employment.
      • Certified Nursing Assistants who have successfully passed background screening within 90 days of applying for a certificate to practice are exempt from an additional rescreening requirement if their initial results are not retained in the background screening clearinghouse.
  • Alzheimer’s Purple Ribbon Task Force (HB 473/SB 682) – Rep. Matt Hudson (R-Naples) and Sen. Garrett Richter (R-Naples) introduced legislation that will establish the Purple Ribbon Task Force within the Department of Elder Affairs to consist of 18 volunteer members who are tasked with developing a comprehensive state plan to address the needs of individuals with Alzheimer’s disease and their caregivers. As it relates to home care, the bill requires the task force to assess the availability of home and community based services and respite care for people with Alzheimer’s or a related form of dementia. The bill requires the members of the task force to be appointed by July 1, 2012.
  • Physical Therapy Temporary License (HB 799/SB 1228) – Rep. Tom Goodson (R-Titusville) and Sen. Bill Montford (D-Tallahassee) introduced legislation that gives the Board of Physical Therapy Practices within the Department of Health the authority to grant a temporary permit to an individual who has graduated from an accredited program of study as a physical therapist or a physical therapist assistant. The applicant for a temporary license must practice under the direct supervision of a licensed PT. In addition, to receive a temporary permit the applicant must have: graduated from a PT program recognized by the Commission on Accreditation in Physical Therapy Education; proof of possessing malpractice insurance; and, proof of achieving a passing score on the Florida Jurisprudence exam administered by the Federation of State Boards of Physical Therapy. A temporary permit is not renewable and is void if a passing score on the National Physical Therapy Examination (NPTE) is not obtained six months after the date of graduation from a physical therapy program. The bill, if signed by the governor, will go into effect on July 1, 2012.
  • Remuneration (HB 787/SB 1292) – Rep. Carlos Trujillo (R-Miami) and Sen. Ellyn Setnor Bogdanoff (R-Fort Lauderdale) introduced legislation that will revise the definition of remuneration to exclude items having a value of $15 or less, including but not limited to a plaque, a certificate, a trophy or a novelty item that is intended solely for presentation or is customarily given away solely for promotional, recognition, or advertising purposes. This bill also allows nurse registry administrators to manage up to five NRs if they all have an identical controlling interest and are located in one geographic service area or within an immediately contiguous county. An administrator must designate, in writing, for each licensed entity, a qualified alternate administrator to serve during the administrator’s absence.

The bills below did not get passed into law by the legislature:

  • AHCA Core Bill (HB 1419/SB 1884) – Rep. Jason Brodeur (R-Sanford) and Sen. Rene Garcia (R-Hialeah) introduced legislation that would impact health care providers licensed by AHCA. HCAF’s quarterly report reform language was included in the core bill. The bill successfully passed the House but it did only the Senate version included quarterly report language. The chambers failed to agree on a final bill by the time session ended.
  • Nametags (HB 1267/SB 1014) ­­– Rep. Charles Van Zant (R-Palatka) and Sen. Mike Bennett (R-Bradenton) introduced legislation that would, among many other things, require a health care practitioner to wear a name badge that indicates his or her appropriate licensure credentials. Both bills died in the committee stage early-on during session.
  • Quarterly Report (SB 1316) – Sen. Don Gaetz (R-Destin) introduced legislation that would, among many other things, lower the AHCA quarterly report fine for home care agencies to $50 per day. The bill was not voted on by the full Senate and there was no House companion bill.
  • Home Health Care Patients Bill of Rights (S 1370) – Sen. Mike Fasano (R-New Port Richey) introduced legislation that would establish a bill of rights and responsibilities for patients receiving home care. HCAF and the Florida Alliance of Home Care Services (home medical equipment association) pushed the bill, but it did not make it out of the committee stage. There was also no House companion bill.

In spite of some losses this session, including the opportunity to reduce the excessive and punitive amount for quarterly report fines, the industry was not subject to cuts in a year where many industries were slashed. Additionally, our wins – particularly our membership in the coalition to reform PIP, one of Gov. Scott’s chief initiatives this session – will advance HCAF’s influence in Tallahassee and the association’s ability to achieve legislative and regulatory goals in sessions to come.

Learn more about the 2012 session at your upcoming district meeting, which will take place across Florida beginning April 9 in Tampa and concluding May 2 in Fort Myers!

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