Senate Democrats are huddling to discuss proposed changes to nursing home funding. Nick Evans reports the chamber’s spending plan alters the way Medicaid dollars flow to facilities.
Right now in Florida, nursing homes get paid on a retrospective basis—providers get Medicaid dollars after the fact, based on the costs they incurred. But for years state lawmakers have wanted to move to a prospective model, where the compensation amount is set ahead of time. The Florida Healthcare Association which represents the majority of the state’s nursing homes supports the move, and Lobbyist Bob Asztalos explains why.
“High quality care, low quality care you’re paid on your cost,” Asztalos says, “and some buildings provide high quality care and they’re paid high and some buildings provide low quality care and they’re paid high, and vice versa.”
“What this does is nursing homes are paid a price, but they’re also paid based on quality,” he goes on, “so the Senate Health and Human Services bill, what it does is you can get a six percent add on based on your quality outcomes and your quality indicators.”
That Senate plan is based at least in part on a study authored by an outside firm called Navigant. Last year the Legislature paid the group half a million dollars to develop a proposal.
“The initial rollout of this proposal that was known as the Navigant report I think initially, universally, everyone agreed saying it’s just not ready for primetime,” Sen. Anitere Flores (R-Miami) says.
She chairs the Senate’s budget committee for Health and Human Services.
The chief complaint against the Navigant plan was it seemed to shift money from high quality facilities to lower performing ones. But Flores is attempting to salvage the prospective payment system.
“The House has said that right now they are not going to include this,” Flores explains, “but I think that it is important for us to not shut the door on the conversation.”
One of the primary critics of the proposal is LeadingAge Florida, a group representing nursing homes as well as senior service providers throughout the state. But CEO Steve Bahmer says his organization actually supports a prospective model, it’s just the offer on the table needs work.
“What the Florida Healthcare plan does—the Senate budget plan—divides the state into two regions and then pays a percentage of the median in each region,” Bahmer says.
“And so it gets complicated and I don’t want to get into the weeds—here are the regions: Broward, Miami-Dade, Okeechobee and Palm Beach County. The North region is everyone else,” he says.
“So that means Sarasota County is the same as Gilchrist County for the sake of establishing the median and devising rates. We think that’s problematic.”
Minority Leader Oscar Braynon wants to see some changes to Senate’s current proposal—he’s filed an amendment demanding any new money a facility receives go to patient care or quality of life improvements. But so far as his caucus, he says their positions are still shaking out.
“I think that they’re still digesting what it means, right? Because one of the reasons they didn’t have an opinion, a real strong opinion, was because they didn’t know what was actually happening,” Braynon says. “And so they do now and I think that as we move forward we’ll start to see some opinions formulating from the caucus.”
As Flores says, the House budget doesn’t include the move to prospective payments. She’s holding out hope House and Senate lawmakers can settle the issue in the budget conference.
