Florida Senate - 2025                                     SB 170
       
       
        
       By Senator Burton
       
       
       
       
       
       12-01060C-25                                           2025170__
    1                        A bill to be entitled                      
    2         An act relating to the quality of care in nursing
    3         homes; reviving, reenacting, and amending s. 400.0225,
    4         F.S., relating to consumer satisfaction surveys;
    5         requiring the Agency for Health Care Administration to
    6         develop user-friendly consumer satisfaction surveys
    7         for nursing home facilities; specifying requirements
    8         for the surveys; authorizing family members,
    9         guardians, and other resident designees to assist the
   10         resident in completing the survey; prohibiting
   11         employees and volunteers of the facility or of a
   12         corporation or business entity with an ownership
   13         interest in the facility from attempting to influence
   14         a resident’s responses to the survey; requiring the
   15         agency to specify certain protocols for administration
   16         of the survey; requiring the agency to publish on its
   17         website aggregated survey data in a manner that allows
   18         for comparison between nursing home facilities;
   19         amending s. 400.141, F.S.; requiring medical directors
   20         of nursing home facilities to obtain, or to be in the
   21         process of obtaining, certain qualifications by a
   22         specified date; requiring the agency to include such
   23         medical director’s name on each nursing home
   24         facility’s online provider profile; requiring nursing
   25         home facilities to conduct biennial patient safety
   26         culture surveys; specifying requirements for
   27         administration of such surveys; requiring nursing home
   28         facilities to submit the results of such surveys
   29         biennially to the agency in a format specified by
   30         agency rule; authorizing nursing home facilities to
   31         develop an internal action plan between surveys to
   32         identify measures for improvement of the survey and
   33         submit such plan to the agency; amending s. 400.191,
   34         F.S.; requiring the agency to include the results from
   35         specified consumer satisfaction surveys as part of the
   36         Nursing Home Guide on its website; amending s.
   37         408.051, F.S.; requiring nursing home facilities that
   38         maintain certain electronic health records to make
   39         available certain data to the agency’s Florida Health
   40         Information Exchange program for a specified purpose;
   41         authorizing the agency to adopt rules; amending s.
   42         408.061, F.S.; requiring the agency to impose
   43         administrative fines against home offices of nursing
   44         homes for failing to comply with certain reporting
   45         requirements; defining the term “violation”; providing
   46         construction; requiring the agency to adopt rules;
   47         providing requirements for such rules; amending s.
   48         409.908, F.S.; requiring the agency to submit an
   49         annual report to the Governor and the Legislature on
   50         payments made under the Quality Incentive Program;
   51         specifying requirements for the report; providing an
   52         effective date.
   53          
   54  Be It Enacted by the Legislature of the State of Florida:
   55  
   56         Section 1. Notwithstanding the repeal of section 400.0225,
   57  Florida Statutes, in section 14 of chapter 2001-377, Laws of
   58  Florida, that section is revived, reenacted, and amended to
   59  read:
   60         400.0225 Consumer satisfaction surveys.—
   61         (1) The agency shall develop user-friendly consumer
   62  satisfaction surveys to capture resident and family member
   63  satisfaction with care provided by nursing home facilities. The
   64  consumer satisfaction surveys must be based on a core set of
   65  consumer satisfaction questions to allow for consistent
   66  measurement and must be administered annually to a random sample
   67  of long-stay and short-stay residents of each facility and their
   68  family members. The survey tool must be based on an agency
   69  validated survey instrument whose measures have received an
   70  endorsement by the National Quality Forum.
   71         (2)Family members, guardians, or other resident designees
   72  may assist a resident in completing the consumer satisfaction
   73  survey.
   74         (3)Employees and volunteers of the nursing home facility
   75  or of a corporation or business entity with an ownership
   76  interest in the nursing home facility are prohibited from
   77  attempting to influence a resident’s responses to the consumer
   78  satisfaction survey.
   79         (4)The agency shall specify the protocols for conducting
   80  the consumer satisfaction surveys, ensuring survey validity,
   81  reporting survey results, and protecting the identity of
   82  individual respondents. The agency shall make aggregated survey
   83  data available to consumers on the agency’s website pursuant to
   84  s. 400.191(2)(a)15. in a manner that allows for comparison
   85  between nursing home facilities, or its contractor, in
   86  consultation with the nursing home industry and consumer
   87  representatives, shall develop an easy-to-use consumer
   88  satisfaction survey, shall ensure that every nursing facility
   89  licensed pursuant to this part participates in assessing
   90  consumer satisfaction, and shall establish procedures to ensure
   91  that, at least annually, a representative sample of residents of
   92  each facility is selected to participate in the survey. The
   93  sample shall be of sufficient size to allow comparisons between
   94  and among facilities. Family members, guardians, or other
   95  resident designees may assist the resident in completing the
   96  survey. Employees and volunteers of the nursing facility or of a
   97  corporation or business entity with an ownership interest in the
   98  facility are prohibited from assisting a resident with or
   99  attempting to influence a resident’s responses to the consumer
  100  satisfaction survey. The agency, or its contractor, shall survey
  101  family members, guardians, or other resident designees. The
  102  agency, or its contractor, shall specify the protocol for
  103  conducting and reporting the consumer satisfaction surveys.
  104  Reports of consumer satisfaction surveys shall protect the
  105  identity of individual respondents. The agency shall contract
  106  for consumer satisfaction surveys and report the results of
  107  those surveys in the consumer information materials prepared and
  108  distributed by the agency.
  109         (5) The agency may adopt rules as necessary to implement
  110  administer this section.
  111         Section 2. Paragraph (b) of subsection (1) of section
  112  400.141, Florida Statutes, is amended, and paragraph (x) is
  113  added to that subsection, to read:
  114         400.141 Administration and management of nursing home
  115  facilities.—
  116         (1) Every licensed facility shall comply with all
  117  applicable standards and rules of the agency and shall:
  118         (b) Appoint a medical director licensed pursuant to chapter
  119  458 or chapter 459. By January 1, 2026, the medical director of
  120  each nursing home facility must obtain designation as a
  121  certified medical director by the American Medical Directors
  122  Association, hold a similar credential bestowed by an
  123  organization recognized by the agency, or be in the process of
  124  seeking such designation or credentialing, according to
  125  parameters adopted by agency rule. The agency shall include the
  126  name of each nursing home facility’s medical director on the
  127  facility’s provider profile published by the agency on its
  128  website. The agency may establish by rule more specific criteria
  129  for the appointment of a medical director.
  130         (x) Conduct, at least biennially, a patient safety culture
  131  survey using the applicable Survey on Patient Safety Culture
  132  developed by the federal Agency for Healthcare Research and
  133  Quality. Each facility shall conduct the survey anonymously to
  134  encourage completion of the survey by staff working in or
  135  employed by the facility. A facility may contract with a third
  136  party to administer the survey. Each facility shall biennially
  137  submit the survey data to the agency in a format specified by
  138  agency rule, which must include the survey participation rate.
  139  Each facility may develop an internal action plan between
  140  conducting surveys to identify measures to improve the survey
  141  and submit such plan to the agency.
  142         Section 3. Paragraph (a) of subsection (2) of section
  143  400.191, Florida Statutes, is amended to read:
  144         400.191 Availability, distribution, and posting of reports
  145  and records.—
  146         (2) The agency shall publish the Nursing Home Guide
  147  quarterly in electronic form to assist consumers and their
  148  families in comparing and evaluating nursing home facilities.
  149         (a) The agency shall provide an Internet site which must
  150  shall include at least the following information either directly
  151  or indirectly through a link to another established site or
  152  sites of the agency’s choosing:
  153         1. A section entitled “Have you considered programs that
  154  provide alternatives to nursing home care?” which must shall be
  155  the first section of the Nursing Home Guide and must which shall
  156  prominently display information about available alternatives to
  157  nursing homes and how to obtain additional information regarding
  158  these alternatives. The Nursing Home Guide must shall explain
  159  that this state offers alternative programs that allow permit
  160  qualified elderly persons to stay in their homes instead of
  161  being placed in nursing homes and must shall encourage
  162  interested persons to call the Comprehensive Assessment Review
  163  and Evaluation for Long-Term Care Services (CARES) Program to
  164  inquire as to whether if they qualify. The Nursing Home Guide
  165  must shall list available home and community-based programs and
  166  must which shall clearly state the services that are provided,
  167  including and indicate whether nursing home services are covered
  168  under those programs when necessary included if needed.
  169         2. A list by name and address of all nursing home
  170  facilities in this state, including any prior name by which a
  171  facility was known during the previous 24-month period.
  172         3. Whether such nursing home facilities are proprietary or
  173  nonproprietary.
  174         4. The current owner of the facility’s license and the year
  175  that that entity became the owner of the license.
  176         5. The name of the owner or owners of each facility and
  177  whether the facility is affiliated with a company or other
  178  organization owning or managing more than one nursing facility
  179  in this state.
  180         6. The total number of beds in each facility and the most
  181  recently available occupancy levels.
  182         7. The number of private and semiprivate rooms in each
  183  facility.
  184         8. The religious affiliation, if any, of each facility.
  185         9. The languages spoken by the administrator and staff of
  186  each facility.
  187         10. Whether or not each facility accepts Medicare or
  188  Medicaid recipients or insurance, health maintenance
  189  organization, United States Department of Veterans Affairs,
  190  CHAMPUS program, or workers’ compensation coverage.
  191         11. Recreational and other programs available at each
  192  facility.
  193         12. Special care units or programs offered at each
  194  facility.
  195         13. Whether the facility is a part of a retirement
  196  community that offers other services pursuant to part III of
  197  this chapter or part I or part III of chapter 429.
  198         14. Survey and deficiency information, including all
  199  federal and state recertification, licensure, revisit, and
  200  complaint survey information, for each facility. For
  201  noncertified nursing homes, state survey and deficiency
  202  information, including licensure, revisit, and complaint survey
  203  information, shall be provided.
  204         15. The results of consumer satisfaction surveys conducted
  205  pursuant to s. 400.0225.
  206         Section 4. Present subsections (6) and (7) of section
  207  408.051, Florida Statutes, are redesignated as subsections (7)
  208  and (8), respectively, and a new subsection (6) is added to that
  209  section, to read:
  210         408.051 Florida Electronic Health Records Exchange Act.—
  211         (6) NURSING HOME DATA.—A nursing home facility as defined
  212  in s. 400.021 which maintains certified electronic health record
  213  technology shall make available all admit, transfer, and
  214  discharge data to the agency’s Florida Health Information
  215  Exchange program for the purpose of supporting public health
  216  data registries and patient care coordination. The agency may
  217  adopt rules to implement this subsection.
  218         Section 5. Subsection (6) of section 408.061, Florida
  219  Statutes, is amended to read:
  220         408.061 Data collection; uniform systems of financial
  221  reporting; information relating to physician charges;
  222  confidential information; immunity.—
  223         (6)(a) Within 120 days after the end of its fiscal year,
  224  the home office of each nursing home as defined in s. 408.07
  225  shall file with the agency, on forms adopted by the agency and
  226  based on the uniform system of financial reporting, its actual
  227  financial experience for that fiscal year, including
  228  expenditures, revenues, and statistical measures. Such data may
  229  be based on internal financial reports that are certified to be
  230  complete and accurate by the chief financial officer of the
  231  nursing home. However, the home office’s actual financial
  232  experience shall be its audited actual experience. This audited
  233  actual experience must include the fiscal year-end balance
  234  sheet, income statement, statement of cash flow, and statement
  235  of retained earnings and must be submitted to the agency in
  236  addition to the information filed in the uniform system of
  237  financial reporting. The financial statements must tie to the
  238  information submitted in the uniform system of financial
  239  reporting, and a crosswalk must be submitted along with the
  240  audited financial statements.
  241         (b)1.Beginning January 1, 2026, the agency shall impose an
  242  administrative fine of $10,000 per violation against a home
  243  office that fails to comply with paragraph (a). For purposes of
  244  this paragraph, the term violation means failing to file the
  245  financial report required by paragraph (a) on or before the
  246  reports due date. Failing to file the report during any
  247  subsequent 10-day period occurring after the due date
  248  constitutes a separate violation until the report has been
  249  submitted.
  250         2. The agency shall adopt rules to implement this
  251  paragraph. The rules must include provisions for a home office
  252  to present factors in mitigation of the imposition of the fines
  253  full dollar amount. The agency may determine not to impose the
  254  fines full dollar amount upon a showing that the full fine is
  255  inappropriate under the circumstances.
  256         Section 6. Paragraph (b) of subsection (2) of section
  257  409.908, Florida Statutes, is amended to read:
  258         409.908 Reimbursement of Medicaid providers.—Subject to
  259  specific appropriations, the agency shall reimburse Medicaid
  260  providers, in accordance with state and federal law, according
  261  to methodologies set forth in the rules of the agency and in
  262  policy manuals and handbooks incorporated by reference therein.
  263  These methodologies may include fee schedules, reimbursement
  264  methods based on cost reporting, negotiated fees, competitive
  265  bidding pursuant to s. 287.057, and other mechanisms the agency
  266  considers efficient and effective for purchasing services or
  267  goods on behalf of recipients. If a provider is reimbursed based
  268  on cost reporting and submits a cost report late and that cost
  269  report would have been used to set a lower reimbursement rate
  270  for a rate semester, then the provider’s rate for that semester
  271  shall be retroactively calculated using the new cost report, and
  272  full payment at the recalculated rate shall be effected
  273  retroactively. Medicare-granted extensions for filing cost
  274  reports, if applicable, shall also apply to Medicaid cost
  275  reports. Payment for Medicaid compensable services made on
  276  behalf of Medicaid-eligible persons is subject to the
  277  availability of moneys and any limitations or directions
  278  provided for in the General Appropriations Act or chapter 216.
  279  Further, nothing in this section shall be construed to prevent
  280  or limit the agency from adjusting fees, reimbursement rates,
  281  lengths of stay, number of visits, or number of services, or
  282  making any other adjustments necessary to comply with the
  283  availability of moneys and any limitations or directions
  284  provided for in the General Appropriations Act, provided the
  285  adjustment is consistent with legislative intent.
  286         (2)
  287         (b) Subject to any limitations or directions in the General
  288  Appropriations Act, the agency shall establish and implement a
  289  state Title XIX Long-Term Care Reimbursement Plan for nursing
  290  home care in order to provide care and services in conformance
  291  with the applicable state and federal laws, rules, regulations,
  292  and quality and safety standards and to ensure that individuals
  293  eligible for medical assistance have reasonable geographic
  294  access to such care.
  295         1. The agency shall amend the long-term care reimbursement
  296  plan and cost reporting system to create direct care and
  297  indirect care subcomponents of the patient care component of the
  298  per diem rate. These two subcomponents together shall equal the
  299  patient care component of the per diem rate. Separate prices
  300  shall be calculated for each patient care subcomponent,
  301  initially based on the September 2016 rate setting cost reports
  302  and subsequently based on the most recently audited cost report
  303  used during a rebasing year. The direct care subcomponent of the
  304  per diem rate for any providers still being reimbursed on a cost
  305  basis shall be limited by the cost-based class ceiling, and the
  306  indirect care subcomponent may be limited by the lower of the
  307  cost-based class ceiling, the target rate class ceiling, or the
  308  individual provider target. The ceilings and targets apply only
  309  to providers being reimbursed on a cost-based system. Effective
  310  October 1, 2018, a prospective payment methodology shall be
  311  implemented for rate setting purposes with the following
  312  parameters:
  313         a. Peer Groups, including:
  314         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  315  Counties; and
  316         (II) South-SMMC Regions 10-11, plus Palm Beach and
  317  Okeechobee Counties.
  318         b. Percentage of Median Costs based on the cost reports
  319  used for September 2016 rate setting:
  320         (I) Direct Care Costs........................100 percent.
  321         (II) Indirect Care Costs......................92 percent.
  322         (III) Operating Costs.........................86 percent.
  323         c. Floors:
  324         (I) Direct Care Component.....................95 percent.
  325         (II) Indirect Care Component................92.5 percent.
  326         (III) Operating Component...........................None.
  327         d. Pass-through Payments..................Real Estate and
  328  ...............................................Personal Property
  329  ...................................Taxes and Property Insurance.
  330         e. Quality Incentive Program Payment
  331  Pool.....................................10 percent of September
  332  .......................................2016 non-property related
  333  ................................payments of included facilities.
  334         f. Quality Score Threshold to Quality for Quality Incentive
  335  Payment.....................................................20th
  336  ..............................percentile of included facilities.
  337         g. Fair Rental Value System Payment Parameters:
  338         (I) Building Value per Square Foot based on 2018 RS Means.
  339         (II) Land Valuation...10 percent of Gross Building value.
  340         (III) Facility Square Footage......Actual Square Footage.
  341         (IV) Movable Equipment Allowance..........$8,000 per bed.
  342         (V) Obsolescence Factor......................1.5 percent.
  343         (VI) Fair Rental Rate of Return................8 percent.
  344         (VII) Minimum Occupancy.......................90 percent.
  345         (VIII) Maximum Facility Age.....................40 years.
  346         (IX) Minimum Square Footage per Bed..................350.
  347         (X) Maximum Square Footage for Bed...................500.
  348         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  349         h. Ventilator Supplemental payment of $200 per Medicaid day
  350  of 40,000 ventilator Medicaid days per fiscal year.
  351         2. The direct care subcomponent shall include salaries and
  352  benefits of direct care staff providing nursing services
  353  including registered nurses, licensed practical nurses, and
  354  certified nursing assistants who deliver care directly to
  355  residents in the nursing home facility, allowable therapy costs,
  356  and dietary costs. This excludes nursing administration, staff
  357  development, the staffing coordinator, and the administrative
  358  portion of the minimum data set and care plan coordinators. The
  359  direct care subcomponent also includes medically necessary
  360  dental care, vision care, hearing care, and podiatric care.
  361         3. All other patient care costs shall be included in the
  362  indirect care cost subcomponent of the patient care per diem
  363  rate, including complex medical equipment, medical supplies, and
  364  other allowable ancillary costs. Costs may not be allocated
  365  directly or indirectly to the direct care subcomponent from a
  366  home office or management company.
  367         4. On July 1 of each year, the agency shall report to the
  368  Legislature direct and indirect care costs, including average
  369  direct and indirect care costs per resident per facility and
  370  direct care and indirect care salaries and benefits per category
  371  of staff member per facility.
  372         5. Every fourth year, the agency shall rebase nursing home
  373  prospective payment rates to reflect changes in cost based on
  374  the most recently audited cost report for each participating
  375  provider.
  376         6. A direct care supplemental payment may be made to
  377  providers whose direct care hours per patient day are above the
  378  80th percentile and who provide Medicaid services to a larger
  379  percentage of Medicaid patients than the state average.
  380         7. Pediatric, Florida Department of Veterans Affairs, and
  381  government-owned facilities are exempt from the pricing model
  382  established in this subsection and shall remain on a cost-based
  383  prospective payment system. Effective October 1, 2018, the
  384  agency shall set rates for all facilities remaining on a cost
  385  based prospective payment system using each facility’s most
  386  recently audited cost report, eliminating retroactive
  387  settlements.
  388         8.By October 1, 2025, and each year thereafter, the agency
  389  shall submit to the Governor, the President of the Senate, and
  390  the Speaker of the House of Representatives a report on each
  391  Quality Incentive Program payment made pursuant to sub
  392  subparagraph 1.e. The report must, at a minimum, include all of
  393  the following information:
  394         a.The name of each facility that received a Quality
  395  Incentive Program payment and the dollar amount of such payment
  396  each facility received.
  397         b.The total number of quality incentive metric points
  398  awarded by the agency to each facility and the number of points
  399  awarded by the agency for each individual quality metric
  400  measured.
  401         c.An examination of any trends in the improvement of the
  402  quality of care provided to nursing home residents which may be
  403  attributable to incentive payments received under the Quality
  404  Incentive Program. The agency shall include examination of
  405  trends both for the program as a whole as well as for each
  406  individual quality metric used by the agency to award program
  407  payments.
  408  
  409  It is the intent of the Legislature that the reimbursement plan
  410  achieve the goal of providing access to health care for nursing
  411  home residents who require large amounts of care while
  412  encouraging diversion services as an alternative to nursing home
  413  care for residents who can be served within the community. The
  414  agency shall base the establishment of any maximum rate of
  415  payment, whether overall or component, on the available moneys
  416  as provided for in the General Appropriations Act. The agency
  417  may base the maximum rate of payment on the results of
  418  scientifically valid analysis and conclusions derived from
  419  objective statistical data pertinent to the particular maximum
  420  rate of payment. The agency shall base the rates of payments in
  421  accordance with the minimum wage requirements as provided in the
  422  General Appropriations Act.
  423         Section 7. This act shall take effect July 1, 2025.