Florida Senate - 2025 CS for SB 170
By the Committee on Health Policy; and Senator Burton
588-02134-25 2025170c1
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 nursing homes and home
44 offices of nursing homes for failing to comply with
45 certain reporting requirements; defining the term
46 “violation”; providing construction; requiring the
47 agency to adopt rules; providing requirements for such
48 rules; amending s. 408.08, F.S.; exempting health care
49 facilities from imposition of administrative fines if
50 they have otherwise been fined for the same violation
51 pursuant to other provisions; amending s. 409.908,
52 F.S.; requiring the agency to submit an annual report
53 to the Governor and the Legislature on payments made
54 under the Quality Incentive Program; specifying
55 requirements for the report; providing an effective
56 date.
57
58 Be It Enacted by the Legislature of the State of Florida:
59
60 Section 1. Notwithstanding the repeal of section 400.0225,
61 Florida Statutes, in section 14 of chapter 2001-377, Laws of
62 Florida, that section is revived, reenacted, and amended to
63 read:
64 400.0225 Consumer satisfaction surveys.—
65 (1) The agency shall develop user-friendly consumer
66 satisfaction surveys to capture resident and family member
67 satisfaction with care provided by nursing home facilities. The
68 consumer satisfaction surveys must be based on a core set of
69 consumer satisfaction questions to allow for consistent
70 measurement and must be administered annually to a random sample
71 of long-stay and short-stay residents of each facility and their
72 family members. The survey tool must be based on an agency
73 validated survey instrument whose measures have received an
74 endorsement by the National Quality Forum.
75 (2) Family members, guardians, or other resident designees
76 may assist a resident in completing the consumer satisfaction
77 survey.
78 (3) Employees and volunteers of the nursing home facility
79 or of a corporation or business entity with an ownership
80 interest in the nursing home facility are prohibited from
81 attempting to influence a resident’s responses to the consumer
82 satisfaction survey.
83 (4) The agency shall specify the protocols for conducting
84 the consumer satisfaction surveys, ensuring survey validity,
85 reporting survey results, and protecting the identity of
86 individual respondents. The agency shall make aggregated survey
87 data available to consumers on the agency’s website pursuant to
88 s. 400.191(2)(a)15. in a manner that allows for comparison
89 between nursing home facilities, or its contractor, in
90 consultation with the nursing home industry and consumer
91 representatives, shall develop an easy-to-use consumer
92 satisfaction survey, shall ensure that every nursing facility
93 licensed pursuant to this part participates in assessing
94 consumer satisfaction, and shall establish procedures to ensure
95 that, at least annually, a representative sample of residents of
96 each facility is selected to participate in the survey. The
97 sample shall be of sufficient size to allow comparisons between
98 and among facilities. Family members, guardians, or other
99 resident designees may assist the resident in completing the
100 survey. Employees and volunteers of the nursing facility or of a
101 corporation or business entity with an ownership interest in the
102 facility are prohibited from assisting a resident with or
103 attempting to influence a resident’s responses to the consumer
104 satisfaction survey. The agency, or its contractor, shall survey
105 family members, guardians, or other resident designees. The
106 agency, or its contractor, shall specify the protocol for
107 conducting and reporting the consumer satisfaction surveys.
108 Reports of consumer satisfaction surveys shall protect the
109 identity of individual respondents. The agency shall contract
110 for consumer satisfaction surveys and report the results of
111 those surveys in the consumer information materials prepared and
112 distributed by the agency.
113 (5) The agency may adopt rules as necessary to implement
114 administer this section.
115 Section 2. Paragraph (b) of subsection (1) of section
116 400.141, Florida Statutes, is amended, and paragraph (x) is
117 added to that subsection, to read:
118 400.141 Administration and management of nursing home
119 facilities.—
120 (1) Every licensed facility shall comply with all
121 applicable standards and rules of the agency and shall:
122 (b) Appoint a medical director licensed pursuant to chapter
123 458 or chapter 459. By January 1, 2026, the medical director of
124 each nursing home facility must obtain designation as a
125 certified medical director by the American Medical Directors
126 Association, hold a similar credential bestowed by an
127 organization recognized by the agency, or be in the process of
128 seeking such designation or credentialing, according to
129 parameters adopted by agency rule. The agency shall include the
130 name of each nursing home facility’s medical director on the
131 facility’s provider profile published by the agency on its
132 website. The agency may establish by rule more specific criteria
133 for the appointment of a medical director.
134 (x) Conduct, at least biennially, a patient safety culture
135 survey using the applicable Survey on Patient Safety Culture
136 developed by the federal Agency for Healthcare Research and
137 Quality. Each facility shall conduct the survey anonymously to
138 encourage completion of the survey by staff working in or
139 employed by the facility. A facility may contract with a third
140 party to administer the survey. Each facility shall biennially
141 submit the survey data to the agency in a format specified by
142 agency rule, which must include the survey participation rate.
143 Each facility may develop an internal action plan between
144 conducting surveys to identify measures to improve the survey
145 and submit such plan to the agency.
146 Section 3. Paragraph (a) of subsection (2) of section
147 400.191, Florida Statutes, is amended to read:
148 400.191 Availability, distribution, and posting of reports
149 and records.—
150 (2) The agency shall publish the Nursing Home Guide
151 quarterly in electronic form to assist consumers and their
152 families in comparing and evaluating nursing home facilities.
153 (a) The agency shall provide an Internet site which must
154 shall include at least the following information either directly
155 or indirectly through a link to another established site or
156 sites of the agency’s choosing:
157 1. A section entitled “Have you considered programs that
158 provide alternatives to nursing home care?” which must shall be
159 the first section of the Nursing Home Guide and must which shall
160 prominently display information about available alternatives to
161 nursing homes and how to obtain additional information regarding
162 these alternatives. The Nursing Home Guide must shall explain
163 that this state offers alternative programs that allow permit
164 qualified elderly persons to stay in their homes instead of
165 being placed in nursing homes and must shall encourage
166 interested persons to call the Comprehensive Assessment Review
167 and Evaluation for Long-Term Care Services (CARES) Program to
168 inquire as to whether if they qualify. The Nursing Home Guide
169 must shall list available home and community-based programs and
170 must which shall clearly state the services that are provided,
171 including and indicate whether nursing home services are covered
172 under those programs when necessary included if needed.
173 2. A list by name and address of all nursing home
174 facilities in this state, including any prior name by which a
175 facility was known during the previous 24-month period.
176 3. Whether such nursing home facilities are proprietary or
177 nonproprietary.
178 4. The current owner of the facility’s license and the year
179 that that entity became the owner of the license.
180 5. The name of the owner or owners of each facility and
181 whether the facility is affiliated with a company or other
182 organization owning or managing more than one nursing facility
183 in this state.
184 6. The total number of beds in each facility and the most
185 recently available occupancy levels.
186 7. The number of private and semiprivate rooms in each
187 facility.
188 8. The religious affiliation, if any, of each facility.
189 9. The languages spoken by the administrator and staff of
190 each facility.
191 10. Whether or not each facility accepts Medicare or
192 Medicaid recipients or insurance, health maintenance
193 organization, United States Department of Veterans Affairs,
194 CHAMPUS program, or workers’ compensation coverage.
195 11. Recreational and other programs available at each
196 facility.
197 12. Special care units or programs offered at each
198 facility.
199 13. Whether the facility is a part of a retirement
200 community that offers other services pursuant to part III of
201 this chapter or part I or part III of chapter 429.
202 14. Survey and deficiency information, including all
203 federal and state recertification, licensure, revisit, and
204 complaint survey information, for each facility. For
205 noncertified nursing homes, state survey and deficiency
206 information, including licensure, revisit, and complaint survey
207 information, shall be provided.
208 15. The results of consumer satisfaction surveys conducted
209 pursuant to s. 400.0225.
210 Section 4. Present subsections (6) and (7) of section
211 408.051, Florida Statutes, are redesignated as subsections (7)
212 and (8), respectively, and a new subsection (6) is added to that
213 section, to read:
214 408.051 Florida Electronic Health Records Exchange Act.—
215 (6) NURSING HOME DATA.—A nursing home facility as defined
216 in s. 400.021 which maintains certified electronic health record
217 technology shall make available all admission, transfer, and
218 discharge data to the agency’s Florida Health Information
219 Exchange program for the purpose of supporting public health
220 data registries and patient care coordination. The agency may
221 adopt rules to implement this subsection.
222 Section 5. Present subsections (7) through (15) of section
223 408.061, Florida Statutes, are redesignated as subsections (8)
224 through (16), respectively, and a new subsection (7) is added to
225 that section, to read:
226 408.061 Data collection; uniform systems of financial
227 reporting; information relating to physician charges;
228 confidential information; immunity.—
229 (7)(a) Beginning January 1, 2026, the agency shall impose
230 an administrative fine of $10,000 per violation against a
231 nursing home or home office that fails to comply with subsection
232 (5) or subsection (6), as applicable. For purposes of this
233 paragraph, the term “violation” means failing to file the
234 financial report required by subsection (5) or subsection (6),
235 as applicable, on or before the report’s due date. Failing to
236 file the report during any subsequent 10-day period occurring
237 after the due date constitutes a separate violation until the
238 report has been submitted.
239 (b) The agency shall adopt rules to implement this
240 subsection. The rules must include provisions for a nursing home
241 or home office to present factors in mitigation of the
242 imposition of the fine’s full dollar amount. The agency may
243 determine not to impose the fine’s full dollar amount upon a
244 showing that the full fine is inappropriate under the
245 circumstances.
246 Section 6. Subsection (2) of section 408.08, Florida
247 Statutes, is amended to read:
248 408.08 Inspections and audits; violations; penalties;
249 fines; enforcement.—
250 (2) Unless otherwise fined pursuant to s. 408.061(7), any
251 health care facility that refuses to file a report, fails to
252 timely file a report, files a false report, or files an
253 incomplete report and upon notification fails to timely file a
254 complete report required under s. 408.061; that violates this
255 section, s. 408.061, or s. 408.20, or rule adopted thereunder;
256 or that fails to provide documents or records requested by the
257 agency under this chapter shall be punished by a fine not
258 exceeding $1,000 per day for each day in violation, to be
259 imposed and collected by the agency. Pursuant to rules adopted
260 by the agency, the agency may, upon a showing of good cause,
261 grant a one-time extension of any deadline for a health care
262 facility to timely file a report as required by this section, s.
263 408.061, or s. 408.20.
264 Section 7. Paragraph (b) of subsection (2) of section
265 409.908, Florida Statutes, is amended to read:
266 409.908 Reimbursement of Medicaid providers.—Subject to
267 specific appropriations, the agency shall reimburse Medicaid
268 providers, in accordance with state and federal law, according
269 to methodologies set forth in the rules of the agency and in
270 policy manuals and handbooks incorporated by reference therein.
271 These methodologies may include fee schedules, reimbursement
272 methods based on cost reporting, negotiated fees, competitive
273 bidding pursuant to s. 287.057, and other mechanisms the agency
274 considers efficient and effective for purchasing services or
275 goods on behalf of recipients. If a provider is reimbursed based
276 on cost reporting and submits a cost report late and that cost
277 report would have been used to set a lower reimbursement rate
278 for a rate semester, then the provider’s rate for that semester
279 shall be retroactively calculated using the new cost report, and
280 full payment at the recalculated rate shall be effected
281 retroactively. Medicare-granted extensions for filing cost
282 reports, if applicable, shall also apply to Medicaid cost
283 reports. Payment for Medicaid compensable services made on
284 behalf of Medicaid-eligible persons is subject to the
285 availability of moneys and any limitations or directions
286 provided for in the General Appropriations Act or chapter 216.
287 Further, nothing in this section shall be construed to prevent
288 or limit the agency from adjusting fees, reimbursement rates,
289 lengths of stay, number of visits, or number of services, or
290 making any other adjustments necessary to comply with the
291 availability of moneys and any limitations or directions
292 provided for in the General Appropriations Act, provided the
293 adjustment is consistent with legislative intent.
294 (2)
295 (b) Subject to any limitations or directions in the General
296 Appropriations Act, the agency shall establish and implement a
297 state Title XIX Long-Term Care Reimbursement Plan for nursing
298 home care in order to provide care and services in conformance
299 with the applicable state and federal laws, rules, regulations,
300 and quality and safety standards and to ensure that individuals
301 eligible for medical assistance have reasonable geographic
302 access to such care.
303 1. The agency shall amend the long-term care reimbursement
304 plan and cost reporting system to create direct care and
305 indirect care subcomponents of the patient care component of the
306 per diem rate. These two subcomponents together shall equal the
307 patient care component of the per diem rate. Separate prices
308 shall be calculated for each patient care subcomponent,
309 initially based on the September 2016 rate setting cost reports
310 and subsequently based on the most recently audited cost report
311 used during a rebasing year. The direct care subcomponent of the
312 per diem rate for any providers still being reimbursed on a cost
313 basis shall be limited by the cost-based class ceiling, and the
314 indirect care subcomponent may be limited by the lower of the
315 cost-based class ceiling, the target rate class ceiling, or the
316 individual provider target. The ceilings and targets apply only
317 to providers being reimbursed on a cost-based system. Effective
318 October 1, 2018, a prospective payment methodology shall be
319 implemented for rate setting purposes with the following
320 parameters:
321 a. Peer Groups, including:
322 (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
323 Counties; and
324 (II) South-SMMC Regions 10-11, plus Palm Beach and
325 Okeechobee Counties.
326 b. Percentage of Median Costs based on the cost reports
327 used for September 2016 rate setting:
328 (I) Direct Care Costs........................100 percent.
329 (II) Indirect Care Costs......................92 percent.
330 (III) Operating Costs.........................86 percent.
331 c. Floors:
332 (I) Direct Care Component.....................95 percent.
333 (II) Indirect Care Component................92.5 percent.
334 (III) Operating Component...........................None.
335 d. Pass-through Payments..................Real Estate and
336 ...............................................Personal Property
337 ...................................Taxes and Property Insurance.
338 e. Quality Incentive Program Payment
339 Pool.....................................10 percent of September
340 .......................................2016 non-property related
341 ................................payments of included facilities.
342 f. Quality Score Threshold to Quality for Quality Incentive
343 Payment.....................................................20th
344 ..............................percentile of included facilities.
345 g. Fair Rental Value System Payment Parameters:
346 (I) Building Value per Square Foot based on 2018 RS Means.
347 (II) Land Valuation...10 percent of Gross Building value.
348 (III) Facility Square Footage......Actual Square Footage.
349 (IV) Movable Equipment Allowance..........$8,000 per bed.
350 (V) Obsolescence Factor......................1.5 percent.
351 (VI) Fair Rental Rate of Return................8 percent.
352 (VII) Minimum Occupancy.......................90 percent.
353 (VIII) Maximum Facility Age.....................40 years.
354 (IX) Minimum Square Footage per Bed..................350.
355 (X) Maximum Square Footage for Bed...................500.
356 (XI) Minimum Cost of a renovation/replacements$500 per bed.
357 h. Ventilator Supplemental payment of $200 per Medicaid day
358 of 40,000 ventilator Medicaid days per fiscal year.
359 2. The direct care subcomponent shall include salaries and
360 benefits of direct care staff providing nursing services
361 including registered nurses, licensed practical nurses, and
362 certified nursing assistants who deliver care directly to
363 residents in the nursing home facility, allowable therapy costs,
364 and dietary costs. This excludes nursing administration, staff
365 development, the staffing coordinator, and the administrative
366 portion of the minimum data set and care plan coordinators. The
367 direct care subcomponent also includes medically necessary
368 dental care, vision care, hearing care, and podiatric care.
369 3. All other patient care costs shall be included in the
370 indirect care cost subcomponent of the patient care per diem
371 rate, including complex medical equipment, medical supplies, and
372 other allowable ancillary costs. Costs may not be allocated
373 directly or indirectly to the direct care subcomponent from a
374 home office or management company.
375 4. On July 1 of each year, the agency shall report to the
376 Legislature direct and indirect care costs, including average
377 direct and indirect care costs per resident per facility and
378 direct care and indirect care salaries and benefits per category
379 of staff member per facility.
380 5. Every fourth year, the agency shall rebase nursing home
381 prospective payment rates to reflect changes in cost based on
382 the most recently audited cost report for each participating
383 provider.
384 6. A direct care supplemental payment may be made to
385 providers whose direct care hours per patient day are above the
386 80th percentile and who provide Medicaid services to a larger
387 percentage of Medicaid patients than the state average.
388 7. Pediatric, Florida Department of Veterans Affairs, and
389 government-owned facilities are exempt from the pricing model
390 established in this subsection and shall remain on a cost-based
391 prospective payment system. Effective October 1, 2018, the
392 agency shall set rates for all facilities remaining on a cost
393 based prospective payment system using each facility’s most
394 recently audited cost report, eliminating retroactive
395 settlements.
396 8. By October 1, 2025, and each year thereafter, the agency
397 shall submit to the Governor, the President of the Senate, and
398 the Speaker of the House of Representatives a report on each
399 Quality Incentive Program payment made pursuant to sub
400 subparagraph 1.e. The report must, at a minimum, include all of
401 the following information:
402 a. The name of each facility that received a Quality
403 Incentive Program payment and the dollar amount of such payment
404 each facility received.
405 b. The total number of quality incentive metric points
406 awarded by the agency to each facility and the number of points
407 awarded by the agency for each individual quality metric
408 measured.
409 c. An examination of any trends in the improvement of the
410 quality of care provided to nursing home residents which may be
411 attributable to incentive payments received under the Quality
412 Incentive Program. The agency shall include examination of
413 trends both for the program as a whole as well as for each
414 individual quality metric used by the agency to award program
415 payments.
416
417 It is the intent of the Legislature that the reimbursement plan
418 achieve the goal of providing access to health care for nursing
419 home residents who require large amounts of care while
420 encouraging diversion services as an alternative to nursing home
421 care for residents who can be served within the community. The
422 agency shall base the establishment of any maximum rate of
423 payment, whether overall or component, on the available moneys
424 as provided for in the General Appropriations Act. The agency
425 may base the maximum rate of payment on the results of
426 scientifically valid analysis and conclusions derived from
427 objective statistical data pertinent to the particular maximum
428 rate of payment. The agency shall base the rates of payments in
429 accordance with the minimum wage requirements as provided in the
430 General Appropriations Act.
431 Section 8. This act shall take effect July 1, 2025.