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.