Florida Senate - 2025 CS for CS for SB 170
By the Appropriations Committee on Health and Human Services;
the Committee on Health Policy; and Senator Burton
603-02910-25 2025170c2
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.; exempting nursing homes operated by
43 state agencies from certain financial reporting
44 requirements; requiring the agency to impose
45 administrative fines against nursing homes and home
46 offices of nursing homes for failing to comply with
47 certain reporting requirements; defining the term
48 “violation”; providing construction; requiring the
49 agency to adopt rules; providing requirements for such
50 rules; amending s. 408.08, F.S.; prohibiting nursing
51 homes subject to certain administrative fines from
52 being fined under a specified provision for the same
53 violation; amending s. 409.908, F.S.; requiring the
54 agency to revise its methodology for calculating
55 Quality Incentive Program payments; providing
56 requirements for such revision; requiring the agency
57 to submit an annual report to the Governor and the
58 Legislature on payments made under the Quality
59 Incentive Program; specifying requirements for the
60 report; requiring the agency to contract with a third
61 party vendor to conduct a comprehensive study of
62 nursing home quality incentive programs in other
63 states; providing minimum requirements for the report;
64 requiring the agency to submit a final report on the
65 study to the Governor and the Legislature by a
66 specified date; providing an effective date.
67
68 Be It Enacted by the Legislature of the State of Florida:
69
70 Section 1. Notwithstanding the repeal of section 400.0225,
71 Florida Statutes, in section 14 of chapter 2001-377, Laws of
72 Florida, that section is revived, reenacted, and amended to
73 read:
74 400.0225 Consumer satisfaction surveys.—
75 (1) The agency shall develop user-friendly consumer
76 satisfaction surveys to capture resident and family member
77 satisfaction with care provided by nursing home facilities. The
78 consumer satisfaction surveys must be based on a core set of
79 consumer satisfaction questions to allow for consistent
80 measurement and must be administered annually to a random sample
81 of long-stay and short-stay residents of each facility and their
82 family members. The survey tool must be based on an agency
83 validated survey instrument whose measures have received an
84 endorsement by the National Quality Forum.
85 (2) Family members, guardians, or other resident designees
86 may assist a resident in completing the consumer satisfaction
87 survey.
88 (3) Employees and volunteers of the nursing home facility
89 or of a corporation or business entity with an ownership
90 interest in the nursing home facility are prohibited from
91 attempting to influence a resident’s responses to the consumer
92 satisfaction survey.
93 (4) The agency shall specify the protocols for conducting
94 the consumer satisfaction surveys, ensuring survey validity,
95 reporting survey results, and protecting the identity of
96 individual respondents. The agency shall make aggregated survey
97 data available to consumers on the agency’s website pursuant to
98 s. 400.191(2)(a)15. in a manner that allows for comparison
99 between nursing home facilities, or its contractor, in
100 consultation with the nursing home industry and consumer
101 representatives, shall develop an easy-to-use consumer
102 satisfaction survey, shall ensure that every nursing facility
103 licensed pursuant to this part participates in assessing
104 consumer satisfaction, and shall establish procedures to ensure
105 that, at least annually, a representative sample of residents of
106 each facility is selected to participate in the survey. The
107 sample shall be of sufficient size to allow comparisons between
108 and among facilities. Family members, guardians, or other
109 resident designees may assist the resident in completing the
110 survey. Employees and volunteers of the nursing facility or of a
111 corporation or business entity with an ownership interest in the
112 facility are prohibited from assisting a resident with or
113 attempting to influence a resident’s responses to the consumer
114 satisfaction survey. The agency, or its contractor, shall survey
115 family members, guardians, or other resident designees. The
116 agency, or its contractor, shall specify the protocol for
117 conducting and reporting the consumer satisfaction surveys.
118 Reports of consumer satisfaction surveys shall protect the
119 identity of individual respondents. The agency shall contract
120 for consumer satisfaction surveys and report the results of
121 those surveys in the consumer information materials prepared and
122 distributed by the agency.
123 (5) The agency may adopt rules as necessary to implement
124 administer this section.
125 Section 2. Paragraph (b) of subsection (1) of section
126 400.141, Florida Statutes, is amended, and paragraph (x) is
127 added to that subsection, to read:
128 400.141 Administration and management of nursing home
129 facilities.—
130 (1) Every licensed facility shall comply with all
131 applicable standards and rules of the agency and shall:
132 (b) Appoint a medical director licensed pursuant to chapter
133 458 or chapter 459. By January 1, 2026, the medical director of
134 each nursing home facility must obtain designation as a
135 certified medical director by the American Medical Directors
136 Association, hold a similar credential bestowed by an
137 organization recognized by the agency, or be in the process of
138 seeking such designation or credentialing, according to
139 parameters adopted by agency rule. The agency shall include the
140 name of each nursing home facility’s medical director on the
141 facility’s provider profile published by the agency on its
142 website. The agency may establish by rule more specific criteria
143 for the appointment of a medical director.
144 (x) Conduct, at least biennially, a patient safety culture
145 survey using the applicable Survey on Patient Safety Culture
146 developed by the federal Agency for Healthcare Research and
147 Quality. Each facility shall conduct the survey anonymously to
148 encourage completion of the survey by staff working in or
149 employed by the facility. A facility may contract with a third
150 party to administer the survey. Each facility shall biennially
151 submit the survey data to the agency in a format specified by
152 agency rule, which must include the survey participation rate.
153 Each facility may develop an internal action plan between
154 conducting surveys to identify measures to improve the survey
155 and submit such plan to the agency.
156 Section 3. Paragraph (a) of subsection (2) of section
157 400.191, Florida Statutes, is amended to read:
158 400.191 Availability, distribution, and posting of reports
159 and records.—
160 (2) The agency shall publish the Nursing Home Guide
161 quarterly in electronic form to assist consumers and their
162 families in comparing and evaluating nursing home facilities.
163 (a) The agency shall provide an Internet site which must
164 shall include at least the following information either directly
165 or indirectly through a link to another established site or
166 sites of the agency’s choosing:
167 1. A section entitled “Have you considered programs that
168 provide alternatives to nursing home care?” which must shall be
169 the first section of the Nursing Home Guide and must which shall
170 prominently display information about available alternatives to
171 nursing homes and how to obtain additional information regarding
172 these alternatives. The Nursing Home Guide must shall explain
173 that this state offers alternative programs that allow permit
174 qualified elderly persons to stay in their homes instead of
175 being placed in nursing homes and must shall encourage
176 interested persons to call the Comprehensive Assessment Review
177 and Evaluation for Long-Term Care Services (CARES) Program to
178 inquire as to whether if they qualify. The Nursing Home Guide
179 must shall list available home and community-based programs and
180 must which shall clearly state the services that are provided,
181 including and indicate whether nursing home services are covered
182 under those programs when necessary included if needed.
183 2. A list by name and address of all nursing home
184 facilities in this state, including any prior name by which a
185 facility was known during the previous 24-month period.
186 3. Whether such nursing home facilities are proprietary or
187 nonproprietary.
188 4. The current owner of the facility’s license and the year
189 that that entity became the owner of the license.
190 5. The name of the owner or owners of each facility and
191 whether the facility is affiliated with a company or other
192 organization owning or managing more than one nursing facility
193 in this state.
194 6. The total number of beds in each facility and the most
195 recently available occupancy levels.
196 7. The number of private and semiprivate rooms in each
197 facility.
198 8. The religious affiliation, if any, of each facility.
199 9. The languages spoken by the administrator and staff of
200 each facility.
201 10. Whether or not each facility accepts Medicare or
202 Medicaid recipients or insurance, health maintenance
203 organization, United States Department of Veterans Affairs,
204 CHAMPUS program, or workers’ compensation coverage.
205 11. Recreational and other programs available at each
206 facility.
207 12. Special care units or programs offered at each
208 facility.
209 13. Whether the facility is a part of a retirement
210 community that offers other services pursuant to part III of
211 this chapter or part I or part III of chapter 429.
212 14. Survey and deficiency information, including all
213 federal and state recertification, licensure, revisit, and
214 complaint survey information, for each facility. For
215 noncertified nursing homes, state survey and deficiency
216 information, including licensure, revisit, and complaint survey
217 information, shall be provided.
218 15. The results of consumer satisfaction surveys conducted
219 pursuant to s. 400.0225.
220 Section 4. Present subsections (6) and (7) of section
221 408.051, Florida Statutes, are redesignated as subsections (7)
222 and (8), respectively, and a new subsection (6) is added to that
223 section, to read:
224 408.051 Florida Electronic Health Records Exchange Act.—
225 (6) NURSING HOME DATA.—A nursing home facility as defined
226 in s. 400.021 which maintains certified electronic health record
227 technology shall make available all admission, transfer, and
228 discharge data to the agency’s Florida Health Information
229 Exchange program for the purpose of supporting public health
230 data registries and patient care coordination. The agency may
231 adopt rules to implement this subsection.
232 Section 5. Present subsections (7) through (15) of section
233 408.061, Florida Statutes, are redesignated as subsections (8)
234 through (16), respectively, a new subsection (7) is added to
235 that section, and subsections (5) and (6) of that section are
236 amended, to read:
237 408.061 Data collection; uniform systems of financial
238 reporting; information relating to physician charges;
239 confidential information; immunity.—
240 (5) Within 120 days after the end of its fiscal year, each
241 nursing home as defined in s. 408.07, excluding nursing homes
242 operated by state agencies, shall file with the agency, on forms
243 adopted by the agency and based on the uniform system of
244 financial reporting, its actual financial experience for that
245 fiscal year, including expenditures, revenues, and statistical
246 measures. Such data may be based on internal financial reports
247 that are certified to be complete and accurate by the chief
248 financial officer of the nursing home. However, a nursing home’s
249 actual financial experience shall be its audited actual
250 experience. This audited actual experience must include the
251 fiscal year-end balance sheet, income statement, statement of
252 cash flow, and statement of retained earnings and must be
253 submitted to the agency in addition to the information filed in
254 the uniform system of financial reporting. The financial
255 statements must tie to the information submitted in the uniform
256 system of financial reporting, and a crosswalk must be submitted
257 along with the financial statements.
258 (6) Within 120 days after the end of its fiscal year, the
259 home office of each nursing home as defined in s. 408.07,
260 excluding nursing homes operated by state agencies, shall file
261 with the agency, on forms adopted by the agency and based on the
262 uniform system of financial reporting, its actual financial
263 experience for that fiscal year, including expenditures,
264 revenues, and statistical measures. Such data may be based on
265 internal financial reports that are certified to be complete and
266 accurate by the chief financial officer of the nursing home.
267 However, the home office’s actual financial experience shall be
268 its audited actual experience. This audited actual experience
269 must include the fiscal year-end balance sheet, income
270 statement, statement of cash flow, and statement of retained
271 earnings and must be submitted to the agency in addition to the
272 information filed in the uniform system of financial reporting.
273 The financial statements must tie to the information submitted
274 in the uniform system of financial reporting, and a crosswalk
275 must be submitted along with the audited financial statements.
276 (7)(a) Beginning January 1, 2026, the agency shall impose
277 an administrative fine of $10,000 per violation against a
278 nursing home or home office that fails to comply with subsection
279 (5) or subsection (6), as applicable. For purposes of this
280 paragraph, the term “violation” means failing to file the
281 financial report required by subsection (5) or subsection (6),
282 as applicable, on or before the report’s due date. Failing to
283 file the report during any subsequent 10-day period occurring
284 after the due date constitutes a separate violation until the
285 report has been submitted.
286 (b) The agency shall adopt rules to implement this
287 subsection. The rules must include provisions for a nursing home
288 or home office to present factors in mitigation of the
289 imposition of the fine’s full dollar amount. The agency may
290 determine not to impose the fine’s full dollar amount upon a
291 showing that the full fine is inappropriate under the
292 circumstances.
293 Section 6. Subsection (2) of section 408.08, Florida
294 Statutes, is amended to read:
295 408.08 Inspections and audits; violations; penalties;
296 fines; enforcement.—
297 (2) Any health care facility that refuses to file a report,
298 fails to timely file a report, files a false report, or files an
299 incomplete report and upon notification fails to timely file a
300 complete report required under s. 408.061; that violates this
301 section, s. 408.061, or s. 408.20, or rule adopted thereunder;
302 or that fails to provide documents or records requested by the
303 agency under this chapter shall be punished by a fine not
304 exceeding $1,000 per day for each day in violation, to be
305 imposed and collected by the agency. Pursuant to rules adopted
306 by the agency, the agency may, upon a showing of good cause,
307 grant a one-time extension of any deadline for a health care
308 facility to timely file a report as required by this section, s.
309 408.061, or s. 408.20. A facility fined under s. 408.061(7) may
310 not be additionally fined under this subsection for the same
311 violation.
312 Section 7. Paragraph (b) of subsection (2) of section
313 409.908, Florida Statutes, is amended to read:
314 409.908 Reimbursement of Medicaid providers.—Subject to
315 specific appropriations, the agency shall reimburse Medicaid
316 providers, in accordance with state and federal law, according
317 to methodologies set forth in the rules of the agency and in
318 policy manuals and handbooks incorporated by reference therein.
319 These methodologies may include fee schedules, reimbursement
320 methods based on cost reporting, negotiated fees, competitive
321 bidding pursuant to s. 287.057, and other mechanisms the agency
322 considers efficient and effective for purchasing services or
323 goods on behalf of recipients. If a provider is reimbursed based
324 on cost reporting and submits a cost report late and that cost
325 report would have been used to set a lower reimbursement rate
326 for a rate semester, then the provider’s rate for that semester
327 shall be retroactively calculated using the new cost report, and
328 full payment at the recalculated rate shall be effected
329 retroactively. Medicare-granted extensions for filing cost
330 reports, if applicable, shall also apply to Medicaid cost
331 reports. Payment for Medicaid compensable services made on
332 behalf of Medicaid-eligible persons is subject to the
333 availability of moneys and any limitations or directions
334 provided for in the General Appropriations Act or chapter 216.
335 Further, nothing in this section shall be construed to prevent
336 or limit the agency from adjusting fees, reimbursement rates,
337 lengths of stay, number of visits, or number of services, or
338 making any other adjustments necessary to comply with the
339 availability of moneys and any limitations or directions
340 provided for in the General Appropriations Act, provided the
341 adjustment is consistent with legislative intent.
342 (2)
343 (b) Subject to any limitations or directions in the General
344 Appropriations Act, the agency shall establish and implement a
345 state Title XIX Long-Term Care Reimbursement Plan for nursing
346 home care in order to provide care and services in conformance
347 with the applicable state and federal laws, rules, regulations,
348 and quality and safety standards and to ensure that individuals
349 eligible for medical assistance have reasonable geographic
350 access to such care.
351 1. The agency shall amend the long-term care reimbursement
352 plan and cost reporting system to create direct care and
353 indirect care subcomponents of the patient care component of the
354 per diem rate. These two subcomponents together shall equal the
355 patient care component of the per diem rate. Separate prices
356 shall be calculated for each patient care subcomponent,
357 initially based on the September 2016 rate setting cost reports
358 and subsequently based on the most recently audited cost report
359 used during a rebasing year. The direct care subcomponent of the
360 per diem rate for any providers still being reimbursed on a cost
361 basis shall be limited by the cost-based class ceiling, and the
362 indirect care subcomponent may be limited by the lower of the
363 cost-based class ceiling, the target rate class ceiling, or the
364 individual provider target. The ceilings and targets apply only
365 to providers being reimbursed on a cost-based system. Effective
366 October 1, 2018, a prospective payment methodology shall be
367 implemented for rate setting purposes with the following
368 parameters:
369 a. Peer Groups, including:
370 (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
371 Counties; and
372 (II) South-SMMC Regions 10-11, plus Palm Beach and
373 Okeechobee Counties.
374 b. Percentage of Median Costs based on the cost reports
375 used for September 2016 rate setting:
376 (I) Direct Care Costs........................100 percent.
377 (II) Indirect Care Costs......................92 percent.
378 (III) Operating Costs.........................86 percent.
379 c. Floors:
380 (I) Direct Care Component.....................95 percent.
381 (II) Indirect Care Component................92.5 percent.
382 (III) Operating Component...........................None.
383 d. Pass-through Payments..................Real Estate and
384 ...............................................Personal Property
385 ...................................Taxes and Property Insurance.
386 e. Quality Incentive Program Payment
387 Pool.....................................10 percent of September
388 .......................................2016 non-property related
389 ................................payments of included facilities.
390 f. Quality Score Threshold to Qualify Quality for Quality
391 Incentive Payment...........................................20th
392 ..............................percentile of included facilities.
393 g. Fair Rental Value System Payment Parameters:
394 (I) Building Value per Square Foot based on 2018 RS Means.
395 (II) Land Valuation...10 percent of Gross Building value.
396 (III) Facility Square Footage......Actual Square Footage.
397 (IV) Movable Equipment Allowance..........$8,000 per bed.
398 (V) Obsolescence Factor......................1.5 percent.
399 (VI) Fair Rental Rate of Return................8 percent.
400 (VII) Minimum Occupancy.......................90 percent.
401 (VIII) Maximum Facility Age.....................40 years.
402 (IX) Minimum Square Footage per Bed..................350.
403 (X) Maximum Square Footage for Bed...................500.
404 (XI) Minimum Cost of a renovation/replacements$500 per bed.
405 h. Ventilator Supplemental payment of $200 per Medicaid day
406 of 40,000 ventilator Medicaid days per fiscal year.
407 2. The agency shall revise its methodology for calculating
408 Quality Incentive Program payments to include the results of
409 consumer satisfaction surveys conducted pursuant to s. 400.0225
410 as a measure of nursing home quality. The agency shall so revise
411 the methodology after the surveys have been in effect for an
412 amount of time the agency deems sufficient for statistical and
413 scientific validity as a meaningful quality measure that may be
414 incorporated into the methodology.
415 3. The direct care subcomponent shall include salaries and
416 benefits of direct care staff providing nursing services
417 including registered nurses, licensed practical nurses, and
418 certified nursing assistants who deliver care directly to
419 residents in the nursing home facility, allowable therapy costs,
420 and dietary costs. This excludes nursing administration, staff
421 development, the staffing coordinator, and the administrative
422 portion of the minimum data set and care plan coordinators. The
423 direct care subcomponent also includes medically necessary
424 dental care, vision care, hearing care, and podiatric care.
425 4.3. All other patient care costs shall be included in the
426 indirect care cost subcomponent of the patient care per diem
427 rate, including complex medical equipment, medical supplies, and
428 other allowable ancillary costs. Costs may not be allocated
429 directly or indirectly to the direct care subcomponent from a
430 home office or management company.
431 5.4. On July 1 of each year, the agency shall report to the
432 Legislature direct and indirect care costs, including average
433 direct and indirect care costs per resident per facility and
434 direct care and indirect care salaries and benefits per category
435 of staff member per facility.
436 6.5. Every fourth year, the agency shall rebase nursing
437 home prospective payment rates to reflect changes in cost based
438 on the most recently audited cost report for each participating
439 provider.
440 7.6. A direct care supplemental payment may be made to
441 providers whose direct care hours per patient day are above the
442 80th percentile and who provide Medicaid services to a larger
443 percentage of Medicaid patients than the state average.
444 8.7. Pediatric, Florida Department of Veterans Affairs, and
445 government-owned facilities are exempt from the pricing model
446 established in this subsection and shall remain on a cost-based
447 prospective payment system. Effective October 1, 2018, the
448 agency shall set rates for all facilities remaining on a cost
449 based prospective payment system using each facility’s most
450 recently audited cost report, eliminating retroactive
451 settlements.
452 9. By October 1, 2025, and each year thereafter, the agency
453 shall submit to the Governor, the President of the Senate, and
454 the Speaker of the House of Representatives a report on each
455 Quality Incentive Program payment made pursuant to sub
456 subparagraph 1.e. The report must, at a minimum, include all of
457 the following information:
458 a. The name of each facility that received a Quality
459 Incentive Program payment and the dollar amount of such payment
460 each facility received.
461 b. The total number of quality incentive metric points
462 awarded by the agency to each facility and the number of points
463 awarded by the agency for each individual quality metric
464 measured.
465 c. An examination of any trends in the improvement of the
466 quality of care provided to nursing home residents which may be
467 attributable to incentive payments received under the Quality
468 Incentive Program. The agency shall include examination of
469 trends both for the program as a whole as well as for each
470 individual quality metric used by the agency to award program
471 payments.
472
473 It is the intent of the Legislature that the reimbursement plan
474 achieve the goal of providing access to health care for nursing
475 home residents who require large amounts of care while
476 encouraging diversion services as an alternative to nursing home
477 care for residents who can be served within the community. The
478 agency shall base the establishment of any maximum rate of
479 payment, whether overall or component, on the available moneys
480 as provided for in the General Appropriations Act. The agency
481 may base the maximum rate of payment on the results of
482 scientifically valid analysis and conclusions derived from
483 objective statistical data pertinent to the particular maximum
484 rate of payment. The agency shall base the rates of payments in
485 accordance with the minimum wage requirements as provided in the
486 General Appropriations Act.
487 Section 8. (1) To support and enhance quality outcomes in
488 Florida’s nursing homes, the Agency for Health Care
489 Administration shall contract with a third-party vendor to
490 conduct a comprehensive study of nursing home quality incentive
491 programs in other states.
492 (a) At a minimum, the study must include a detailed
493 analysis of quality incentive programs implemented in each of
494 the states examined, identify components of such programs which
495 have demonstrably improved nursing home quality outcomes, and
496 provide recommendations to modify or enhance this state’s
497 existing Medicaid Quality Incentive Program based on its
498 historical performance and trends since it was first
499 implemented.
500 (b) The study must also include:
501 1. An in-depth review of emerging and existing technologies
502 applicable to nursing home care and an analysis of how their
503 adoption in this state could improve quality of care and
504 operational efficiency; and
505 2. An examination of other states’ Medicaid add-on payment
506 structures related to the provision of ventilator care,
507 bariatric services, and behavioral health services.
508 (2) The agency shall submit a final report on the study,
509 including findings and actionable recommendations, to the
510 Governor, the President of the Senate, and the Speaker of the
511 House of Representatives by December 1, 2025.
512 Section 9. This act shall take effect July 1, 2025.