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 residents 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 directors name on each nursing home 24 facilitys 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 agencys 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: 60 400.0225Consumer 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 residents 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 agencys 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 residents 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: 114 400.141Administration 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 facilitys medical director on the 127 facilitys 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: 144 400.191Availability, 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 agencys 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 facilitys 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: 210 408.051Florida 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 agencys 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: 220 408.061Data 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 offices 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: 258 409.908Reimbursement 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 providers 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 facilitys 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.