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 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.; 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: 74 400.0225Consumer 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 residents 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 agencys 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 residents 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: 128 400.141Administration 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 facilitys medical director on the 141 facilitys 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: 158 400.191Availability, 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 agencys 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 facilitys 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: 224 408.051Florida 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 agencys 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: 237 408.061Data 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 homes 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 offices 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 reports 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 fines full dollar amount. The agency may 290 determine not to impose the fines 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: 295 408.08Inspections 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: 314 409.908Reimbursement 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 providers 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 facilitys 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 Floridas 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 states 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.