FHCA Member Update

April 27, 2009

Dear FHCA Member Nursing Homes:

During the January 2009 special session, FHCA presented a strong, unified message to urge legislators to implement the Quality Assessment Program to fund nursing home care. As a result, Senate Bill 8-A passed and on April 1, 2009, the Quality Assessment Program went into effect. An assessment will be imposed on all nursing homes (with certain exceptions) not to exceed 5.5 percent of total aggregate net patient service revenue. The assessment will be pooled and will allow the state to draw down additional federal matching revenues for the purpose of funding the cost of nursing home services to Medicaid beneficiaries. As a result, nursing homes will "buy back" nearly $390 million in rate reductions that were implemented January 1, 2008, January 1, 2009 and March 1, 2009.

The Agency for Health Care Administration (Agency) is responsible for implementing the assessment, which is calculated monthly on a per-resident-day basis, excluding Medicare resident days. Today, April 27, the Agency's online reporting form went live, allowing for nursing homes to register to submit the required information each month. In order to comply with ss.409.9082 Florida Statute, each licensed nursing home must complete their registration with the Agency, even if exempt from the assessment, between April 27 - May 1, 2009. Additionally, each facility must report their data online and remit the first monthly assessment payment no later than May 15, 2009.

The assessment will be calculated annually on a per-resident-day basis, excluding Medicare resident days, and shall be uniform except as otherwise provided in the law. Nursing homes may not create a separate line-item charge for the purpose of passing through the assessment to facility residents. The Agency for Health Care Administration (AHCA) is required to seek necessary federal approval of waivers and state plan amendments, and everything is on track for approval from the Centers for Medicare & Medicaid Services for the program. You can read more about the Nursing Home Quality Assessment Program, including facts and figures about exemptions, Medicaid rates and penalties in the special article from FHCA's April Pulse newsletter.

How to Register
Registration is a two-part process initiated by the nursing home facility and finalized by the Agency. The facility must complete the online registration form between April 27 - May 1, 2009, after which the User Agreement Form must be printed, signed by the Nursing Home Administrator and returned to the Agency by fax (850-922-3659) or e-mail. Nursing homes can have multiple registrants, including a representative at the facility or at the corporate office who may register on behalf of multiple facilities.

Once the Agency receives and approves the nursing home facility's registration, a confirmation e-mail will be sent to the facility, which will allow you to then report net patient revenue and patient day data to the Agency (Please note: the Agency is aware of an error that some facilities may be experiencing when attempting to print the User Agreement Form and is working to rectify this situation as soon as possible).

Reporting Data
Nursing home facilities shall use the online data collection form to submit monthly: net patient revenue, Medicaid patient days, private/other non-Medicare patient days and Medicare patient days.

FHCA has made the Agency aware that facilities cannot report a reliable net patient revenue by the 15th of the month, and we are working with them to address this issue. While the Agency will require that net patient revenues are reported, the field included in the current online collection form is not mandatory for submitting the form at ths time.

Remitting Payment
Payments are due by the 15th day of the following calendar month (ex: the April 2009 assessment shall be paid by May 15, 2009). Delinquent payments are subject to fines, liens against medical assessment payments and/or licensure action.

Nursing home facilities will use the online data collection form to enter patient day data, with the system automatically calculating the facility's monthly assessment amount. This will be done by multiplying the number of non-Medicare resident days by the assessment rate, which is $10.62 for most facilities, $1.92 for high-Medicaid volume facilities with annual Medicaid days exceeding 53,000 or $0 for certain exempt facilities. The online data reporting tool also contains an Assessment Cost Document where facilities can view their assessment rate.

If an amount is due, the facility should print, sign and submit the remittance document with payment. The document can be signed by the Nursing Home Administrator or a designee (which could include a representative from the corporate office submitting payments on behalf of multiple facilities). If a facility is exempt, the rate will be zero and no remittance page will print.

To read more from the Agency's Instructions on the Quality Assessment Fee, click here. If you have questions about the online reporting form or need further information, please contact John Fortier at the Agency by phone at (850) 921-6999 or via e-mail.

Without the strong and unified message presented to lawmakers by FHCA members, combined with the knowledge and expertise of FHCA's staff and lobby team, the Quality Assessment Program may not have passed during this 2009 special session. This legislative victory prevented nursing homes from facing a Medicaid funding shortfall of nearly $231 million, which would have resulted in significant financial instability, staff layoffs and the elimination of services that would have affected our residents' quality of care and quality of life. As we enter the final days of the 2009 regular session, know that FHCA will continue working on your behalf to fight for adequate reimbursement.

FHCA has posted information on our Web site regarding the Quality Assessment Program, which can be found under the What's New link. Thank you again for your attention to this important issue.

Sincerely,

J. Emmett Reed, CAE 
FHCA Executive Director