With only two weeks left in the 2018 legislative session, proposed rules requiring generators for long-term care providers continue to await action, in part because of the financial impact on assisted living facilities.
House Health & Services Chairman Travis Cummings. R-Fleming Island, continues to struggle with ratifying a rule requiring, among other things, nearly 3,0000 assisted living facilities to have backup-power generators on site. Unlike nursing homes, assisted living facilities can’t offset the costs with Medicaid funding.
Agency for Health Care Administration Secretary Justin Senior told The News Service of Florida on Thursday that his agency has been meeting with House members to discuss the proposed rules for ALFs and nursing homes and said ratification was one of his agency’s top priorities this session.
“We’re hopeful, obviously, next week that the rules will start moving,” Senior said. “And we’ve talked to the members and answered their questions, so that’s where we are.
Gov. Rick Scott’s administration has pushed for generators at ALFs and nursing homes since the deaths in September of residents of The Rehabilitation Center at Hollywood Hills, a Broward County nursing home that lost its air-conditioning system in Hurricane Irma. But long-term care providers have raised repeated concerns about issues such as costs and requirements to store fuel.
Assisted living facilities are designed to provide services in a less-restrictive and more home-like environment than nursing homes. They range from one resident to several hundred residents and offer various types of personal and nursing services.
One of the proposed rules would mandate that ALFs have generators on site, but the equipment wouldn’t have to be installed. ALFs with 16 or fewer beds would have to keep onsite 48 hours of fuel, and facilities with 17 or more beds would have to keep onsite 72 hours of fuel, unless barred by local ordinances. During declared emergencies, they would have to obtain another 24 hours of fuel.
An estimate shows it would cost the 2,951 assisted living facilities in the state more than $243 million to comply with the rule.
Those are costs that providers cannot absorb, said Doug Adkins, owner of two assisted living facilities in Nassau County. Adkins said ALFs are facing rising overhead costs and are providing services to people with higher levels of medical needs than ever before.
“People are struggling, so the reality is the dollars are not there. So the question is who pays? And there’s no answer to that question,” Adkins said
Senior said this is the first time the Agency for Health Care Administration has proposed rules that require legislative ratification because of the fiscal impact. Since 2010, any rule that increases the costs of regulation by $1 million over a five-year period has required legislative ratification to take effect.
That process usually starts with a bill in a legislative policy committee, but there aren’t any hard and fast rules, which means an issue that appears stalled in the process can suddenly spring to life.
“We’re learning about the process as it goes along, and we’ve had good conversations about it with everybody,” Senior said. “So we’re still feeling very hopeful about it.”
The ALF rule, along with a similar mandate on nursing homes, was agreed to by long-term care providers and the Scott administration, which had been in a legal tussle following the deaths of the Broward nursing-home residents.
The House has included in a proposed tax package a $6.7 million sales-tax exemption for generator purchases by nursing homes and assisted living facilities.
But the overall generator issue likely will come down to funding. Also, Cummings said lawmakers will have less discretionary money available as they increase spending for mental health and school safety after the mass shooting Feb. 14 at Marjory Stoneman Douglas High School in Parkland.
“However, we know it’s important, with Hurricane Irma, in trying to be better prepared moving forward to care for our elderly citizens in the state of Florida,” he said. “So we haven’t made a decision, is my point. We have got to revisit that.”
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