Bush Enters Florida Nursing Home ‘Fray’ with Reform Package

Florida Gov. Jeb Bush (R) on Jan. 9 "jumped" into the state's nursing home discussion, proposing litigation reforms and a $128 million plan to improve staffing and offer care alternatives for seniors, the Florida Times-Union reports (Mattson/Saunders, Florida Times-Union, 1/10). Under the proposal, Florida would provide $52.4 million for a "diversion" program that allows seniors to reside at an assisted living facility or at home instead of a nursing home. The plan also calls for $46 million to bolster the quality of care in nursing homes and $30 million to provide prescription drugs for low-income seniors (LaCorte, AP/Tallahassee Democrat, 1/10). In addition, Bush's "elder-friendly" proposal "revived" the nursing home industry's quest for litigation reform after a state-appointed task force on long term care failed to agree on any recommendations for the Florida Legislature before disbanding last month. "I think it's good [Bush is] not letting this just die," Bennett Napier, executive director of the Florida Life Care Residents Association, said (Florida-Times Union, 1/10). Although Bush and the long term care industry hope to cap lawsuits against nursing homes, trial lawyers oppose such reforms (Tallahassee Democrat, 1/10). Trial lawyers call reforms that "make it harder to sue" the nursing home industry without imposing "tougher" regulatory enforcement and quality improvements "unfair." While Bush admitted that litigation reform would prove "controversial," he called the recent surge of lawsuits against long term care facilities a "serious threat" to the availability of care. "There's got to be some middle ground here. To ignore it -- we do it at our peril," Bush said. Florida Senate Majority Leader Jim King (R) praised Bush's plan, concluding, "If we don't do something quickly, Aunt Carol is going to come home" (Florida Times-Union, 1/10).

Necessary Surgery?
Meanwhile, the head of Florida's health care administration agency has introduced a plan to use budget cuts and a competitive bidding process to trim the state's projected $966 million Medicaid budget shortfall, the Business Journal of Jacksonville reports. The shortfall, the "largest cumulative Medicaid deficit in [Florida's] history," is a result of rising enrollment and prescription drug costs. It includes deficits incurred from fiscal year 1999 to those estimated through fiscal year 2001. Bush is scheduled to announce this month his proposed budget for the fiscal year from July 1, 2001, though June 30, 2002, and Agency for Health Care Administration Secretary Ruben King-Shaw recently submitted his budget request for the same period. His request included roughly $118 million in deductions, along with a proposal "requiring hospitals in certain regions of the state to bid on the Medicaid program." While all hospitals who participated in Medicaid could continue to provide emergency care under the proposal, "non-emergency care would be limited to hospitals selected in the competitive bid process." King-Shaw estimates that competitive bidding could lead to a 5% annual savings. The secretary also suggested that $105 million be cut from MediPass, the state's "popular ... primary care case management program" that "allows Medicaid recipients to see the doctor of their choice." Under the proposal, the program would cease in counties with at least two Medicaid HMOs, leaving MediPass in "only 16 counties, mostly rural." Currently there are roughly 600,944 MediPass participants statewide, compared to 490,758 individuals participating in a Medicaid HMO. These cuts, according to the Business Journal, "threaten to hurt" providers, but the shortfall will place "more pressure" on the governor and state legislators "to trim other parts of the state budget or reduce promised tax cuts in 2001" (Sexton, Business Journal of Jacksonville, 1/8).