Nursing Homes Look For State Money For Generators

November 14, 2017

Florida’s largest nursing-home association has one question as the 2018 legislative session approaches: Will the state help foot the costs of generators at nursing homes?

But getting an answer is proving elusive.

Florida Health Care Association chief lobbyist Bob Asztalos on Monday asked a top Medicaid official whether nursing homes would be authorized to include generators on the cost reports facilities are required to submit to the state.

The answer from Tom Wallace, who is the interim assistant deputy secretary for Medicaid finance and analytics at the Agency for Health Care Administration, did not give a clear picture.

“The agency’s response right now would be, we are looking at that. We are looking into that and what is the best approach to doing this,” Wallace said.

Asztalos asked the question at the third and final meeting of the Nursing Home Prospective Payment Working Group, which met Monday at the agency’s Tallahassee headquarters.

The question was posed as the group started discussing Hurricane Irma and the state’s response to the storm.

The Legislature during the 2017 session directed AHCA to assemble the group and have it examine the myriad issues involved in switching the state’s Medicaid reimbursement for nursing homes away from a cost-based system and toward a “prospective payment” system.

Under a cost-based system, nursing homes annually submit unaudited cost reports that are used as the basis for payment. After the reports are audited, providers can go back and demand higher reimbursements.

Under the prospective payment system, nursing homes will be reimbursed predetermined, fixed amounts.

Nursing homes became a high-profile issue after residents of a sweltering Broward County nursing home died following Hurricane Irma. Eight residents of The Rehabilitation Center at Hollywood Hills died Sept. 13, three days after the storm knocked out the facility’s air-conditioning system. Six others died after evacuation.

The deaths prompted Gov. Rick Scott’s administration to issue emergency rules requiring nursing homes and assisted-living facilities to have generators and enough fuel to cool buildings for 96 hours.

The rules were challenged by three long-term care associations that argued the Scott administration violated state law because there was no emergency and that the rules overstepped legislative authority. Though an administrative law judge sided with the groups, the Scott administration took the issue to the 1st District Court of Appeal. The administration maintains the rules stay in effect during the appeal.

The Florida Health Care Association estimates that it would cost about $230 million for more than 650 nursing homes to get generators. The association would like Medicaid — which pays for about 60 percent of nursing-homes days on average — to help offset a corresponding amount of the costs. If that were the case, it would cost Florida taxpayers about $53.8 million. Another $84.1 million would be absorbed by federal matching dollars.

Asztalos, whose association did not challenge the rules, said nursing homes are precluded from transferring residents to special needs shelters. Generally, nursing homes ink agreements with other nursing homes that allow them to transfer patients in case of hurricanes or storms.

During Hurricane Irma, Asztalos said, many East Coast nursing homes transferred patients to facilities on the state’s West Coast. But when Hurricane Irma changed course and started barreling toward the West Coast, that put some nursing homes who agreed to take residents from East Coast facilities in the awkward position of evacuating not only their residents but the residents they agreed to take from sister facilities.

“We agree with the governor we’ve got to get these generators,” he said.

Asztalos said that hardening nursing homes would not only allow the facilities to keep residents in place but enable the facilities to serve as special-needs shelters and take in people who need shelter from storms.

“I think this does have a public policy point for the state,” he said, adding that generators could also help abate what could be a growing problem in that nursing homes are beginning to “pull back on evacuation agreements (with other facilities).”

Working group member, Scott Hopes said Manatee County opened 25 shelters that had capacity to serve about 25,000 people. But only one of the shelters, he said, was a dedicated special needs shelter. It was able to accommodate about 500 people.

“We had special needs residents in every one of the (shelters),” Hopes said adding that people with oxygen and oxygen generators, “just were everywhere.”

Jennifer Langer Jacobs, an administrator with Sunshine Health, told the panel that care coordinators who work at the HMO were worried about their clients and where they could be evacuated.

“Ultimately, everybody got where they needed to get to, but I think the stress level in the system was much higher than what it needed to be,” she said.

by Christine Sexton, The News Service of Florida

Comments

7 Responses to “Nursing Homes Look For State Money For Generators”

  1. Howie on November 15th, 2017 12:26 pm

    These facilities that are required to put in place standby generators – yes they can afford it. A 100 KW Electric Generator costs $24,500 because I priced them. That size will cover a large square foot area. Your buildings may need 5 generators, and so what. Nursing homes and assisted living facilities are the richest business in the US. Hospitals and Medical Centers already have in place a standby alternate power source. I’m glad that Gov. Scott is making this mandatory. You never know when you or I may be in one of these facilities.

    Great comments by all of you !

  2. bewildered on November 15th, 2017 4:56 am

    The State and private companies have to keep all institutionalized people as comfortable as humanly possible (Prisons, mental health facilities, etc) or lawsuits would go through the roof. It’s a fine line between death due to the result of a natural disaster (an act of God) and gross negligence. No matter how hard we try to overcome the law of nature that weeds out the weak, old, and feeble of any other species or plant category – we will fail in certain instances where Humans are concerned.

  3. Dan on November 14th, 2017 7:14 pm

    Good comments on the need for nursing and rehab centers to have standby generators to provide needed power during storms. I do believe that any care facility currently has to provide a written plan to the state in the event of storms or any other emergency. Do these plans include the ability to power themselves following an event? I doubt it.
    Keep in mind that simply installing a generator and closing the doors is not in itself an answer. Generators need fuel, if natural gas fired what is the reliability of the local or municipal utilities to provide an uninterrupted supply of natural gas? If diesel fired, which comes with FDEP regulations for containment in the event of a spill. What inspections are in place to test the fuel that has been in a fuel tank for five years?
    A generator with a running engine can only produce electricity if the generator is sound so an annual load test is needed to confirm the integrity of the electrical producing piece of the package. All of these things cost money that the operators will certainly complain about.
    There is no easy answer but I do think that onsite operational electrical generation should be mandated for these facilities to protect and care for some of our most vulnerable citizens. Wasn’t something similar put in place for gasoline retailers so we could fill our cars? Take a look around the hospitals, do they have standby generators? Yes, they do. Do they install and maintain this equipment because they want to or are they mandated to do it? In all likelihood they are mandated. Why should it be any different for nursing homes?
    This issue should not be buried in our state chambers.

  4. phillip on November 14th, 2017 5:51 pm

    completely agree fred and retired, there is no reason they can not pay for the generators. Nursing homes are like our prison system and education system, there is more than enough money for the necessities the spending habits need to be corrected.

  5. Retired2 on November 14th, 2017 2:54 pm

    Our friends in Alabama should take a lesson from Florida , and also look at flooding as well. I personally know one that needs both.

  6. retired on November 14th, 2017 6:54 am

    with what nursing homes and asisteded living homes charge they can a ford to buy the genarators

  7. fred on November 14th, 2017 6:27 am

    If you saw the lavish lifestyle that owners of nursing homes live, you’d roll your eyes at the suggestion that they can’t afford generators. Ridiculous.





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