Florida

1
Floridas Agency for Health Care Administration

• Secretary Andrew Agwunobi, M.D.

2
Mission

• The Agency for Health Care Administration
  champions accessible, affordable, quality health
  care for all Floridians.

3
Division of Health Quality Assurancestate
licensurefederal certificationof health care
facilitiesCONcomplaints

• Long Term Care
• Licensure and Certification
• Nursing Home Gold Seal
• Quality of Long Term Care Facility Improvement
  Trust Fund
• Nursing Home Guide and Watch List
• Adverse Incidents and Nursing Home Reporting
• Background Screening
• Certificate of Need Program
• Plans and Construction Review
• Managed Care
• Managed Care Subscriber Assistance
• Statewide Provider/Health Plan Claim Dispute
  Resolution

4
Division of Health Quality Assurance

• Emergency Support Function (ESF8) with the
  Department of Health
• Emergency Status System
• 94 of Nursing Homes Enrolled
• Field Operations
• Eight Field Offices Inspections and
  Investigations
• Complaint Administration Call Center and 5-day
  Abuse Reports
• Quality of Care Monitors
• Survey Integrity and Training
• Informal Dispute Resolution (IDR)
• MDS/OASIS Help Desk

5
Quality Indicator Survey Process

• Federal Quality Indicator Survey Process
• Florida First Statewide Pilot
• Improve Consistency/Accuracy of QOC/QOL Problem
  Identification Using a More Structured Process
• Comprehensive Review of Regulatory Care Areas
  within the Current Survey Process
• Enhanced Documentation by Organizing Survey
  Findings through Automation
• Focus Survey Resources on Facilities with Largest
  Number of Quality Concerns

6
QIS Florida Roll-out Plan

• Tallahassee/Pensacola November 2007 Complete
• Alachua/Miami January July 2008
• Orlando/Ft. Myers February October 2008
• Delray/Tampa-St. Pete July 2008 November 2009

7
Government Performance Results Act (GPRA)

• Congressional Directive
• Initiate Program Performance Reform
• Series of Pilot Projects in Setting Program Goals
• Measuring Program Performance Against Goals
• Reporting Publicly on Progress
• Improve Federal Program Effectiveness and Public
  Accountability
• Promoting a New Focus on
• Results
• Service Quality
• Customer Satisfaction

8
Nursing Home GPRA Focus

• Reduce Restraint Use
• 2006 (4th Quarter)
• 8.6 Florida
• 5.8 Nation
• 2007 (1st Quarter)
• 8.3 Florida
• 5.5 Nation

• Reduce Pressure Ulcers
• 2006 (4th Quarter)
• 9.7 Florida
• 8.4 Nation
• 2007 (1st Quarter)
• 9.6 Florida
• 8.6 Nation

9
Strategies for Improvement

• Register to Participate in the Advancing
  Excellence in Americas Nursing Homes Campaign
• www.nhqualitycampaign.org
• Consider Partnerships with other Health Care
  Providers
• Southeast Region Workgroup
• Nursing Home Association Participation
• Hospital Association Participation
• State Agency Participation

10
Division of MedicaidDirects all Medicaid
program planning and development activities

• 15.6 Billion Annual Medicaid Services Budget
  2.0 Million Eligibles
• Bureau of Medicaid Program Analysis
• Nursing Home Reimbursement and Rate Setting
• Cost Reports and Audits
• Bureau of Medicaid Contract Management
• Provider Enrollment Fiscal Intermediary
  Management / Claims
• Bureau of Medicaid Pharmacy Services

11
Medicaid Reimbursement

• Budget Reduction Session Impact
• Nursing Home Rate Reduction 3 Effective January
  1, 2008
• Recurring Reduction Based on Annualized Amount
  each Rate Semester
• Crossover Payments
• Initial Implementation Issues Corrected
• Claims Reprocessed
• Recovery of Automatic Crossover Payments Pending
• Fiscal Agent Transition to EDS

12
Division of Medicaid

• Bureau of Medicaid Services
• Handbook and Policy
• Waiver Programs
• Pre-Admission Screening and Resident Review
  (PASRR)
• 11 Area Offices
• Claim Reconciliation
• Beneficiary Assistance
• Bureau of Medicaid Health Systems Development
• Medicaid Managed Care Policy and Disease
  Management
• Bureau of Medicaid Quality Management
• Provider Satisfaction Surveys

13
Florida Senior Care

• Integrate All Medicaid Services, including
  Nursing Facility and Waiver Services, in a
  Managed Care Plan
• Medicaid Beneficiaries Age 60 and Older and
  Dually Eligible (Medicaid and Medicare)
  Beneficiaries Age 21 and Older Can Participate in
  Brevard, Osceola, Orange, Seminole, Miami-Dade,
  and Monroe Counties
• Enrollment is Voluntary in These Areas of the
  State
• Enrollees Can Choose to Enroll or Disenroll at
  Any Time
• Any Willing, Qualified Managed Care Plan May
  Enroll as a Provider
• Individuals Living in Residential Facilities Can
  Stay in Their Facility Even if the Facility Does
  Not Have a Contract with a Florida Senior Care
  Managed Care Plan
• Implementation is Expected in November 2008

14
Florida Center for Health Information and Policy
Analysiscollectionanalysisdissemination of
health-related data

• Health Information Infrastructure
• Fosters the Deployment of Electronic Medical
  Records and E-prescribing
• Data Collection, Dissemination and Quality
  Assurance
• Transparency in Health Care
• Consumer-Driven
• Floridahealthfinder.Gov
• Search Tools to Compare Short-term Acute Care
  Hospitals, Ambulatory (Outpatient) Surgery
  Centers, Health Plans, and Nursing Homes
• A.D.A.M. Health Encyclopedia with Thousands of
  Health Articles and Illustrations
• Health Care Facility Finder
• Information About Insurance, Medications,
  Seniors, Medical Conditions, and Resources for
  Medical Care
• Consumer Publications
• Information for Health Care Professionals and
  Much More

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Nursing Home White PaperLong Term Care Review

• Overview of Regulation, Quality, Ownership,
  Reimbursement
• Significant Regulatory Oversight Exists
• Ownership Disclosure is Limited
• Unable to Identifiable Correlation between
  Quality and Ownership but More Extensive Analysis
  Is Warranted

18
Nursing Home White Paper

• Recommendations
• Revise Nursing Home Guide
• Increase Transparency of Information
• Examine Proof Standard for Nursing Home
  Sanctions
• Revise Change of Ownership Definition and
  Requirements
• Expand Disclosure of Ownership
• Commission Statistical Analysis to Evaluate
  Quality and Ownership
• Review Regulation of Alternative Settings
  Assisted Living/Adult Family Homes

19
Long Term Care Issues

• Aging Demographics
• Certificate of Need Moratorium until 2011
• MRSA Workgroup
• Department of Health Partnership
• State Budget Pressure