Agency for Health Care Administration
Secretary Rhonda Medows, M.D.
Division of Health Quality Assurance Liz Dudek
Division of Administrative Services Christy Gregg
Division of Medicaid Bob Sharpe
Payment of Fines Payment of Medicaid Overpayments
Health Facility Regulation Health Standards & Quality Field Operations Managed Health Care Plans and Construction Long Term Care Services
Medicaid Area Offices Health Systems Development Program Analysis Contract Management Pharmacy Services Research Medicaid Services
Inspector GeneralJudy Hefren,
Acting
Medicaid Program IntegrityFraud and Abuse
General CounselValda Clark-Christian
Legal Representation Imposition of Administrative
Sanctions Receivership
Agency for Health Care Administration
Division of Health Quality Assurance Liz Dudek
Bureau of Health Facility Regulation Jeff Gregg
Bureau of Field Operations Polly Weaver
Bureau of Long Term CareMolly McKinstry
Survey Field Offices Complaint Administration
Call Center Contract Manager 5-Day Abuse Reporting
Licensure and CertificationHome CareAcute CareLabsHealth Care Clinics
Certificate of Need Financial Analysis Background Screening
Bureau of Plans and Construction Skip Gregory
Plan Review for Health Care Facilities including Nursing Homes
Health Standards and Quality Susan Acker
Quality of Care Monitors Survey Integrity and Support Branch Informal Dispute Resolution MDS/OASIS Help Desk State Survey Training Coordination
Bureau of Managed Care Tom Warring
Regulation of Commercial HMOs Regulation of Medicaid HMOs – Quality
Control, Monitoring and Review
Deputy Rebecca Knapp
Licensure and Certification Nursing Homes and other LTC Facilities
Teaching Nursing Home Contract Management
Gold Seal Program Long Term Care Policy Issues Rule Development Receivership Nursing Home Watch List Guide to Nursing Homes (Joint with FO)
Long Term Care UnitCaraLee Starnes
Licensure of Assisted Living Programs Long Term Care Policy Issues
Facilities Data Analysis UnitJane Boerger
Assisted Living UnitAlberta Granger
Adverse Incidents and Liability Claims Nursing Home Staffing Reports and Bed
Vacancy
Agency for Health Care Administration
Research Program Analysis
Robert Butler
Medicaid Services Bob Maryanski
Reimbursement Policy Rate Setting Cost Report Processing & Audits Medicaid Lease Bonds Medicaid Budget Estimates
Medicaid Research Projects Medicaid Up or Out Contract
Management
Handbook Development Waiver Programs State Plan Program Development Medicaid Placement Issues PASSR Medicaid Nursing Home Bed
Reduction Efforts
Division of Medicaid Bob Sharpe
Contract Management Allan Strowd
Medicaid Provider Enrollment Contract Management for Fiscal Agent
Medicaid Claim Payment
Chief Operating OfficerSteve Grigas
Chief Financial OfficerKen Thurston
Health Systems Development
Steve Presnell
Pharmacy Services Pharmacy Prior Authorization Restocking Fees
Pharmacy ServicesGeorge Kitchens
Managed Care
Policy Development MediPass Disease Management
Medicaid Field Offices11 FO Managers
Field Offices Provider Claims Resolution,
Technical Assistance, andPolicy Training
Medicaid Beneficiary Support, Advocacy, and Assistance
Long Term Care Bed Growth
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
ALF beds
NH beds
Nursing Home Closures
Nursing Home Closures 2003 – Three Nursing Homes (459 Beds) 2002 – Twelve Nursing Homes (1,258 Beds) 2001 – Six Nursing Homes (605 Beds)
Based Upon Date Residents Were Discharged
Nursing Home Occupancy
80%
82%
84%
86%
88%
90%
92%
94%
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
occ
up
ancy
rat
e
Nursing Home Medicaid Reimbursement Versus Total Cost
Nursing Home Medicaid Reimbursement Versus Total Cost
$22.50
$13.96 $14.06 $13.42 $12.98 $14.30 $14.67 $14.37 $15.17 $11.64 $12.43 $15.33
$-
$20.00
$40.00
$60.00
$80.00
$100.00
$120.00
$140.00
$160.00
$180.00
199801 199807 199901 199907 200001 200007 200101 200107 200201 200207 200301 200307
Rate Sem ester
Per
Die
m
Average Total Cost Average Total Reimbursement Total Difference
Nursing Home Reimbursement Versus Patient Care Cost
$6.51 $6.75 $6.86 $7.29 $6.07 $7.09 $7.02 $6.91
$1.37 $1.57 $1.75 $1.51
$-
$20.00
$40.00
$60.00
$80.00
$100.00
$120.00
199801 199807 199901 199907 200001 200007 200101 200107 200201 200207 200301 200307
Rate Semester
Per
Die
m
Patient Care Average Reimbursement Patient Care Average Cost Patient Care Difference
Nursing Home Reimbursement Versus Patient Care Cost
Nursing Home and Assisted Living Facility: Adverse Incidents & Notices of Intent Filed
Report to the LegislatureMay 2003 – Status Report
www.fdhc.state.fl.us - Publications and Forms
Adverse Incidents Reported
Total Number of Adverse Incidents
0
1000
2000
3000
4000
ALF NH
Year 1
Year 2
Adverse Incidents by Type May 15, 2002 – May 14, 2003
Type Nursing Home
Assisted Living
Death 26 17
Brain/Spinal 2 0
Disfigurement 5 2
Fracture/Dislocation 948 332
Functional Limitation 9
No Consent 34 6
Transfer 1568 815
Adult Abuse (A/N/E) 1088 122
Child Abuse 9
Elopement 357 155
Law Enforcement 238 135
Adverse Incident Inspections May 15, 2002 - May 14, 2003
# of Completed Inspections
# With Deficiencies
#Serious Deficiencies
% With Deficiencies
NH ALF NH ALF NH ALF NH ALF
GRAND TOTAL 47 35 11 11 3 1 24% 31%
Nursing Home Notices of Intent ReceivedUpdated Monthly http://www.fdhc.state.fl.us/MCHQ/Long_Term_Care/FDAU/Reports.shtml
Nursing Home NOIs* Received by Nursing Homes as Reported to AHCA**
0
50
100
150
200
250
*Notice of Intents (NOIs) **Late reporting by nursing homes may cause data to change.
# of Claims 113 224 144 94 116 58 48 64 68 63 56 74 46 60 82 80 108 96 83 75 102 74 75 54 70
9/01 10/01 11/01 12/01 1/02 2/02 3/02 4/02 5/02 6/02 7/02 8/02 9/02 10/02 11/02 12/02 1/03 2/03 3/03 4/03 5/03 6/03 7/03 8/03 9/03
Assisted Living Facility Notices of Intent Received Updated Monthly
http://www.fdhc.state.fl.us/MCHQ/Long_Term_Care/FDAU/Reports.shtml
0
2
4
6
8
10
12
14
16
18
20
*Notice of Intents (NOIs) **Late reporting by ALFs may cause data to change.
# Claims 8 19 5 9 6 5 5 5 4 6 1 5 2 0 6 6 8 1 2 2 6 2 6 3
9/01 10/01 11/01 12/01 1/02 2/02 3/02 4/02 5/02 6/02 7/02 8/02 9/02 10/02 11/02 12/02 1/03 2/03 3/03 4/03 5/03 6/03 7/03 8/03
Semi-Annual Report onNursing Homes
Liability Claim Information
– Notices of Intent to Litigate– Claims File with Clerk of Court
Survey Deficiencies Federal Quality Measures
Nursing Home NOIs Reported
For-Profit
Non-Profit
Multi-Facility Owner
Total
Licensed Nursing Homes
506 (76%)
163 (24%)
337 (50%)
669
Nursing Homes reporting NOIs
408 (81%)
97 (19%)
275 (55%)
505
NOIs Per Nursing HomeBased Upon 505 Nursing Homes Reporting
# Nursing Homes # NOIs Reported
129 1
227 2 to 4
115 5 to 9
34 10 or more
Notices of Intent By Nursing Home Profit Status
0
50
100
150
200
250
J un-01
J ul-01
Aug-01
Sep-01
Oct-01
Nov-01
Dec-01
J an-02
Feb-02
Mar-02
Apr-02
May-02
J un-02
J ul-02
Aug-02
Sep-02
Oct-02
Nov-02
Dec-02
J an-03
Feb-03
Mar-03
Apr-03
Not For Profit
For Profit
Total Federal “F” Tags Cited by Quarter
Note: Number is subject to change based on the entry of surveys in the system and other actions that change deficiencies such as IDRs and legal actions.
1300 1350 1400 1450 1500 1550 1600 1650 1700 1750
Apr-Jun 2001
July-Sep 2001
Oct-Dec 2001
Jan-Mar 2002
Apr-Jun 2002
Jul-Sep 2002
Oct-Dec 2002
Jan-Mar 2003
Total Federal “K” TagsCited by Quarter
0 50 100 150 200 250 300 350 400 450
Apr-Jun 2001
July-Sep 2001
Oct-Dec 2001
Jan-Mar 2002
Apr-Jun 2002
Jul-Sep 2002
Oct-Dec 2002
Jan-Mar 2003
Most Serious Nursing Home Deficiencies
(Federal "F" and "K" Tags)
0 10 20 30 40 50 60 70 80 90 100
Apr-Jun 2001
July-Sep 2001
Oct-Dec 2001
Jan-Mar 2002
Apr-Jun 2002
Jul-Sep 2002
Oct-Dec 2002
Jan-Mar 2003
Other SeriousDeficienciesG Level
Number of Nursing Homes on the Watch List by Quarter
Calendar Quarter Number of Facilities
April 1, 2001 – June 30, 2001 83
July 1, 2001 – September 30, 2001
90
October 1, 2001 – December 31, 2001
91
January 1, 2002 – March 31, 2002 84
April 1, 2002 – June 30, 2002 92
July 1, 2002 – September 30, 2002
72
October 1, 2002 – December 31, 2002
55
January 1, 2003 - March 31, 2003 63
Recent Legislative Changes
Nursing Homes Staffing
– Allows one day at 97% of staffing requirements without citation if facility does not have a Conditional license
– Adds greater flexibility to sharing of staff in a retirement community – rules may be developed
– CNA increase to 2.9 delayed until May 1, 2004 Gold Seal – AHCA will modify financial criteria
– Accept reviewed financial statement– CCRCs may use DOI financial criteria if accredited
Recent Legislative Changes
Quality of Long Term Care Facility Improvement Trust Fund– Allows state portion of federal nursing home fines to be
deposited into fund– Modifies projects that may be funded
Payment of fines – All entities regulated by AHCA must pay or make
arrangements to pay monies due to AHCA prior to a change of ownership
Medicaid expansion of the long-term care diversion– Expand LTC Diversion Program to serve more recipients– Plan for reduction in the number of Medicaid nursing
home beds
Assistance with EatingFederal Regulation Federal Register Vol. 68, No. 187, Friday September 26, 2003
http://www.access.gpo.gov/nara/index.html
Modifies Code of Federal Regulations effective October 27, 2003 Authorizes use of “paid feeding assistants” if:
– The individual has successfully completed a State-approved training course and
– Use of such assistants is consistent with state law
Florida Law Section 400.23(3)(b), Florida Statutes authorizes the agency to
develop rules to allow properly trained staff to assist residents with eating; rule must specify:– Minimum training requirements– Resident physiological conditions or disorders that require
nursing personnel assistance Rule must be in place before implementation in Florida
Federal Requirements
Supervision– Must work under the supervision of an RN or LPN– Must call a supervisory nurse for help on the resident
call system in an emergency
Resident Criteria– Residents without complicated feeding problems,
including difficulty swallowing, recurrent lung aspirations and tube or parenteral/IV feedings
– Base selection upon charge nurse’s assessment and resident’s latest assessment and plan or care
Training Requirements– Minimum 8 hours
Quality Improvement Activities UpdateQuality Improvement Activities Update
Nursing Home Project– QIO is lead– MDS data utilized and publicly reported – Contact Florida Medical Quality Assurance
Linda Wilkes1-813-354-9111
Operation Spot Check– Attorney General’s Office has lead
MDS Data Verification Project (DAVE)– 28 On-site visits to date– Designed to audit MDS data– Facilities identified based on off-site record
reviews and random selections
Nursing Home Staffing Citations
2002 - 260 Citations (206 Facilities) 166 for N063 (Staffing Ratios)16 for N069 (Self-Imposed Moratorium)78 for F353 (Insufficient to Meet Needs)21 for N063 with F35357 for F353 without N063
2003 to date - 129 Citations (116 Facilities) 74 for N063 (Staffing Ratios)3 for N069 (Self-Imposed Moratorium)52 for F353 (Insufficient to Meet Needs)6 for N063 with F35346 for F353 without N063
Nursing Home Immediate Jeopardy by Region
7/1/02-6/30/03
1/ 2 3 4 5/ 6 7 8 9 / 10 11
Current IJ Surveys
5 3 4 3 4 6 5 2
Past IJ (F698)
1 1 1
Total 5 3 4 4 4 7 6 2
Top 10 Deficiencies Nursing Homes
F371 Food must be stored, prepared and distributed under sanitary conditions
F281 Services provided by the facility must meet professional standards
F279 Facility must develop comprehensive care plans for each resident
F514 Facility must maintain clinical records professionally and accurately
F241 Facility must treat residents with dignity and respect
Top 10 DeficienciesNursing Homes Continued
F432 Drugs must be stored in locked compartments at proper temperature
F253 Facility must provide adequate housekeeping and maintenance services
F309 Facility must provide necessary care for highest practicable well being
F280 Comprehensive care plan must be timely, accurate and periodically reviewed
F323 Facility must be kept free of accident hazards
Top 10 Complaint AllegationsNursing Homes
Allegation Total Confirmed Resident Care 890 108 Resident Rights 469 58 Medicine Prob/Errors/Formulary 326
63 Staffing 324
33 Resident/Patient Abuse/Neglect287 43
Top 10 Complaint AllegationsNursing Homes Continued
Allegation TotalConfirmed
Falls/Injury 222 26 Dietary 218 26 Pressure Sores 177
18 Physical Plant 168
28 Infection Control 167
19
Resources
AHCA Web Site: www.fdhc.state.fl.us
Long-Term Care Unit (850) 488-5861Facilities Data Analysis Unit (850) 922-6089
Field Operations (850) 414-9796Health Standards and Quality (850) 922-9138
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