May 20

Chess Game Begins Between Governor and Legislature - On May 13, the Florida House of Representatives sent the $70.4 billion budget bill to Governor Charlie Crist. He has 15 days, until May 28, to sign the budget, veto all or part of it, or allow the budget to pass without his signature. The Governor has all but ruled out a veto of the total budget, but he has left the door open for line item vetoes. The timing of the 15-day review period initially overlapped with a special session that Governor Crist said he planned to call from May 24 through May 28 to develop a proposed constitutional amendment dealing with offshore oil drilling. This week, the Governor announced that he is delaying the special session until he has more buy-in from the House. It looks like the Governor may have outfoxed the Legislature again. He can do what he thinks is best with the budget bill without worrying about horse trading -- at least for now. The Republican dominated legislature has a lot invested in the 2010-11 budget bill. The Governor wants a proposed constitutional amendment to limit or ban offshore oil drilling. You can bet that both will be playing hardball to get what they want.

AAHSA Audio of Health Care Reform Conference Call Available on Website - Last Thursday, the AAHSA public policy staff held a conference call on national health care reform. The presentation, which lasted 45 minutes, was excellent. If you did not participate, you may listen to it by going to www.aahsa.org/healthreform or go to www.aahsa.org and click on the health reform hub button -blue column on the right side of the home page. Better yet, plan on attending FAHSA's next series of regional meetings from August 31 through September 3 on national health care reform. Barbara Gay from AAHSA's policy staff will be the featured speaker. In the meantime, a few of the most interesting points made by speakers are summarized below.

Most of the major changes for employers will not occur until 2014. If employers make changes too soon, it could affect the grandfathered status authorized in the health care reform act for existing health insurance plans. Speakers advised that employers should not act too quickly. In addition, they suggested that if an organization does not currently offer health insurance to employees, conversations should begin with board members now to prepare for 2014.

The most reassuring information that was provided relates to Medicare. Without healthcare reform, an estimated $6 trillion would have been spent over the next decade on Medicare. With healthcare reform, expenditures over the next decade will be an estimated $5.6 trillion. Per person spending will be less, but most of it will be due to reduced expenditures for hospitalization. Medicare savings resulting from health care reform will be deposited in the Medicare trust fund, expanding the life span for Medicare by 7 to 10 years. This is very good news that should be reassuring to Medicare enrollees and the next generation of Medicare recipients -- namely baby boomers.

Medicare reform will not have any fiscal consequences for home health agencies, hospice organizations or PACE providers for this fiscal year. For skilled nursing facilities, effective October 2010, payments are likely to change because of the new MDS 3.0 and RUGs IV payment system. The changes will benefit nursing homes that provide more complex care according to AAHSA staff.

National healthcare reform includes several incentives for states to provide more home and community-based services. Under "Community First Choice," states can increase their federal match for Medicaid by up to 6% if consumer access to personal attendant care is increased. In addition, the "Home and Community-based Rebalancing Incentive Program" encourages states that spend less than 25% of their long-term care Medicaid budget on home and community-based services to meet a rebalancing target for non-institutional programs by October 1, 2015. Florida spends about 16% of its Medicaid long-term care budget on HCBS, so our state would be eligible for a 5% increase in the Medicaid federal match for HCBS if we took advantage of this program. AAHSA commented that state affiliates should encourage their governors and state legislatures to take advantage of the opportunities to increase the federal Medicaid match. Rebalancing is inevitable so states would be foolish not to apply for the higher federal match while it is available.

The CLASS Act will not take effect until the Health And Human Services Secretary releases details about its implementation. This must occur by October 1, 2012. According to AAHSA staff, the benefits of the program will probably not be seen until 2018.