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Tuesday, Sep 02, 2014

Reform of adult living centers stalls over fines


TALLAHASSEE — How much to fine Assisted Living Facilities for committing serious violations remains a sticking point as lawmakers determine how to reform the system after a spate of abuses.

During a nearly 90 minute hearing, the House Care Appropriations Subcommittee considered an amendment to an ALF reform bill, HB 573, that would fine facilities a set amount for violations instead of following a tiered-system, which is proposed in the bill.

That bill, sponsored by state Rep. Larry Ahern, R-Seminole, creates a structure where larger centers – those over 100 beds – face higher fines than smaller ones. The new plan would bring in an estimated $672,202 in revenue to the Agency for Health Care Administration.

For a Class 1 violation, which includes death and bodily harm, a center with more than 100 beds would be hit with an $11,250 fine, while smaller centers would pay $7,500.

State Rep. David Richardson, D-Miami Beach, who crafted the amendment on fines, said he thought the tiered approach was “likely unconstitutional.”

“We should not be charging people different amounts based on their size,” Richardson said.

Richardson voted for the bill in its previous committee stop based on promises that the fee issue would be addressed, but was the only committee member to oppose it Tuesday because it was not.

“Nothing has happened in the last two weeks, so I have no reason to believe anything will happen in the next two weeks,” he said.

Those who opposed the amendment said they would continue to work on the issue moving forward but were concerned because the changes would cause a $350,000 reduction in revenue flowing into a trust fund that helps pay for ALF regulation.

“This amendment would put a hole in our trust fund,” said state Rep. Jason Brodeur, R-Sanford.

Richardson said he did not want to create a “profit center” for the agency, which has brought in an additional $500,000 in fines over the past four years.

Sandra Hall, who owns a 56-bed facility in Bonifay, said she supported Richardson’s plan because Medicaid-funded facilities, like hers, are facing increasing cuts but have not had rate increases in recent years.

“We are constantly taking on costs, but consistently given more regulations,” she told the committee. “You are going to close a lot of these small Medicaid funded homes.”

After having a brief discussion with Ahern, the bill sponsor, Richardson withdrew his amendment. The bill has one remaining committee stop, and Ahern agreed to continue working on the issue.

The committee did pass an amendment sponsored by Ahern that removed a requirement that the agency develop an ALF rating system by March 2015. Members said that private rating agencies already provide that service.

Among other things, Ahern’s 43-page bill also makes it easier for the agency to take a facility’s license if it has a controlling interest in another facility that closed for financial reasons, allows the agency to impose fines for Class 1 violations even if it is corrected before an agency inspection, and requires facilities to notify new residents that “retaliatory” action can’t be taken against them for filing a grievance.

ALF reform has been a big issue in recent years after the Miami Herald published a 2011 series outing abuses in the system. Past attempts to pass legislation overhauling the industry have come up short.

The Senate’s reform bill, SB 248, will have its final committee hearing Thursday before headed to the full Senate.


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