Inside Florida’s Shift to a Prospective Payment System for SNFs

As skilled nursing providers in Florida brace for the introduction of a prospective payment system (PPS) for nursing home reimbursements under the state’s Medicaid program, the state legislature has required the formation of a working group to ease the transition.

Under the new law—set to take effect in 2018—the state will switch its Medicaid reimbursement policy from a cost-based system to progressive payments, which will provide SNFs with a fixed, per-patient reimbursement based on median costs.

Operating under the Florida Agency for Health Care Administration, the Florida Nursing Home Prospective Payment Working Group consists of 11 representatives from nursing home providers and other stakeholders.


The group will hold three upcoming meetings focusing on recommendations specific to the transition of the payment system, according to Keith Myers.

Myers, president and CEO of the West Palm Beach, Fla.-based MorseLife Health System, Inc., is among the 11 representatives serving on the agency’s working group; MorseLife provides health care and residential services for seniors in Palm Beach County.

The meetings will address a variety of topics including adjustments to Medicaid rate calculations, direct care and indirect care sub-components, the development of quality measures, and a phase-in timeline.


The plan had been met with some resistance in the Sunshine State, with the two primary trade groups — the Florida Health Care Association and LeadingAge Florida — splitting over some of the details, including the ways in which Medicaid reimbursement benchmarks will be calculated.

“It’s a good system, but it needed to be fine-tuned with certain parameters to ensure that quality of care is a factor, because the more quality points you have, the higher the reimbursement. So it helps to promote good quality in nursing facilities,” Myers told Skilled Nursing News. “The end goal is to have an equitable prospective payment reimbursement system so that an organization that spends money in providing quality care and staffing will be paid equitable for it.”

The working group is tasked with submitting a final report of its findings and recommendations to the agency, Florida Gov. Rick Scott, Senate President Joe Negron and State Speaker of the House Richard Corcoran by December 1.

Overall, the state’s new system for nursing home reimbursement will immensely impact how skilled nursing providers deliver care to patients, according to Myers.

“I think it’s going to help promote better quality care in nursing homes because [providers] are going to be awarded for good quality and that means that the quality of life of residents will be more optimal,” Myers said.

Written by Carlo Calma

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