October 12, 2017

Rubio, Frederica Wilson call for federal investigation into nursing homes in Florida, Puerto Rico

Marco Rubio

@alextdaugherty 

Sen. Marco Rubio is asking the Senate Finance Committee to investigate the oversight of nursing homes in Florida and Puerto Rico after 14 people died at a Hollywood nursing home after Hurricane Irma. 

Rubio sent a letter on Thursday to Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Ore., the leading members of the Senate committee responsible for oversight of Medicare and Medicaid. 

"As the chairman and ranking member of the committee with jurisdiction over Medicare and Medicaid, I implore you to investigate the failures that occurred at this nursing home and others throughout the country, particularly in Florida and Puerto Rico, to prevent similar tragedies from happening in the future," Rubio said in the letter. "Additionally, I respectfully request that you consider examining other ways in which Medicare and Medicaid beneficiaries were impacted by these storms and how better planning and coordination between the federal, state, and local government could mitigate harm caused by hurricanes." 

Rep. Frederica Wilson, D-Miami Gardens, whose district contains the Hollywood nursing home, also called for a federal investigation during a meeting between Florida's congressional delegation and Gov. Rick Scott on Wednesday. She plans to introduce legislation that would require nursing homes and long term care facilities that receive federal funding to have generators. 

"We have to do everything we can to keep all these individuals safe," Scott said. "We live in a peninsula, we are going to have hurricanes, we've got to be prepared." 

"While this terrible tragedy is currently under investigation, it has been widely reported that these individuals were left in sweltering conditions after the nursing facility’s air conditioning system lost power," Rubio said. "This has shocked the state of Florida, and rightfully raised questions about the oversight of nursing homes, particularly the enforcement of existing emergency preparedness requirements." 

October 11, 2017

Wasserman Schultz clashes with Rick Scott over hurricane debris removal

Miami2 cleanup lnew cmg (1)

@alextdaugherty 

Debbie Wasserman Schultz argued Wednesday that Gov. Rick Scott is slowing Hurricane Irma debris cleanup by forcing certain municipalities to follow debris removal contracts negotiated before the storm.

The longtime congresswoman from Broward County and the governor engaged in a testy exchange over hurricane debris removal during a meeting between the governor and the entire Florida congressional delegation on Wednesday.

“Debris has become an emergency situation, a public health hazard, rot is setting in,” Wasserman Schulz said. “If we start getting another hurricane all this debris will become projectiles.”

Wasserman Schultz said that the debris removal companies are able to get more money from municipalities who didn’t pre-negotiate a contract because the demand for debris removal is so high around the state. Therefore, certain communities are prioritized for debris removal over others because they can pay more.

The Federal Emergency Management Agency reimburses municipalities for the bulk of hurricane debris removal, while the state picks up about 10 percent of the cost.
 
Scott countered that his biggest priority is making sure that debris removal companies aren’t price-gouging certain municipalities, and that allowing certain towns and cities to be reimbursed for a higher debris removal rate will ultimately hurt taxpayers.

“I’m going to stand to try to make sure that we watch out for taxpayer money,” Scott said. “They have contracts, comply with the contracts. I’m not going to allow people to take advantage of our state.”

Scott said the state is doing “everything we can” to expedite debris removal, citing the National Guard’s presence in the Florida Keys.

Wasserman Schultz continued to press Scott in a public forum with most of the state’s congressional delegation and Agriculture Commissioner Adam Putnam looking on. She said that Scott did not return seven emails and several calls from her over the past week regarding debris cleanup.

“I have tried to reach you and I have gotten no response from you,” Wasserman Schultz said.

“If you contacted me, I don’t have any evidence that you contacted me,” Scott replied.

The meeting’s moderator, Republican Rep. Vern Buchanan, who was physically seated between Scott and Wasserman Schutlz, eventually stopped the exchange as Wasserman Schultz continued to criticize Scott.

“Let’s talk about that a little later,” Buchanan said.

Read more here.

October 10, 2017

Senate Democrats urge governor to waive KidCare payments through November

 

Kid Care18 LNew DSSenate Democrats want Gov. Rick Scott to ask the federal government to let families recovering from the hurricane, and who insure their children through the federal and state subsidized KidCare insurance program, to be excused from paying for their KidCare premiums in October and November. 

The governor and the KidCare agencies have refrained from asking for a federal waiver, preferring instead to give families who lost jobs, income and homes in Hurricane Irma an extension of the Oct. 1 deadline. As a result, families must make two payments by Oct. 31 in order to make sure their children remain insured under the state and federal program.

Related: State tells parents to ‘pay up’ or lose kids’ insurance if Irma caused missed payment

"Thousands of Florida families were hit hard by the hurricane and are working to get their homes, jobs and lives back in order,'' wrote Sen. Oscar Braynon, the Senate Democratic leader in a letter to Scott.

"Merely extending the time to pay a premium until the end of the month, and then compounding it by asking for a double payment, adds to the financial hardships with which many of them are currently struggling.  Given the ongoing emergency situation, these fees should have been waived."

KidCare covers about 160,000 children ages 5-18 and charges most families $15 to $20 a month depending on their family size and income. 

After the Herald/Times published a report on the issue last week, the Agency for Health Care Administration said in a statement it would consider “further extending the deadline should the need arise” and “will work with every family to ensure there is NO lapse in coverage due to Hurricane Irma.”

Braynon noted the precedent set by former Gov. Jeb Bush in 2005 after four hurricanes hit Florida that year. Bush waived the premiums for families with children in the KidCare program, and pointed to the experience in Texas. 

"Texas got rapid federal approval to waive cost sharing and enrollment fees for families enrolled in their children’s health insurance program through the end of November,'' he said. "Florida’s children are no less deserving of this kind of help."

Last month, Agriculture Commissioner Adam Putnam waived the $55 fee to replace a concealed weapons license, saying at the time that “the last thing someone needs to worry about is paying a fee to have their concealed weapon license or security guard license replaced.” 

The Department of Agriculture and Consumer Services has since told the Herald/Times that 246 people have asked for waivers and the  $3,690 in lost revenue to the state was covered by the $76.7 million balance in the Licensing Trust Fund. 

AHCA has not been able to provide a number as to how many families have sought the deadline extension and have not been provided an answer as to what it would cost the state to waive the premiums for October and November for these families. 

Photo: Reina Lobo holds her grandson, Julio, in this 2014 photo. The family met with Nadine Gousse, of the Human Services Coalition, a group working to enroll low-income Hispanic children in Florida KidCare. Enrique Flor eflor@elnuevoherald.com

 

 

October 02, 2017

Florida Republicans create distance with Trump on Puerto Rico

US NEWS LASVEGAS-SHOOTING 21 ABA

@alextdaugherty @patriciamazzei

While President Donald Trump spent the weekend attacking the mayor of San Juan and blasting negative coverage of Hurricane Maria recovery efforts, Florida state Rep. Bob Cortes was worried about his daughter in San Juan’s western suburbs.

Cortes’ daughter, Leslie, and her 2-year-old son, Jeremy, had their roof torn off during Hurricane Maria, and two feet of water rushed into their house in Dorado.

“I was terrified they were going to lose their lives,” Cortes said, as his voice trembled.

The second-term Republican lawmaker from Altamonte Springs spent days trying to reach family members in Puerto Rico and is asking anyone he can for help.

They might not be directly criticizing Trump. But Florida Republicans are taking a noticeably different tack from the leader of their party when it comes to Puerto Rico, an issue that affects some of them, like Cortes, personally — and many of them politically.
 
Instead of adopting the president’s finger-pointing rhetoric, the federal and state GOP lawmakers are highlighting the need for action in Puerto Rico. Some 1 million Puerto Ricans call Florida home.

Last week, U.S. Sen. Marco Rubio urged Trump to let the military lead logistical Hurricane Maria relief efforts. Gov. Rick Scott announced Monday that Florida will open relief centers Tuesday for Puerto Ricans arriving in Miami and Orlando. He also asked schools to give in-state tuition to Puerto Rican students displaced by the hurricane.

How many might come is unknown. “A lot,” Scott guessed.

Rubio has said this isn’t the time to talk hurricane-relief politics, but a day before Trump was scheduled to land in San Juan, the senator acknowledged the initial response from the administration could have been swifter.

“In hindsight, we all wish we could get those three or four days back,” Rubio told reporters in Miami on Monday after they asked if Washington could have done more — and more quickly — to aid the island. “I want us to focus 100 percent on what we need to do to improve the recovery effort. And we have plenty of time in the future to sit there and point to the mistakes that were made.... But right now every minute we spend doing that sort of thing is a minute that isn’t being spent trying to improve reconstruction and deal with it.”

State lawmakers said that an influx of thousands of Puerto Ricans won’t go unnoticed.

“Florida’s the closest one to Puerto Rico, and it’s ground zero for relief efforts,” said Cortes, who represents a portion of Orange and Seminole Counties. “We’re going to be shipping most of the things they need to get back on their feet.”

Cortes said he expects at least 100,000 Puerto Ricans to relocate to Florida after the storm, and many of them will settle in greater Orlando. Puerto Ricans already tend to vote Democratic, potentially altering the political dynamics of America’s largest swing state ahead of the 2018 elections.

“It can be a game-changer politically,” said state Rep. Amy Mercado, a Puerto Rican Democrat from Orlando. “The speed of what’s occurring, that’s the million-dollar question. How fast, how much and how long?”

A 100,000-vote swing in favor of Democrats would have given Charlie Crist the governorship in 2014 over Scott and would have eaten up most of Trump’s margin of victory over Hillary Clinton in 2016.

But the math isn’t that simple. Not all Puerto Ricans will vote for Democrats, and many will choose not to vote at all. Cortes argued that Puerto Ricans coming directly from the island are more likely to vote Republican than second-or third-generation Puerto Ricans.

“Those that have been coming usually tend to be more ideologically with the Republican Party because they are leaving a place that had fiscal issues,” Cortes said, adding that both parties need to do a better job of reaching out to Puerto Ricans in Florida.

Read more here.

Rick Scott for HHS secretary? The governor laughs.

@PatriciaMazzei

Now that U.S. Health and Human Services Secretary Tom Price has resigned, could President Donald Trump be considering Florida Gov. Rick Scott for the high-profile gig?

Scott laughed off the suggestion Monday, at a Latin America summit he organized in Miami.

"I have a really good job right now," he told reporters. "Ii have about 365 days -- 465 days, is that right? -- yeah, 465 days left in this job.

"My job is to do what I came here to do with the summit, to try to create a state where everybody can get a good job, people can get a good education, and people are safe. We're in a 46-year low on our crime rate. We've added over 1.4 million jobs. That's what I do every day."

Could he be Florida's next U.S. senator, if he challenges Democrat Bill Nelson?

"That's 2018," Scott said. "We'll worry about stuff like that in 2018."

Rubio on federal response to Puerto Rico: 'In hindsight, we all wish we could get those 3 or 4 days back'

@PatriciaMazzei

Florida Republicans don't want to criticize President Donald Trump's administration for its slow-moving response to assist Puerto Rico after Hurricane Maria.

But they're also not going out of their way to praise it.

"In hindsight, we all wish we could get those three or four days back," U.S. Sen. Marco Rubio told reporters in Miami on Monday after they asked if Washington could have done more -- and more quickly -- to aid the island. "The good news is, now that Lt. Gen. [Jeffrey] Buchanan is on the ground, it appears that every single day that goes by, they have more control and authority over the reestablishment of logistics."

Delicate politics are at play: Republicans expect perhaps thousands of Puerto Ricans to move to states like Florida in the storm's aftermath. Puerto Ricans already tend to vote Democratic. And now some of them are upset at Trump's Twitter jabs at San Juan Mayor Carmen Yulín Cruz -- and at Puerto Rican workers -- after Maria.

Will they remember once they move here and go to the polls on Election Day?

"I haven't thought about the political dynamic of it, because we're still in the middle of a response to a hurricane," Rubio said. "So, in the short-term, all I've said is, I want us to focus 100 percent on what we need to do to improve the recovery effort. And anything that isn't about that is taking away [from that]. And we have plenty of time in the future to sit there and point to the mistakes that were made, and what could be done better, and what we would do differently, but right now every minute we spend sort of doing that sort of thing is a minute that isn't being spent trying to improve reconstruction and deal with it." 

Trump plans to visit Puerto Rico on Tuesday. Puerto Rico's resident commissioner in Congress, Jenniffer González-Colón, estimated in an interview that aired Sunday on Miami's local Univision affiliate that as many as half a million Puerto Ricans could move to the mainland in the coming months.

Gov. Rick Scott, a fellow Republican who like Rubio traveled to Puerto Rico last week to view the hurricane's devastation firsthand, announced Monday he will open three relief centers in Miami and Orlando to help new Puerto Rican arrivals. 

Scott declined to say whether the White House could have acted with more urgency.

"I'm not here to assign blame," he said. "I know that we've worked hard to make sure we solve our problems in our state, and I know Gov. [Ricardo] Rosselló is doing [the same] over there in Puerto Rico. My experience by being over there is, I saw people working their tail off."

Scott wouldn't speculate on whether any new Florida voters from Puerto Rico could take out their frustration against him if he runs as U.S. Senate next year.

"I've been governor now for almost seven years," Scott said. "I reach out to people and talk to people and try to solve problems.... I know that people are going to come here from Puerto Rico are going to be hardworking. They're going to be part of our society, and my job as governor is to provide as many resources as I can, and give them the same opportunity that every other Floridian has."

Only Miami Republican Rep. Ileana Ros-Lehtinen, a frequent, outspoken Trump critic who is retiring next year, openly lamented the federal government's handling of Puerto Rico, calling it "a terrible response to a horrible tragedy."

She made a point, however, to thank Rubio and Scott for their efforts -- putting them on a separate plane from the GOP president.

September 23, 2017

AHCA halts heavy redactions on nursing home reports -- but creates another transparency hurdle

Nursing home redactionsFlorida regulators decided Friday they will abandon the use of software that allowed them to heavily redact key words from nursing home inspection reports posted online, choosing instead to link to the more complete reports available on a federal site.

“To avoid confusion for the nursing home reports, our agency links to the federal site, www.medicare.gov/nursinghomecompare,” said Mallory McManus, spokesperson for the Agency for Health Care Administration. “We no longer use the automated redaction tool.”

The decision came a day after the Miami Herald/Tampa Bay Times Tallahassee bureau reported that the redaction software the agency started using last year was removing key words, dates and descriptions from the inspection reports posted online while the same reports posted on the federal website did not contain the heavy redactions.

State law requires the agency to post the inspection reports on its website to aid the public in monitoring conditions at the 683 nursing homes and more than 3,100 assisted living facilities in the state. But by ending one transparency problem, the agency created another.

The redaction software was used retroactively to block words from inspection reports that went back seven years. Before last year, these documents were available to the public without the heavy redaction. Rather than restoring the documents to that format, the state on Friday linked to the federal documents, which go back only three years, resulting in less access for families, advocates and consumers who want to analyze a nursing home's track record. Story here. 

September 21, 2017

When elders are in peril, whom do you call — 911 or Rick Scott’s cell?

Hollywood Hills Rehabilitation Center

@MaryEllenKlas @MarbinMiller @DChangMiami

Twelve hours after Irma blasted through South Florida, conditions at Larkin Community Hospital in Hollywood were miserable.

The Broward psychiatric hospital was at full capacity with adults and adolescents who were mentally ill; the air conditioning wasn’t working and they couldn’t open windows. So what did the director of nursing at Larkin do to seek help? He wrote an email — to a Broward County commissioner, whose office was closed.

Twelve hours after Irma blasted through South Florida, conditions at Larkin Community Hospital in Hollywood were miserable.

The Broward psychiatric hospital was at full capacity with adults and adolescents who were mentally ill; the air conditioning wasn’t working and they couldn’t open windows. So what did the director of nursing at Larkin do to seek help? He wrote an email — to a Broward County commissioner, whose office was closed.

Larkin Community Hospital Behavioral Health Services is the sister operation to the adjacent Hollywood Hills rehab center, where eight residents died on Sept. 13 when power was lost to an air conditioning system and a set of portable air coolers malfunctioned. A ninth resident died Tuesday.

Ryan had forwarded the email to Justin Senior, secretary of the Agency for Health Care Administration, and its release Tuesday night was intended to underscore the inadequacy of the nursing home’s calls for help. But beyond highlighting the nursing home’s feckless response, the email also raises doubts about the state’s strategy for helping elder-care operators brace for a looming catastrophe.

During a conference call with nursing home and ALF representatives in the run-up to the storm, Gov. Scott did something that might seem unusual for the leader of the nation’s third-largest state.

Scott, who wedged in the conference call amid a flurry of interviews with cable news anchors, gave out a private cell phone number to the caregivers. He said give us a call if you have a problem.

Many did just that, including the Hollywood Hills nursing home. The rehab center made multiple calls to the cell phone and to a separate state information hotline set up to deal with storm-related emergencies. In the calls, the Hollywood nursing home reported the electrical breakdown and indicated the situation was becoming increasingly urgent.

Not only did those calls fail to yield any substantive help, but they have resulted in sharp criticism from the governor’s office, which said the nursing home never reported that lives were in jeopardy. It also questioned why the staff didn’t take the sick and dying residents to Memorial Regional Hospital, which is next door.

Late Wednesday, the state added to the barrage of condemnations, saying the nursing home had fudged its medical records after residents had been evacuated. One resident was reported to be breathing without difficulty — after already having died.

The deaths at Hollywood Hills have raised questions about the strategy of routing emergency pleas through the governor’s office as well as the thought process behind phoning Tallahassee or emailing a county commissioner rather than calling 911 when conditions are careening from uncomfortable to stifling to deadly. More here. 

September 20, 2017

Nursing homes, accustomed to Rick Scott admin's soft touch, scramble to meet hard deadline

Hollywood Hills Rehabilitation Center@MaryEllenKlas

Florida’s nursing homes and assisted-living facilities find themselves in an unfamiliar place this week — pushing back against Gov. Rick Scott’s administration over new rules that require them to purchase generator capacity by Nov. 15 to keep their residents safe and comfortable in a power outage.

With 56 days remaining before the state imposes $1,000-a-day fees, full panic mode has set in on an industry that is more accustomed to dealing with the gentle touch of state regulators and industry-friendly legislators than it is with facing new rules.

The board of directors of LeadingAge, an industry association that represents 350 non-profit senior homes, on Monday voted to ask the governor’s office to delay the mandate as impractical.

Another group, the Florida Health Care Association, which represents 550 for-profit nursing homes, announced it was convening a “summit” on Friday to voice its concerns about the timing, the logistics and the cost of the new rule. And the national board of Florida Argentum, which represents assisted living and memory care facilities, said Tuesday it is hoping for more time to pay for the new rules in Florida — which it estimates carry price tags of $75,000 to $200,000 per home.

“Our members almost uniformly agree with the spirit of what the governor is trying to accomplish — the idea of keeping residents safe in an emergency — but our members have concerns about the practical implications of the rule,” said Steve Bahmer, president and CEO of LeadingAge Florida, which is also hosting the summit.

Like others in the senior care industry, these groups say they support the idea, but they also want some flexibility in the 60-day deadline as they seek contractors, buy generators, hire engineers, retrofit buildings and find financing.

“So many contractors and engineers are involved with the recovery process statewide, it’s going to be very difficult to comply,” said Susan Anderson, vice president of policy for the ALF association, Florida Argentum.

It’s an about-face for most of the senior care industry and for the governor. Since Scott took office in 2011, he has significantly rolled back oversight of the powerful industry that represents more than 73,000 seniors in 683 certified nursing homes, and tens of thousands of others in 3,109 assisted living facilities and memory care centers across the state. Story here. 

September 18, 2017

Bill Nelson criticizes Rick Scott over nursing home deaths

BillNelsonCarlJusteApril172017

@alextdaugherty 

Sen. Bill Nelson decried the lax regulatory standards for backup generators in Florida nursing homes after the deaths of eight elderly people at a Broward County facility during a speech on the Senate floor on Monday, and his criticism included a jab at his likely 2018 senate opponent: Gov. Rick Scott

"Eight people died in a nursing home right across the street from a major hospital in Hollywood, Florida," Nelson said. "Eight frail, elderly (people) from ages 70 to 99. Eight needless deaths." 

Nelson said that "all the phone calls that had been made that were not answered both to the government as well as to the power company as reported" will "come out in the criminal investigation." 

He was referencing a report by CBS Miami that an official from the nursing home called a cellphone provided by Scott 36 hours before the first death. The nursing home also called Florida Power and Light, though the utility did not immediately restore power to the building. 

"We don’t know all the facts, it will come out in the criminal investigation, but it is inexcusable that eight frail elderly people would die," Nelson said.

Hurricane Irma was already turning into a political spectacle for Nelson and Scott, as President Donald Trump encouraged Scott to run against Nelson while viewing storm damage in the Naples area on Thursday.

"I hope this man right here, Rick Scott, runs for the Senate," Trump said. Scott wasn't present during Trump's remarks. 

Nelson did not mention Scott by name during his floor speech, where he also jabbed his likely opponent over a reluctance to attribute powerful hurricanes like Irma to climate change. 

“Clearly the environment changes all the time, and whether that’s cycles we’re going through or whether that’s man-made, I couldn’t tell you which one it is,” Scott said last week. “But I can tell you this: We ought to solve problems.”

Nelson disagreed with Scott, who generally avoids using the term climate change. 

"Hurricane Irma is just another reminder that we are going to confront huge natural occurrences and maybe just maybe people will relate that there is something to the fact that the earth is getting hotter," Nelson said, adding that warmer oceans allow hurricanes to gain strength. 

Nelson and Sen. Marco Rubio were absent for votes in Washington last week after Irma.