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Fines an Issue for Assisted Living

No one questions that assisted living facilities need to be regulated - or if they do question it, they’re being quiet about it. But there’s disagreement on how the regulation should be carried out, especially how much the fines should be.

The issue cropped up in Tallahassee Tuesday when Rep. Larry Ahern, R-Seminole, presented his ALF reform bill (HB 573) to the House Health Care Appropriations Subcommittee. It sets up a tiered system of fines for infractions, with larger homes paying more than small ones.

The idea was to keep small homes from closing and to cover the costs of inspection  for the Agency for Health Care Administration. But ALF administrator Sandra Hall of Bonifay said the system would not be fair.

Homes like hers, Happy Acres in Bonifay, are large and on the tiered system would have to pay the largest fines. Yet her home specializes in residents who have mental illness and for whom AHCA pays the home less than $10 a day apiece, she said.

Medicaid ALFs  barely survive financially now, Hall said.  She said she supports the concept of regulations and fines, but fines shouldn’t be so great as to force homes to close if no residents are being harmed.

Rep. David Richardson, D-Miami Beach, argued that charging different facilities a different amount for the same violation was probably  unconstitutional. He offered an amendment that would impose set fines, regardless of the ALF’s size.

But some members of the panel noted that the amendment would reduce the revenue collected by the fines, which is needed to cover the cost of regulation. Richardson withdrew his amendment, saying that he would work with Ahern to figure out a solution.

ALF reform has been a  pressing issue for lawmakers ever since the Miami Herald published an investigative series three years ago describing incidents in which ALF residents were badly injured or killed because of poor administration and oversight.

The 43-page bill, and its Senate version (SB248) has one more committee stop Thursday before heading to the full Senate. 

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.