A House bill intended to create a safety net for the mentally ill got an unexpected rider attached to it late last week — one that would limit competition for Louisiana nursing homes.
Sens. Fred Mills, R-Parks, and Jay Luneau, D-Alexandria, asked the Senate to approve the amendment for House Bill 402, which had already passed the House floor and a Senate health committee at the time. The amendment was added Friday, less than a week before the close of the legislative session.
The amendment, which is unrelated to the original bill, was written to extend a 5-year moratorium on "Level 4" assisted living facilities that provide a more independent level of care for people with higher medical needs. The sponsor of the bill negotiated the moratorium down to one year.
Assisted living facilities in Louisiana do not accept Medicaid; they typically offer apartment-style living for the elderly and provide more independence than a traditional nursing home.
Year after year, Louisiana lawmakers gather in Baton Rouge and grouse about the unpalatable choices they face: Cut state services, raise taxes or do some of both.
Mills, who owns a stake in a nursing home, said he asked for the amendment at the behest of the Louisiana Nursing Home Association. He said he agreed with the association that the moratorium was needed.
Asked why he said regulating assisted living facilities is expensive for the state. In addition, he pointed out that the federal Centers for Medicare and Medicaid Services have not approved those facilities, which means they cannot accept patients on Medicaid. The moratorium effectively blocks private-pay assisted living facilities from entering the market.
The amendment was added to the original bill sponsored by Rep. Kenny Havard, R-St. Francisville, who fought the amendments.
"I think that something that important should be its own bill," Havard said. "It was not related to my bill at all. I had no intention of trying to deal with nursing homes."
The past 10 months have ticked away at a torturously slow pace for Kenny Johnson, who prayed every day he’d get the call telling him it was time to leave the nursing home.
Havard rejected the amendments, sending the final version to a conference committee, where three members from both chambers negotiated the bill. The Senate conferees were Mills, Eric LaFleur, D-Ville Platte, and Danny Martiny, R-Metairie. LaFleur, like Mills, has a financial stake in nursing homes: Both LaFleur and his wife are licensed nursing home administrators who have minority ownership interests in a nursing facility.
Mills owns a pharmacy in addition to his roughly 10 percent share in a nursing home. He said he handles legislation dealing with nursing homes, along with bills in other health care sectors, because he's knowledgeable about the industry.
"You get asked to do legislation when you understand the subject matter," he said. "It seemed to me it wasn't improper."
In conference committee, the moratorium was negotiated down to a single year. Havard said that means the nursing home advocates will have to return with their own bill next year if they want to extend it further.
Rep. Jay Morris, R-Monroe, rejected the compromise. He said he completely opposed the concept of a moratorium, believing the intention was to eliminate businesses that compete with nursing homes.
"I believe that because it was the nursing home industry that lobbied for the amendment," he said.
He said the amendment could have been its own bill, but lawmakers were hampered by a rule that prevents them from sponsoring more than five bills unrelated to the budget.
Sharla Aloisio, executive director of the Louisiana Assisted Living Association, said her organization had not been informed about the moratorium until after the amendment was attached. But she said her board ultimately decided not to oppose the legislation because the boards have not received inquiries from businesses trying to establish new assisted living facilities in Louisiana.
A team of government experts and industry stakeholders spent more than two years painstakingly crafting a plan that would have reduced Louisiana’s expensive and unpopular reliance on nursing homes to house the state’s most helpless residents.
"Is it a perfect solution for seniors? Maybe not, maybe so," she said, opting not to take a hard position.
There has been a moratorium since 2012, and it was set to expire this year.
The Louisiana Nursing Home Association could not immediately be reached for comment.
Hugh Eley, a former deputy secretary at the Louisiana Department of Health who has been outspoken about the influence wielded by the nursing home industry, said nursing home owners "have traditionally tried to limit assisted living facilities."
"Their concern was that they would be competition," he said.
Even as the nursing home industry was flexing its muscles by getting the rider attached to an unrelated bill, those who want to subject nursing homes to more competition made a move of their own.
State Rep. Rick Edmonds, R-Baton Rouge, was able to pass a resolution urging Gov. John Bel Edwards' administration to issue a request for proposals for providing managed long-term care.
Effectively, that means the state wants to hire private insurance companies to oversee its elderly and disabled Medicaid services. It already does this for the rest of the Medicaid population. Such a change, according to analysts, would generate more than $100 million for the state in a managed care tax, while also giving people in nursing homes more options to receive care in their own homes.
Similar measures with the force of law behind them have failed both this year and last year. The nursing home lobby has strenuously opposed various versions of the bill.
But the victory, unlike the one the nursing homes won with their amendment, was purely symbolic. The resolution was nonbinding.
AARP lobbyist Andrew Muhl said it was a step in the right direction. But he questioned why a quarter of the House would vote against a nonbinding resolution that benefits seniors.
"Long-term care is simply not working for many of the seniors in our state, as evidenced by long wait lists and escalating spending," he said. "Rep. Edmonds and the 63 house members that voted in favor are likely all too familiar with seniors in their district who want to live at home rather than in a nursing home. We were also disappointed to see the 31 legislators ignore the needs of their constituents by voting against this."