Senate Finance Committee Releases Build Back Better Title

Over the weekend the Senate Finance Committee released its 1180-page draft provisions for Build Back Better, covering Medicare, Medicaid, tax and other provisions in its jurisdiction.  Here is a quick topline list of provisions affecting nursing homes and other post-acute providers.  We will have a longer article, along with revised advocacy, in a few days.  Right now, the bill continues to be in the Parliamentarian’s hands, there is a lot of pressure on Senator Schumer to bring to the floor before Christmas but there may not be enough time.  High points in the Senate Finance draft for LeadingAge members:

• There is a big good change in the bill – the requirement that CMS implement minimum staffing ratios has been eliminated, while the study to determine if there should be minimums has been retained and CMS is now directed to report to Congress on its conclusions, starting in 2025 and every 5 years thereafter.
• However, the requirement that beginning in 2024 both SNFs and NFs must have an RN on duty 24/7 has been retained.  While we did not success on our arguments that this requirement should be subject to a real study and that it is not feasible in parts of the country, there is a provision that could help fund new staff. “Grants to Improve Staffing and Infection Control” provides $800M beginning in 2024 to states to provide wage or benefit enhancements or improve and develop training and career development opportunities and/or expand staffing for nursing staff that care for Medicaid recipients. 
• The second grant that members need to be aware of is the Nursing Home Worker Training Grant provision, approximately $1.7B – directed at non-RN workforce (direct care workers, HH, hospice, LPNs).  Again, opportunity to work with states.
• The special focus facility program is expanded with funding to CMS to increase total SNFs in the program to 3.5% (recall that hearing several years ago revealed that CMS kept the program at a very low number because it had not been funded, with big waiting list), and creates a mandatory on-site consultation program (but no new penalties), which was included  in a bill LeadingAge supports, the Nursing Home Reform and Modernization Act of 2021, and is the first time Congress has recognized the importance of not focusing on punishment as the first response to poor performance.
• The bill also includes funds to CMS to improve the survey system, including training, tools, tech assistance and funding to state agencies to improve surveys – a little disappointing as no focus on consistency or alternative ways of looking at ensuring compliance, like the consultation program for SFFs…
• There are 2 additional reporting requirements – resident assessment data and direct care staffing data – that will be subject to 2% penalty for inaccurate reporting from FY 2026-2031 (the reporting requirements aren’t new, the implications for inaccurate reporting are).
• Another positive:  the bill retains the HCBS expansion we support — this is another critical opportunity for state partners to ensure that their state applies for an HCBS Improvement Grant – extensive work will be needed to identify current and future needs, especially around workforce and expanding opportunities for Medicaid recipients – the benefit is a 6% FMAP increase, with additional 2% for states that support self-directed care and the self-directed workforce.  Really critical source of funds to enhance direct care workforce
• Other provisions – Money Follows the Person demonstration program is permanently extended, as are protections against spousal impoverishment for Medicaid home-based recipients; and the Independence at Home demonstration program is also made permanent.

Senate HELP Committee BBB Title Too

The Senate HELP Committee also released its draft bill, preserving many of the workforce provisions LeadingAge supports.  Highlights are:

• Direct Care Workforce Grants. $1 billion in FY 2022 – 2031; 3-year renewable competitive grant funds specifically for the recruitment, training and retaining direct care workers. Eligible entities include a nonprofit organization with experience in aging, disability, supporting the rights and interests of direct support workers, or training or educating direct support workers. Each eligible entity receiving a grant under subsection shall use the grant funds to provide competitive wages, benefits, and other supportive services, including transportation, child care, dependent care, workplace accommodations, and workplace health and safety protections, to the direct support workers served by the grant that are necessary to enable such workers to participate in the activities supported by the grant.
• Technical Assistance Center for Supporting Direct Care and Caregiving. The Administration for Community Living, for FY 2022, is appropriated, $20 million to remain available until September 30, 2031, for necessary expenses to establish, directly or through grants, contracts, or cooperative agreements, a national technical assistance center to provide technical assistance for supporting direct care workforce recruitment, education and  training, retention, and career advancement, and for supporting family caregivers and caregiving activities.
• Registered Apprenticeships Program. The National Registered Apprenticeships Program is allocated $500 million to support programs described in such paragraph that serve a high or high percentage of individuals with barriers to  employment, including individuals with disabilities, or nontraditional apprenticeship populations.
• Funding for the Aging Network and Infrastructure. Under the Administration for Community Living most of the additional $1.2 billion for OAA authorized programs has been retained. This includes $655 million for necessary expenses to carry out part B of HCBS supportive services for FY 2021. The allocation should be used to invest in the aging services network workforce and physical “infrastructure” investments.
• Palliative Care and Hospice Education and Training Funding, were retained, and it includes the following:
  -$20 Million for Palliative Care and Hospice Academic Career Awards;
  – $25 Million for Training Health Professionals in palliative and hospice care;
  – $30 Million for Palliative Care and Hospice Education and Training; and
  – $20 Million for Hospice and Palliative Nursing, to establish a program to award grants and contracts to 22 accredited schools of nursing, health care facilities and programs leading to certification as a Certified Nursing Assistant.