FEDERAL NEWS
ACL Awards Grants to Increase Number of Older Adults who are Up to Date with Vaccines
Only 14% of eligible adults have gotten the bivalent booster. The HHS Administration for Community Living (ACL) announced on December 19 two major grant awards totally $125 million to rapidly increase the number of older adults and people with disabilities who are up to date with their COVID-19 vaccines (i.e., have had bivalent boosters). USAging was awarded $75 million to establish and leverage partnerships with various entities mostly supported by ACL. The National Council on Aging received $50 million to build and leverage partnerships with senior centers, community centers, and local community organizations. Additional information is available here. These grant programs will be available to vaccinate and boost community residents, including many served by LeadingAge home care and other HCBS member organizations.
LEADINGAGE NATIONAL NEWS
Senate Omnibus Bill Released; Many LeadingAge Advocacy Wins! The Senate released the long-awaited and much discussed 2023 omnibus spending package early this morning. The $1.7 trillion funding bill, H.R. 2617, includes in its 4155 pages a number of provisions LeadingAge advocated strongly for, although not all of our critical requests made it into the final Senate package. This link provides explanatory statements and bill summaries by federal department. The full Senate is expected to act first on the package, then send it to the House. Any Senator can hold up the deal in exchange for amendments or concessions – this is an important milestone, but not a “done deal.” Lawmakers have until Friday (when the current Continuing Resolution ends) to finish work on the bill. (Note: “Discretionary” programs are included in this bill; the bulk of Medicare and Medicaid spending are “mandatory” budget items, not part of this process) LeadingAge will provide more analysis in coming days as we continue reviewing the bill and as it moves through the legislative process. Some highlights of interest to LeadingAge members include:
WORKFORCE – All of these provisions are LeadingAge Advocacy Wins!
- The agreement includes $2,000,000 for the Administration on Community Living (ACL) to implement a direct care workforce demonstration project to identify and reduce barriers to entry for a diverse and high-quality direct care workforce, and to explore new strategies for the recruitment, retention, and advancement opportunities needed to attract or retain direct care workers.
- The agreement provides $285,000,000 to support registered apprenticeships and urges the Department of Labor’s Employment and Training Administration (ETA), in collaboration with the Department of Health and Human Services, to support the expansion of the skilled care workforce to care for a rapidly aging U.S. population and provide home and community-based services to older adults and people with disabilities, including through education and training grant programs, as well as traditional and nontraditional apprenticeship programs.
- The agreement’s report language supports HRSA’s efforts to develop the workforce needed to care for a rapidly aging U.S. population and encourages HRSA to address the skilled care workforce needs of seniors through existing workforce education and training programs.
- The Committee allocates an additional $2 million above the FY 2022 level for HRSA’s Geriatrics Workforce Enhancement Program that supports training to integrate geriatrics into primary care delivery and develops academic primary care-community based partnerships to address gaps in health care for older adults.
HOUSING
- LeadingAge Advocacy Win! The FY23 omnibus bill would add funding to build and operate nearly 1,120 Section 202 Supportive Housing for the Elderly homes, in addition to full renewal funding for Section 202 Project Rental Assistance Contracts and Section 8 Project-Based Rental Assistance contracts. While the bill would fully fund Service Coordinator grant renewals, it is unclear if there is sufficient funding in the bill for it to provide for new grant-funded Service Coordinators. The bill would also provide $6 million to help 202/PRACs convert under the Rental Assistance Demonstration and give HUD authority to make budget-based rent adjustments for post-Mark-to-Market PBRA contracts that are distressed or at risk of becoming distressed. LeadingAge had worked for more funds for these efforts than is in the omnibus but is pleased the bill provides full renewal funding and makes some important strides for housing expansion and preservation efforts. The bill also expands the kinds of households to be assisted by the Older Adult Home Modification program to all 62 and older households (besides those with HUD project-based assistance) and not just homeowners, another LeadingAge request.
- The bill includes $50 million for about 12,000 new Housing Choice Vouchers, which aging services providers can work to project-base in affordable senior housing and in assisted living. The bill also includes a new $85 million program to incentivize local governments to improve zoning practices for affordable housing and a new $75 million program for new Permanent Supportive Housing to expand housing options for people experiencing homelessness.
- Overall, the omnibus bill would provide $58.2 billion for HUD, an increase of $4.5 billion compared to fiscal year 2022.
HOME HEALTH
- LeadingAge Advocacy Win! In the proposed Consolidated Appropriations Act, 2023, Congress instructs CMS to release data that LeadingAge requested in our rule comments. Having this data will allow for the comparison of behavior before and after the change to payment driven groupings model (PDGM) and enable providers to give CMS more accurate feedback on points of disagreement. What’s more, the legislation also requires CMS to meet with stakeholders to receive feedback on rate development for CY2024 and to also release the applicable data in advance of that public meeting. Even though this legislation will not impact the rates for CY2023, that Congress listened to our advocacy and took action to address our concerns is a positive – and we are hopeful that this will put us on the path to achieving a payment approach that works for our mission-driven, nonprofit members and guarantees that all older adults and their families can get needed care and services.
- The home health rural add on was extended for episodes that occur in CY2023.
HOSPICE
- LeadingAge Advocacy Win! The ability for hospices to do the face to face recertification via telehealth was extended for 2 years until 2024 (as part of the broader telehealth extension)
- LeadingAge Advocacy Win! The agreement includes $1,000,000 to fund an evidence review and technical expert panel on the feasibility of developing consensus based quality standards for high quality bereavement and grief care. Hospice is the only provider group specifically named that must be consulted in the process. This was a LeadingAge authored provision. We also advocated for the inclusion of report language on the scope of the need for grief and bereavement services – this language was also included.
- The agreement allows for marriage and family therapists and mental health counselors to serve on the hospice IDT in the social work role (it does not require one of these professionals, it just allows them to fill this role).
NURSING HOMES
- The package includes $150 million for Veterans Administration Grants for Construction of State Extended Care Facilities, an increase of $100 million above the fiscal year 2022 enacted level. This increase will allow the Veterans Administration to provide more grants to assist states in constructing state home facilities, for furnishing domiciliary or nursing home care to veterans, and to expand, remodel, or alter existing buildings.
- The bill includes a $2 million increase for the long-term care ombudsman program, which was funded at $18.8 million in fiscal year 2022. It also provides $15,000,000 for the nationwide Adult Protective Services formula grant program.
TELEHEALTH
- LeadingAge Advocacy Win! Medicare telehealth flexibilities will be extended for two years. The provisions have already been extended for 151 days after the end of the public health emergency.
MEDICARE AND MEDICAID
- LeadingAge Advocacy Win! Medicare telehealth waivers were kept in place for 2 years, through 2024. This includes allowing the home to be the originating site, removal of geographic restrictions, expanded eligible practitioners, allowing the use of audio only telehealth services, and allowing the hospice face to face recertification to be done via telehealth. The legislation also requires a study on telehealth and program integrity.
- The Medicaid “unwinding” was delinked from the public health emergency. The continuous coverage provisions put in place by the Families First Coronavirus Response Act will end March 31, 2023. The increased FMAP will be phased out of the course of 2023. Q1, it remains at 6.2%. Q2, it will be 5%. Q3, it will be 2.5%. Q4, it will be 1.5%. There are a number of guardrails around transparency and reporting tied to states continuing to get the increased FMAP over the course of the year. We will provide more details on this provision in the coming days.
- The proposed physician fee cuts were reduced from CMS’s proposal. The cuts will be 2% for CY2023 and 3.5% for CY2024 – the rule called for a 4.5% cut for CY2023. This impacts providers that bill part b – so among our members, palliative care practices, nursing home medical directors, primary care practices generally, referral sources to home health and adult day, and part b services across the continuum like PT, OT, etc.
- The hospital at home program waiver was kept in place for 2 years.
COVID-19
- Parts of a Pandemic Preparedness bill made it into the package, including making the CDC director into a Senate-confirmed position.
- Long COVID Research – The agreement includes $10,000,000 for health systems research on how best to deliver patient-centered, coordinated care to those living with Long COVID, including the development and implementation of new models of care to help treat the complexity of symptoms those with Long COVID experience.
- Other COVID-related provisions are spread throughout the bill; more information coming on them.
Vaxx and Booster Resource Hub Now Live on LeadingAge.org
A new resource on LeadingAge.org, the All Hands on Deck hub, pulls together a wealth of information and tools created for our All Hands on Deck vaccine and booster uptake initiative. We are pleased to work in partnership with federal agencies and the White House to help drive our shared objective of keeping older adults safe and healthy. Created by a LeadingAge cross-functional team, which includes our New York state partner, the online hub includes:
- Weekly reports LeadingAge national sends to the Department of Health and Human Services with all nursing homes’ vaccination rates data along with breakouts of LeadingAge members’ rates
- Messaging and Talking Points for members
- Press releases sent to national and trade media on LeadingAge’s collaboration with the White House re: the All Hands on Deck campaign and reaction to policy change allowing nursing homes to apply for approval as a Centers for Disease Control & Prevention (CDC) approved vaccinator
- Instructions for nursing homes to apply for approval as CDC-approved vaccinators
- State-specific vaccine education and communications resources
- Public service announcement assets to increase vaccination among health care professionals
LEADINGAGE KANSAS NEWS
No Friday Webinar This Week
Join us each Friday for an update on what is going on pertaining to COVID, updates on the association front, and much more.
If you haven’t registered already, you can do so here. You can also see archived webinars and get handouts here.
THANKS TO OUR PLATINUM PARTNER
