LeadingAge Advocacy Goals

• Extend the Public Health Emergency, including accompanying waivers.
• Ensure that vaccines and booster doses are distributed quickly and efficiently to immunize all staff who serve in aging provider organizations and individuals over age 65, starting with residents of congregate settings.
• Implement education programs to promote vaccine and booster uptake.
• Establish a fully federally funded national testing program that covers all residents and staff in aging services organizations.
• Require vaccination or rigorous testing for nursing home surveyors and ombudsmen as a condition of entering nursing homes.
• Establish a regular system to distribute personal protective equipment (PPE) to aging services providers.
• Ensure that additional Provider Relief Funds for all aging services providers are enacted, current funds are available until fully distributed, reporting requirements are streamlined, and all available funds reach aging services providers swiftly.
• Increase the Federal Medical Assistance Percentage (FMAP) for home and community-based services providers, ensure funding for additional HUD 202 homes, and support investments to address the workforce crisis in aging services, by enacting Build Back Better.
• Make permanent flexibilities currently permitted by the Coronavirus Preparedness and Supplemental Appropriations Act of 2020, the CARES Act, and 1135 waivers.
• Allow hospices more flexibility in the provision of respite care during the emergency.

THE ISSUE

COVID-19 fundamentally changed life in the United States – and the world – in 2020 and 2021, and even as vaccines and treatments become increasingly available, the pandemic’s impact will be felt. As the pandemic continues, providers who serve older adults need relief immediately – funding, staff, and supplies. Once the Public Health Emergency ends, aging services providers will require additional support to maintain their ability to serve older people, evolve based on lessons learned from COVID, and be ready for the next crisis.

People over age 65 are at the highest risk of severe COVID and loss of life; 80% of those who die of COVID in the United States are age 65 or older. The media has focused attention on nursing homes throughout the pandemic, but all congregate living organizations are experiencing previously unimaginable challenges. And providers of home care and home and community-based services are also struggling like never before to serve people, regardless of where they live.

Providers have faced desperate staffing shortages, staff fatigue, PPE shortages, a lack of testing supplies and uncoordinated testing policies, and barriers and supply challenges related to life-saving therapeutics. Unanticipated expenditures have driven many to close or to the brink of closing. The rapid aging of the population of the US – by 2050 one in four Americans will be over age 65 – makes the need to come back from COVID with a strong, high-quality aging services system more pressing.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of COVID legislation LeadingAge is following in this Congress.

• COVID-19 relief. We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.

Executive Branch

• Extension of Public Health Emergency. We support continued extensions of the Coronavirus Public Health Emergency.
• Support to Ensure that Staff and Consumers of Aging Services Can Keep the Vaccinations Up to Date. We support the efficient distribution of vaccines/all necessary boosters to all individuals over age 65 and the staff who serve them. We encourage HHS to implement consumer education programs to encourage keeping up to date on vaccines, particularly targeting reluctant staff members.
• Personal Protective Equipment. We advocate to HHS and the Administration to prioritize aging services providers in the distribution of personal protective equipment to help limit transmission of COVID-19 and protect the staff providing care to vulnerable older adults.
• Provider Relief Fund Reporting. We will continue to work with HRSA to advocate continued streamlining of reporting processes that will provide the Administration with the necessary information for addressing the pandemic while ensuring providers are not burdened with duplicative, time-consuming, or unnecessary data reporting. We advocate to HHS that Provider Relief Fund Reporting balances the need for accountability while minimizing reporting burden by utilizing information that is already reported through other programs.
• Regulatory waivers. We advocate that CMS continue 1135 regulatory waivers to allow providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and that additional flexibility be considered.
• Distribution of testing materials. We call on the Administration to ensure that all aging services providers have adequate COVID-19 testing materials and that nursing homes specifically have the testing resources needed to comply with CMS requirements.
• Distribution of therapeutics. We advocate that the Administration prioritize the most vulnerable older people for access to therapeutics.  Further, we seek federal leadership to address barriers that come up in the current therapeutics distribution systems, which are individually determined by each state.
• Resilience in senior housing. We will carry on with our work with federal agencies to support the needs of affordable senior housing communities with necessary financial and administrative relief.

LeadingAge Advocacy Goals

• Ensure that older adults are able to receive health care and long-term services and supports in their homes and communities if they prefer to do so.
• Advance policy that promotes the availability of HCBS across funding streams, including Medicaid, Medicare, Older Americans Act, and Veterans Affairs.
• Secure funding to stabilize the adult day services field and make sure providers are able to sustain through and beyond the COVID-19 pandemic.
• Support increased availability of PACE organization services to older adults through regulatory and statutory flexibility and investment at the federal and state levels.
• Ensure that any LTSS models from the Center for Medicare and Medicaid Innovation is inclusive of all settings in the home and community (e.g., home health and personal care, adult day other day-based services, PACE services) and provide the supports (e.g., transportation) needed to facilitate these.
• Promote federal rulemaking that ensures access and quality HCBS for beneficiaries while minimizing provider burden.
• Preserve the ability and discretion of states to regulate assisted living.
• Address racial disparities in access to and quality of HCBS.
• Oppose block grant and per capita cap policies.

THE ISSUE

Home and community-based services (HCBS) providers are at an inflection point. Over the last decade, significant improvement has been made in the availability of and public investment in these critical LTSS providers, however, the COVID-19 pandemic has put these resources at risk both at present and over the long term. In addition, federal barriers exist that limit the growth and availability of HCBS, including the optional status of HCBS (waiver, state plan, PACE) as Medicaid benefit categories, limits to emergency relief provisions (e.g., retainer payments), and the lack of an HCBS-centered model from the CMS Innovation Center.

Adult day services providers in particular are at risk. As the pandemic continues,  many centers are closing either by mandate or voluntarily, and many saw most of their revenue streams evaporate overnight. Those that have since reopened have done so at reduced capacity and with fewer participants attending. This has led to centers closing across the country, jeopardizing the availability of these services over the long run. Federal funding, as well as flexibilities from payers like Medicaid and the VA, continue to be sorely needed.

PACE organizations have innovated amidst the pandemic, particularly with respect to the use of telehealth and developing new ways to use their PACE centers. Most PACE organizations have also ramped up their in-home services capacity, versus the traditional center-based model many have historically used. Regulatory change is needed to fully realize the use of telehealth in these centers, and states and the federal government must maintain their investment in this model.

Several other types of home and community-based services, including life plan community “at home” models, Medicaid personal and home care, also face challenges associated with the pandemic, including staffing and PPE.All the while, workers and participants of these providers have not been prioritized for COVID-19 PPE, testing or vaccination distribution. Ensuring that HCBS is included in these critical allocations are fundamental to making sure they are available for older people over the next decade and beyond.

Advocacy Action 2022

117^th Congress

Click here to see the full list of HCBS  legislation LeadingAge is following in the 117th Congress.

• COVID-19 Relief. We will continue to advocate for the inclusion of HCBS providers in COVID-19 relief provisions, including HCBS grant making, provider relief funding or other dollars and/or equipment allocated to health and long-term care providers (e.g., testing, PPE).
• Medicaid FMAP. We support an increase in the Federal Medical Assistance Percentage (FMAP) for Medicaid HCBS and a total increased investment of at least $150 billion by Congress.
• Benefit categories. We ask Congress to revise Medicaid and put HCBS (including waiver and state plan services and PACE) on equal footing with nursing homes and make HCBS a mandatory Medicaid benefit.
• Protecting access. We support making permanent key provisions that ensure access to HCBS, including the federal spousal impoverishment protections for Medicaid HCBS and the Money Follows the Person program.
• Adult Day Coverage under Medicare. We believe Congress should amend the Medicare program to make adult day services available to beneficiaries (e.g., FFS and managed care). See H.R. 4063 from the 116th Congress.
• Appropriations. We support increasing funding for key provisions that support HCBS, including Older Americans Act services.

Executive Branch

• COVID-19. We support the high prioritization of workers and participants of HCBS of all types in federal allocations of COVID-19 vaccination, testing, and PPE. Federal agencies should recommend that state-level decision-makers place a high priority to this group.
• Telehealth. We continue to advocate for revisions to CMS guidance documents to broaden access to telehealth services for PACE participants and Medicare Advantage enrollees. In addition, we ask CMS to encourage states to make telehealth available as a meaningful option for Medicaid HCBS providers unable to deliver in-person services.
• Provider Relief Fund. We will advocate that any additional allocations made from the Provider Relief Fund (or similarly situated future funding streams) be inclusive of HCBS providers.
• Protect Medicaid financing. We oppose any Medicaid waiver or rulemaking that reduces federal funding to the program, as these could ultimately jeopardize HCBS access. To that end, CMS should not approve and/or rescind waivers that allow per capita caps/block grant financing, work requirements and unnecessary coverage/enrollment barriers.
• Innovation Center models. We will closely monitor CMMI action to ensure that home and community-based services of all types are included as part of the proposed LTSS Innovation Fund and in other models.
• VA Coverage of HCBS. We will closely monitor developments with the VA Community Care Network program and other VA initiatives that provide HCBS and advocate for our members and the veterans they support.
• Transportation and Medicaid. We support the maintenance of current rulemaking that assigns non-emergency medical transportation (NEMT) as a mandatory Medicaid benefit.
• Supplemental Services under Medicare Advantage. We will encourage CMS to continue broadening HCBS availability in Medicare Advantage and work with plans on implementation.

 ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center and help your members of Congress understand how policies they make impact Home and Community Based Services.
• Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact HCBS providers and residents.
• Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to create and sustain home and community-based services.

ADDITIONAL RESOURCES

• How Could New Federal Dollars Change Medicaid Home and Community Based Services?

LeadingAge Advocacy Goals

• Promote collaborative not punitive approaches to the enforcement of regulations, focusing on outcomes, not process.
• Ensure regulations promote person-centered quality and support positive clinical outcomes, evidence-based best practices, and reduce the administrative burden.
• Advocate for reimbursement that is sufficient to provide quality of care.
• Address workforce challenges through grants, training, and programs.
• Ensure nursing homes are part of the continuum of care.
• Promote initiatives to meaningfully examine and address the workforce crisis.
• Seek meaningful, transformational change in the structure, care delivery, and financing of residential long-term services and supports.
• Promote a positive vision of the future of nursing homes as an integral part of the continuum of care.
• Advance a quality measurement system underlying the regulatory process that truly reflects quality care and quality of life for residents.
• Ensure staff are well trained and paid a fair wage and that when wages are increased, reimbursement increases to cover new costs.
• Advocate for evidence-based reimbursement rates from Medicare and Medicaid that take into account the full range of costs to provide high-quality care with particular emphasis on staffing and supply needs.
• Ensure the availability of wellness and mental health services to help compassion fatigue of nursing home staff.
• Ensure members have the resources needed to provide person-centered care.
• Advocate for increased telehealth support to improve quality of life.

THE ISSUE

Nursing homes are an essential element of the long-term services and support system, serving individuals with serious functional impairments who are unable to live independently in the community. Although fewer than 4% of those over 65 will ever live in a nursing home, these settings provide treatment and care in a safe, home-like community that supports a quality of life when aging in the community is no longer an option.

Provider Relief Funds, a lifeline for many nursing homes (and other providers) in 2020 and 2021, do not nearly make up for the outlays that nursing homes have had to make or the revenue lost due to vast decreases in elective surgery and consumer hesitance to enter nursing homes.

Medicaid is the primary payer for nursing home care, covering six out of ten stays, but Medicaid rates do not cover the cost of care. The pandemic has further eroded inadequate Medicaid reimbursement rates in most states.  LeadingAge anticipates that 2022 will bring unprecedented demand to Medicaid programs as states struggle to cover newly uninsured individuals and make up for other economic impacts of COVID.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of nursing home legislation LeadingAge is following in the 117th Congress.

• NASEM Study. We support the study underway by the National Academies of Sciences, Engineering, and Medicine to evaluate the current long term care survey process, the link to care outcomes, and alternative strategies to assure quality nursing home care, and will encourage policymakers to address if not adopt the final recommendations expected in 2022.
• IMAGINE Proposal: We propose the creation of an aging-forward immigration system that would engage foreign-born workers to address the workforce crisis faced by many nursing homes and aging services providers.

Executive Branch

• COVID-19 Policies, Guidance, and Resources. We will work with HHS (including CDC, CMS, HRSA, NIA and others) to provide feedback on members’ needs related to guidance for addressing COVID-19. We advocate for policies on operations, including visitation, that will help our members balance residents’ health and safety with psychosocial well-being. We will provide feedback on guidance and training materials and resources to ensure that they are useful and accessible to nursing home staff that have been stretched thin by months of crisis-level operations due to the public health emergency. We will offer input into the need for financial assistance through Provider Relief Funds, advise on the development of any related quality incentive programs, and seek answers to implementation questions and need for guidance on the use of funds.
• Provider Relief Fund Reporting. We will continue to work with CDC and advocate to CMS to implement streamlined reporting processes that will provide the Administration with the necessary information for addressing the pandemic while ensuring providers are not burdened with duplicative, time-consuming, or unnecessary data reporting. We advocate to HHS that Provider Relief Fund Reporting balances the need for accountability while minimizing reporting burden by utilizing information that is already reported through other programs.
• Regulatory waivers. We advocate that CMS continue 1135 regulatory waivers to allow providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and that additional flexibilities be considered. We advocate for making permanent certain waivers (e.g. the 3-day stay) to expand beneficiaries’ access to care despite geographical barriers or workforce insufficiency.
• Distribution of testing materials. We call on the Administration to ensure that all aging services providers have adequate COVID-19 testing materials and that nursing homes specifically have the testing resources needed to ensure the safety of residents and staff and compliance with CMS requirements.
• Integrated MA benefits. We support ongoing flexibility for Medicare Advantage plans to add or amend benefits and policies that improve access to services or deliver a more integrated approach to care, (e.g., adding new supplemental benefit – home delivered meals during the pandemic) and doesn’t add administrative burden to providers.
• Requirements of Participation (RoPs). We will provide feedback to CMS to ensure that regulations and interpretive guidance are clear and evidence-based. We support proposed changes that eliminate duplicative, unnecessary, and burdensome requirements that do not support quality care.
• Survey and Certification. We call on CMS to improve consistency and accuracy in the survey and certification process. We will propose alternatives focused on a collaborative approach to quality improvement and utilization of enforcement remedies that reflect a just culture.
• Quality Measures. We will promote activities to establish quality measures that are evidence-based and accurately reflect quality care. We ensure nursing homes are not negatively impacted under the SNF Value-Based Payment program or SNF Quality Reporting Program payments due to waived data reporting requirements during the public health emergency.
• Medicare Care Compare. We will provide feedback on the additions or changes to the Medicare Care Compare site to ensure important information is clearly displayed and consumers are not misled by icons and formatting that prioritize information that does not accurately capture nursing home quality information.
• Patient-Driven Payment Model (PDPM). We provide feedback to CMS on members’ experiences to accuracy and adequacy of PDPM.
• Alternative Payment Models. We engage in activities geared toward the development of alternative payment models, such as the Unified Post-Acute Care Prospective Payment System Technical Expert Panel.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your representative and senators hear your voice on the issues facing nursing homes.
• Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact nursing homes and the people who live and work in them.
• Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support nursing homes and the care they provide for residents.

ADDITIONAL RESOURCES

• LeadingAge COVID-19 Information for Nursing Homes
• National Academies of Sciences, Engineering, and Medicine study on the quality of care in nursing homes

LeadingAge Advocacy Goals

• Address the severe shortage of affordable senior housing by expanding, preserving, and improving the portfolio.
• Improve resident health by using the affordable housing platform to connect residents to services and supports, including by expanding the number of service coordinators.
• Support HUD processes, requirements, and inspection protocols that correspond to the operation of high-quality affordable senior housing.

THE ISSUE

There is a severe shortage of affordable housing for older adults with low incomes. Between 2009 and 2019, the number of very low income older adult households spending more than half of their incomes on rent increased by an astonishing 68%. The number of older adults who receive federal housing assistance must expand well beyond the 2.5 million older adults who currently benefit from housing assistance. Having affordable, service-connected housing allows older adults to live independently in community and avoid much more expensive and restrictive settings. Any expansion will immediately help erase and shorten current waiting lists of two to five (or more) years and help the nation prepare for the projected 13.8 million new older adult households between 2020 and 2040. Of these, 40% (5.5 million) will be renter households. Of these 5.5 million new older adult renter households, 2.6 million will be Black older adult renter households.

ADVOCACY ACTION 2022

117^th Session of Congress

Click here to see the full list of affordable housing legislation LeadingAge is following in the 117th Congress.

Secure robust Fiscal Year 2023 HUD appropriations funding:

• Expand the supply of affordable senior housing.
  • Provide $600 million for new capital advances and operating assistance, including service coordinators, for approximately 6,200 new Section 202 Supportive Housing for the Elderly homes.
•  Preserve and improve HUD-assisted housing.
  • Provide full funding for Section 8 Project-Based Rental Assistance (PBRA) and Project Rental Assistance Contract (PRAC) renewals, including funding to acknowledge elevated operational costs, including for insurance, safety, and staffing, sustained after the onset of COVID.
  • Ensure RAD for PRAC success.
    • Continue to authorize rent levels for continued availability of services for residents following RAD conversion.
    • Provide $10 million for RAD for PRAC conversion subsidy to ensure the successful and long-term preservation of 202/PRAC homes.
• Connect HUD-assisted residents to the services and supports they need to age in the community. 
  • Provide $125 million for the renewal of existing service coordinator grants.
  • Provide $100 million for 400 new, three-year service coordinator grants and expand eligibility to 202/PRAC communities.
  • Provide a $31 million increase for new, budget-based service coordinators.
  • Expand ConnectHome and Neighborhood Networks programs to improve internet access in HUD multifamily housing; direct HUD to collaborate with the FCC and NTIA to bridge the connectivity divide.
  • Direct HUD to report to Congress on ways to, and progress toward, increasing internet connectivity in HUD multifamily housing, including by expanding HUD-covered housing costs to include ongoing internet service fees.

Expand and improve the Low Income Housing Tax Credit program.

• Increase state Housing Credit allocations by 50%.
• Fix Right of First Refusal issues that continue to rob nonprofit housing providers of their housing credit-financed developments.
• Lower the threshold of Private Activity Bond financing required to trigger the maximum amount of 4% Housing Credits from 50% to 25%.
• Enable the Housing Credit to better serve households with extremely low incomes.
• These and other provisions are in the Affordable Housing Credit Improvement Act (AHCIA), which LeadingAge supports.

Prevent and End Homelessness.

• Fund homeless assistance programs.
• Expand the supply of affordable housing.

Build Back Better / Significant new housing investments.

In any bill to significantly expand affordable housing resources, include:

• $2.5 billion for approximately 26,000 new Section 202 Supportive Housing for the Elderly homes.
• $15 billion for 260,000 new Project-Based Rental Assistance homes.
• Funding for service coordinators across the affordable senior housing portfolio (HUD, Rural Housing Service, Low Income Housing Tax Credit, etc.).

Executive Branch

• Expanded and Preserved Housing Options: Significantly expand the supply of federally subsidized housing for older adults with low incomes and older adults experiencing homelessness; and preserve and improve existing supply of housing.
• Connected, Service-Enriched Housing: Support partnerships between federal agencies to improve access to services and the internet in affordable senior housing communities.
• Public-Private Partnerships: Strengthen partnerships between private housing providers and the federal government to streamline and improve housing operations.
• Resilience in Senior Housing: Improve pandemic recovery and build disaster resiliency throughout the senior housing portfolio while improving the federal approach to disaster preparedness and response.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know you support the expansion and preservation of affordable housing programs for older adults.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact HCBS providers and residents.
• Engage with other affordable senior housing providers through the LeadingAge Housing Advisory Group (and its five working groups), as well as other regular national, regional, and state meetings. Contact Linda or Juliana for more information.

ADDITIONAL RESOURCES

• HUD’s Worst Case Housing Needs 2021 Report to Congress
• The Urban Institute’s 2020 – 2040 household formation projections: The Future of Headship and Homeownership
• Exploring Financing Options for Services in Affordable Senior Housing Communities
• Aging Research from the Joint Center for Housing Studies of Harvard University

LeadingAge Advocacy Goals

• Ensure that older adults are able to receive health care and long-term services and supports in their homes and communities if they prefer to do so.
• Support increased availability of PACE organization services to older adults through regulatory and statutory flexibility and investment at the federal and state levels.
• Promote PACE across the country via new and expanded service areas and increased enrollment.
• Advance policy that promotes the availability of PACE across funding streams.
• Ensure that any LTSS models from the Center for Medicare and Medicaid Innovation are inclusive of all settings in the home and community (e.g., home health and personal care, adult day other day-based services, PACE services) and provide the supports (e.g., transportation) needed to facilitate these.
• Promote federal rulemaking that ensures access and quality home and community services for beneficiaries while minimizing provider burden.
• Oppose block grant and per capita cap policies.

THE ISSUE

PACE organizations have risen to the challenge COVID-19 has presented. Since March of 2020, many PACE organizations transitioned away from in-person services and instead delivered care via home visits and through telehealth. The combination of nimble service delivery, stable reimbursement, and the ability of PACE to keep older adults in their homes and communities make the model attractive to participants, payer (e.g., Medicare and Medicaid), and PACE organizations both during and beyond the pandemic.

PACE organizations have innovated amidst the pandemic, particularly with respect to the use of telehealth and developing new ways to use their PACE centers. Most PACE organizations have also ramped up their in-home services capacity, versus the traditional center-based model many have historically used. Regulatory change is needed to fully realize the use of telehealth in these centers, and states and the federal government must maintain their investment in this model.

In addition, federal barriers exist that limit the growth and availability of PACE, including the optional status of all home and community-based services (waiver, state plan, PACE) as Medicaid benefit categories, limits to emergency relief provisions (e.g., retainer payments), and the lack of an HCBS-centered model from the CMS Innovation Center.

All the while, workers and participants of these providers have not been prioritized for COVID-19 PPE, testing, or vaccination distribution. Ensuring that PACE is included in these critical allocations is fundamental to making sure they are available for older people over the next decade and beyond.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of PACE legislation LeadingAge is following in the 117th Congress.

• COVID-19 Relief. We will continue to advocate for the inclusion of PACE providers in COVID-19 relief provisions, including HCBS grant making, provider relief funding, or other dollars and/or equipment allocated to health and long-term care providers (e.g., testing, PPE).
• Medicaid FMAP. We support an increase in the Federal Medical Assistance Percentage (FMAP) for Medicaid HCBS, which includes state plan/waiver services and the Medicaid share of PACE.
• Benefit categories. We ask Congress to revise Medicaid and put HCBS (including waiver and state plan services and PACE) on equal footing with nursing homes and make HCBS a mandatory Medicaid benefit.
• Appropriations. We support increasing funding for key provisions that support HCBS, including Older Americans Act services.

Executive Branch

• COVID-19. We support high prioritization of workers and participants of HCBS of all types in federal allocations of COVID-19 vaccination, testing, and PPE. Federal agencies should recommend that state-level decision-makers place a high priority on this group.
• Telehealth. We continue to advocate for revisions to CMS guidance documents to broaden access to telehealth services for PACE participants and Medicare Advantage enrollees. If the executive ranch does not act, Congress should.
• Provider Relief Fund. We will advocate that any additional allocations made from the Provider Relief Fund (or similarly situated future funding streams) be inclusive of PACE providers.
• Protect Medicaid financing. We oppose any Medicaid waiver or rulemaking that reduces federal funding to the program, as these could ultimately jeopardize PACE access. To that end, CMS should not approve and/or rescind waivers that allow per capita caps/block grant financing, work requirements, and unnecessary coverage/enrollment barriers. CMS should not propose rulemaking similar to the 2019 Medicaid Fiscal Accountability Regulation (MFAR).
• Innovation Center models. We will closely monitor CMMI action to ensure that home and community-based services of all types are included as part of the proposed LTSS Innovation Fund and in other models.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center and help your Members of Congress understand how policies they make impact PACE organizations.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact PACE organizations and participants.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support more opportunities to create and sustain home and community-based services.

LeadingAge Advocacy Goals

LeadingAge Advocacy Goals

• Advocate for permanent changes to Medicare, Medicaid, and commercial payer telehealth policy based on lessons learned from the coronavirus pandemic.
• Ensure all aging services providers are included in future permanent telehealth expansions.
• Remove Medicare’s restrictions of patients’ homes as an originating site for audio-only, synchronous audio-only, and asynchronous biometric remote patient monitoring (RPM) and for individuals with chronic conditions living independently, and for individuals with chronic conditions living independently but helped by home health clinicians. Also, promote the use of synchronous audio-video telehealth in skilled nursing homes and assisted living communities.
• Create an equitable payment policy for the post-pandemic era that balances providers’ costs with patient protections.
• Promote the adoption of interoperable electronic health records, including funding and technical support.
• Promote the use of standards-based health information exchange between aging services providers and their partners including primary/acute care providers and payers.
• Ensure equitable internet connectivity for all aging services providers and older adults, including in affordable housing where Wi-Fi access should be federally funded.
• Promote policies that support the use of technology to reduce social isolation.
• Promote the LeadingAge proposed “Telehealth Demonstrations” to expand professionals eligible for certain telehealth interventions, such as Chronic Disease Management and Complex Chronic Conditions to include home health nurses, care managers, and clinical social workers at home health agencies that use RPM technologies to manage chronically ill populations, under the supervision of a physician. Such codes are under-utilized by physicians. Similarly, there are opportunities for therapists, pharmacists, and staff at other types of home-based care providers, etc., to provide appropriate interventions using the appropriate modalities of telehealth.

Health IT Incentives:

Secure government funding for the Office of National Coordinator (ONC) at the U.S. Department of Health and Human Services (HHS) to:

• Establish electronic health record (EHR) Interoperability Certification Criteria/Program relevant to LTPAC, but aligned, where possible, with the acute care certification program.
• Establish health IT education and training for staff in LTPAC providers, similar to the Regional Extension Centers (RECs) that supported small physician practices.
• Fund technical assistance resource centers to provide technical assistance for LTPAC providers, similar to the RECs that supported small physician practices.
• Direct financial incentives for LTPAC Providers (SNFs/NFs, home health, hospice, long-term acute care hospitals (LTACHs), in-patient rehabilitation facilities (IRFs) to:
  • Upgrade to interoperable EHR technology;
  • Upgrade their infrastructure and broadband connectivity;
  • Subscribe and connect to health information exchange entities or networks, and add technically competent staff to support the use;
  • Conditional Sustainable Use financial incentives/payment modifiers that, tied to quality measures, would be impacted by effective exchange of health information with partners for the next five years.

Broadband:

• Extend the subsidized broadband connectivity rates for health care providers in rural areas to additional aging services providers by amending the Social Security Act (as was done in the 2015 Rural Connectivity Act, which added nursing homes to the definition of healthcare providers).
• Create funding opportunities for congregate affordable low-income housing providers to collectively apply for and receive broadband internet connectivity to the building and to their residents’ units, to ensure equitable access to services.

THE ISSUE

Massively increased flexibilities, particularly in the Medicare program, to utilize technology to deliver all types of care became an essential lifeline for our health care system during a time of unparalleled challenges and strains. If there is any “silver lining” to the coronavirus pandemic, it has been an increase in the use of technology to deliver appropriate and timely care to keep people safe, healthy, and well-connected.

The ability to use telehealth during this emergency was vitally important to protect staff and patients’ health, but also to expand the reach of overextended health care personnel. Waivers in Medicare rules that allow the home to be an originating site of care expand the types of technology that can be used for telehealth visits (e.g., Facetime and even audio-only in some cases) and expand the types of providers that can bill for telehealth services are all massive changes from the pre-pandemic state of play.

The question now is how to capitalize on the progress made during the pandemic, which in many ways has served as the “demo” of telehealth that many have asked for in the past. Concerns for the future include how to make sure that telehealth is incorporated into practice in an equitable, cost-effective (for both the government and providers), and accessible way. What is clear is that we need to continue moving forward.

In addition to making permanent many of the pandemic flexibilities, aging services providers need to adequately pay their appropriate trained staff, like therapists and nurses. These staff can either deliver interventions, including therapy via telehealth (both synchronous virtual visits as well as asynchronous RPM) under a physician-approved care plan, or can assist a remote physician during an asynchronous telemedicine visit. Moreover, providers need support to maintain and upgrade technology. Hence, they need adequate reimbursement from all payer sources to sustain and maintain the investments they already made in delivering care via telehealth.

Broadband investment, especially in rural and underserved areas, is critical to making sure telehealth is an accessible service nationwide – including in affordable senior housing communities, many of which lack connectivity and where federal investment in wireless internet capability is imperative. Continued investment in broader health IT to support information management and the secure exchange of health information are also critically important and need to be inclusive of aging services providers. Finally, those providers who treat patients in their own home – like home health and hospice as well as PACE – who have not been able to take full advantage of the affordable internet connectivity like their other healthcare peers in rural areas, or telehealth in the past, or even the expanded telehealth flexibilities, need to be included.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of hospice and palliative care legislation LeadingAge is following in the 117th Congress.

• Keeping key pandemic flexibilities.

We support keeping the following pandemic flexibilities in place permanently:

• • Permanently removing the geographic restrictions on telehealth;
  • Allowing the home to be an originating site of care beyond the public health emergency;
  • Permanent expansion of the providers who can furnish telehealth services in both the physical and mental health arenas;
  •  Continued flexibility in the type of modality allowable for video-audio connections (e.g., allowing the use of FaceTime or other smartphone technology) to utilize all tools available, including audio-only, to deliver telehealth services as appropriate and look to work with Congress on the intersection of accessibility and privacy (e.g., HIPAA concerns).
• Hospice face-to-face recertification. We support allowing the hospice face-to-face recertification to take place via telehealth on a permanent basis.
• Prevent a telehealth “cliff” after the end of the PHE. While we support the expansion of telehealth based on the experience of providers and patients during the pandemic, it is critically important that there not be a “cliff” where the flexibilities suddenly end, potentially cutting off access. We support policies that would extend the public health emergency flexibilities for two years after the end of the PHE – though we would want to be sure it was inclusive of both legislative and regulatory flexibilities.
• Reimbursement for home health telehealth visits. We support legislative efforts that allow virtual visits to be reimbursed under the Medicare home health benefit with appropriate guardrails.
• PACE and telehealth. We support legislation that would allow audio-only diagnoses that are made via telehealth to be used for purposes of determining risk adjustment to payments for PACE and Medicare Advantage programs.
• Housing and technology. We support federal funding for the installation and service fees for wireless broadband internet in all HUD-assisted senior housing communities units.
• Meaningful use. Aging services providers were not included in previous funding efforts that supported health care providers’ transition to electronic health records (EHR) systems that contain the medical and treatment histories of patients. We will continue to advocate for funding and payment incentives, including incentives tied to quality, to assist aging services providers in accessing EHR technology that is interoperable with that of their physician and hospital partners and peers and encourage the bi-directional exchange of information.
• Nursing homes and telehealth. We support legislation that allows all nursing homes to use telehealth models to improve care.
• Affordable rural internet connectivity for aging services providers. We support legislative action aimed at expanding the scope of the 2015 Rural Healthcare Connectivity Act to include home health, hospice, and other aging services providers in the home and community. Such action would allow all aging services providers to take advantage of lower internet connectivity costs offered to acute care and nursing homes.

Executive Branch

• CMS commissioned study on telehealth services. HHS announced in a December 2021 research report massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic. The report also provides insights into telehealth visits conducted in 2020, which increased 63-fold from approximately 840,000 in 2019 to 52.7 million. Additionally, the report found: specialists such as behavioral health providers saw the highest utilization relative to other providers; telehealth services were accessed more in urban areas than rural communities; and Black Medicare beneficiaries were less likely than White beneficiaries to utilize telehealth. In light of this report, LeadingAge encourages CMS to improve health equity in telehealth services as highlighted by the COVID-19 PHE and to expand access among underserved populations.
• CMS 1135 waivers. LeadingAge will continue to advocate for a review of telehealth and technology 1135 waivers to see which can be made permanent without Congress, including utilization of telehealth for hospice routine home care visits and flexibility in licensure requirements in the Medicare and Medicaid program.
• Remote patient monitoring. LeadingAge will work to ensure that all appropriate aging services providers can utilize and bill for asynchronous remote patient monitoring, which is critical for individuals with chronic conditions who our providers serve to enhance their service.
• Telehealth codes for home health and hospice. We will advocate for the creation of claims, codes, or modifiers to document home health and hospice virtual visits. Hospice providers are utilizing telehealth for routine home care during the pandemic, and home health providers are allowed to use virtual visits as part of their documented plan of care. We will advocate for the creation of claims codes or modifiers that will allow for analysis of these encounters for a variety of purposes including quality measurement. MedPAC recommended the creation of a claims code for hospice telehealth visits in their December 2021 and January 2022 meetings and we anticipate it will be in the March 2022 report.
• Advocate for allowing home health nurses to bill for services. Therapists and other appropriately licensed professionals are allowed to use telehealth and home health agencies to bill for such services beyond the pandemic. Remote patient and medication adherence monitoring improve chronic care management, reduce hospitalizations, hospital stay, and readmissions, and consequently cost. Chronic care management reimbursement codes currently exist for physicians, physician assistants, and nurse practitioners, but are woefully underutilized. We will advocate for the creation of claims codes or modifiers that will allow the appropriate staff at home health agencies to perform, and for agencies to bill for, a variety of appropriate chronic care management and therapy interventions approved by a physician’s plan of care using telehealth, including remote patient and medication adherence monitoring technologies.
• Make demonstrations inclusive of telehealth. New and current CMS Innovation Center (or Innovation Center) demonstrations should include waivers to allow for the broad utilization of telehealth and technology. We will advocate for the Innovation Center to continue to build the evidence for the role these areas will continue to play in healthcare delivery.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know your views on eliminating barriers for the expansion of telehealth services in the Medicare program.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies related to technology and not incorporating telehealth models in Medicare affect older adults.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know your views on technology and telehealth for older adults.

Resources

• LeadingAge Center for Aging Services Technologies

LeadingAge Advocacy Goals

• Propose and support LTSS reforms for older adults that include key provisions: low-income seniors must have housing and housing must include services as needed; new financing approaches must be considered, and communities must be prepared to include increasing numbers of older adults.
• Promote LTSS financing reform to ensure that people at all economic levels are able to access services when they need them.
• Support the evolution of an aging-services continuum that builds on both the lessons of COVID and current successes and helps providers keep moving toward systems and services consumers want.
• Create policies that recognize that the consumer long-term care experience involves using many types of services; policies should enable consumers to transition to different types of services within the continuum.
• Identify and create solutions to enhance provider access to high-quality aging and LTSS options for middle-income individuals.
• Support and complement the work of family caregivers.

THE ISSUE

The Coronavirus pandemic hammered home the fact that the nation’s aging and long-term care services are not where they should be. COVID’s differential impact on older people put into crisp clarity the fact that we must take steps to ensure a safe, high-quality range of choices for people who need functional supports as they age.

The pandemic further had deleterious effects on the economic status of many in the nation, especially those in lower wage tiers. Most people in the United States do not save or plan for their own likely future need for LTSS, and the federal government has yet to offer a program. Family caregivers provide much of that care, and LTSS insurance has shown limited success. Medicare does not cover ongoing LTSS needs. Medicaid finances some LTSS for people who have very limited incomes and assets, and for those whose health and LTSS expenditures drive them into poverty. But Medicaid, too, will emerge from the pandemic badly battered, needing to provide more services to more people. Individuals at the top of the income spectrum may be able to self-finance care. Those in the vast and increasing “middle market” have few options to meet their LTSS needs. While many LTSS benefit proposals have been discussed, few address financing. Increasingly, states—disappointed with the lack of federal attention—are discussing LTSS financing proposals of their own.

While most people prefer to remain in place, at least until they need extensive supports, few reform proposals to date have taken into account that many low-income people have no real options to receive extensive services in any place other than a nursing home. The administration’s caregiver support proposal offers more substantial supports to help people stay in the community.

LTSS reform proposals typically focus on benefit plans and financing. They must also take into account housing and age-ready communities. To receive home and community-based services, individuals must have a home. Any viable LTSS reform proposal must start with provisions to provide housing for people who qualify for public housing but do not receive it, and proposals must ensure that people in that housing have the ability to receive some services that help them remain in the community. Finally, proposals should address the infrastructure of communities across the country to ensure they support aging and multigenerational populations.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of LTSS finance reform legislation LeadingAge is following in the 117th Congress.

• Build Back Better expansions. We support the House-passed Build Back Better provisions to expand access to home and community-based services, make more low-income senior housing available, and support the LTSS workforce. We will work with Congress and the Administration to pursue passage and implementation of Build Back Better, or, at minimum, the aging services-related provisions.
• Educating policymakers. We will continue to build awareness of the need for LTSS after age 65 and promote proposals to address these needs, especially proposals that include a financing strategy, housing plus services, and community infrastructure building. We will work with any Members of Congress interested in these ideas.

Executive Branch

• Encourage federal agencies (e.g., HHS, Treasury, OMB, White House) to continue developing and supporting LTSS financing reform proposals and conversations.
• Supplemental Benefits. We support efforts to encourage plans to include supplemental benefits that include some home and community-based services as well as targeted services and supports for those with chronic illness. We advocate for these benefits and their corresponding eligibility requirements to be clearly communicated to beneficiaries. We seek to ensure providers of all sizes have an opportunity to be part of these networks.
• Medicaid Managed Care and LTSS. Monitor Medicaid managed care regulations relating to LTSS.
• New Models of Integrated Care. Engage the Center for Medicare and Medicaid Innovation in further development of new demonstration projects or models that will allow post-acute providers and/or LTSS providers to be accountable and financially at-risk for the care of a population or an episode of care.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know that you support meaningful LTSS financing and infrastructure reform.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand the importance of LTSS financing and infrastructure reform.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support programs that create a sustainable LTSS financing system and accompanying infrastructure development.

ADDITIONAL RESOURCES

• Special Issue of Generations, “The Financing of Long-Term Care: An American Conundrum,” April 2019.

LeadingAge Advocacy Goals

• Advocate for the availability of aging services across the continuum in Medicare and Medicaid.
• Ensure that regulations governing the Medicare and Medicaid programs promote high-quality care and are not burdensome to providers.
• Oppose block grant and per capita cap policies in Medicaid.
• Ensure that state Medicaid rates paid to nursing homes are sufficient to cover the costs of care.
• Ensure appropriate reimbursement to provide quality end-of-life care.
• Advance policy that promotes the availability of HCBS across funding streams, including Medicare and Medicaid.
• Advance managed care arrangements, reimbursement, and operational policies that enable aging services providers to meet their mission of serving older adults.

THE ISSUE

Medicare and Medicaid are critical revenue sources for most aging services providers and provide coverage to older adults who need post-acute care and/or long-term services and supports. These programs provide coverage to more than 100 million Americans, including millions of older Americans. The COVID-19 pandemic has underscored just how critical Medicare and Medicaid are and has unearthed challenges providers and consumers alike face as they interact with both. As detailed in other sections of these policy priorities, many provider types interact with Medicare and/or Medicaid differently and have their own needs. Across the board, however, preserving, strengthening, and improving these systems are vital to realizing an aging services system that meets the needs of every older adult. To achieve that, LeadingAge supports specific policy actions from both Congress and the executive branch as described below.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of Medicare and Medicaid legislation LeadingAge is following in the 117th Congress.

• Medicare home health reimbursement. We continue to support legislative efforts that seek to ensure transparent and evidence-based approaches to Medicare reimbursement in the Patient-Driven Groupings Model.
• Reimbursement for home health telehealth visits. We support legislative efforts to allow Medicare reimbursement of virtual home health visits, with appropriate guardrails and visit equivalency between in-person and virtual visits.
• Sequestration: We support an extension of the Medicare sequestration moratorium.
• Keeping key pandemic flexibilities: Support making key pandemic related telehealth provisions a permanent part of the Medicare program: permanently removing the geographic restrictions on telehealth; allowing the home to be an originating site of care beyond the public health emergency; and permanent expansion of the providers who can furnish telehealth services in both the physical and mental health arenas.
• Medicaid FMAP. We support an increase in the general Federal Medical Assistance Percentage for long-term care services to ensure states have the funds needed to sustain these services.
• Benefit categories. We ask Congress to revise Medicaid and put HCBS (including waiver and state plan services and PACE) on equal footing with nursing homes and make HCBS a mandatory Medicaid benefit.
• Protecting access to Medicaid HCBS. We support making permanent key provisions that ensure access to HCBS, including the federal spousal impoverishment protections for Medicaid HCBS and the Money Follows the Person program (as included in Build Back Better).
• Adult Day Coverage under Medicare. We believe Congress should amend the Medicare program to make adult day services available to beneficiaries (e.g., FFS and managed care).
• Medicaid rates. We will continue to work with state partners and members to ensure that state Medicaid rates paid to aging services providers are sufficient to cover the costs of care.

Executive Branch

• Rules, guidance, other federal policy documents. We will work with CMS on Medicaid and Medicare rules and guidance documents relevant to providers across the continuum—nursing homes, PACE, home health, hospice, HCBS waiver services.
• Regulatory waivers. We advocate that CMS continue 1135 regulatory waivers to allow providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and that additional flexibilities be considered. We advocate for making permanent certain waivers (e.g., the 3-day stay) to expand beneficiaries’ access to care despite geographical barriers or workforce insufficiency.
• Accelerated and advance payment program. We will continue to monitor the accelerated and advance payment program repayment to ensure repayment will not deleteriously impact providers’ finances.
• Extend administrative flexibility. Support continuation of the Public Health Emergency 1135 Blanket Waivers that CMS put in place during the pandemic allowing providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and that additional flexibilities be considered.
• IMPACT Act. We will participate in the Medicare unified post-acute prospective payment system technical expert panel to provide the voice of LeadingAge members regarding possible future payment system design. This includes advocacy to slow the pace of model development work of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to reflect relevant data collection not skewed by the experiences of the COVID-19 pandemic.
• Telehealth. We continue to advocate for revisions to CMS guidance documents to broaden access to telehealth services for PACE participants and Medicare Advantage enrollees. In addition, we ask CMS to encourage state Medicaid agencies to make telehealth available as a meaningful option for Medicaid HCBS providers unable to deliver in-person services.
• Protect Medicaid financing. We oppose any Medicaid waiver or rulemaking that reduces federal funding to the program, as these could ultimately jeopardize HCBS access. To that end, CMS should not approve and/or rescind waivers that allow per capita caps/block grant financing, work requirements, and unnecessary coverage/enrollment barriers.
• Innovation Center models. We will closely monitor CMMI action to ensure that home and community-based services of all types are included as part of the proposed LTSS Innovation Fund and in other models.
• Transportation and Medicaid. We support the maintenance of current rulemaking that assigns non-emergency medical transportation (NEMT) as a mandatory Medicaid benefit.
• Supplemental Services under Medicare Advantage. We will encourage CMS to continue broadening HCBS availability in Medicare Advantage and work with plans on implementation.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know that you support the expansion and preservation of Medicare and Medicaid for older adults.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact providers and residents.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support more opportunities to create and sustain Medicare and Medicaid.

ADDITIONAL RESOURCES

LeadingAge Advocacy Goals

• Ensure that home health providers have access to testing, personal protective equipment, and vaccines to face the challenges of the Coronavirus pandemic.
• Ensure appropriate reimbursement methodology and rates for home care and home health services across payers.
• Advocate for reasonable home health and home care regulations to allow quality, community-based care without unnecessary burdens.
• Work for meaningful inclusion of home care services in Medicare Advantage supplemental benefits with efficient processes and fair payment.
• Promote a vision for the future of home health services and their role in the continuum of post-acute, long-term, and end-of-life care.

THE ISSUE

Home health agencies lived through a rollercoaster of activity during the pandemic with swings noted based on time and community cases of COVID. The combination of the introduction of the Patient-Driven Groupings Model payment system coupled with the loss of income and the increased expense of COVID have placed extraordinary financial strains on many home health agencies. While the regulatory flexibilities and relief funds that have come through the Administration and Congress have been helpful, more support is needed.

Like all health care providers in the pandemic, home health agencies’ ability to provide care to patients has been challenged. Specifically, since home health agencies deliver care in people’s homes, they faced a combination of fear and preference from both staff and patients and their families to receive fewer contacts and therefore, fewer in-person visits. Like others, home health providers have been able to overcome these challenges by utilizing telehealth to deliver some services to Medicare beneficiaries. However, a statutory provision prohibits visits made via telehealth from being considered equivalent to in-person visits. Therefore, unlike all other providers during the pandemic, the use of telehealth as an alternative to in-person visits often significantly reduced the level of reimbursement received by home health agencies. As a result, our home health members have been put in the untenable position of forfeiting adequate reimbursement to better protect their staff and patients.

Home health services are a vital component of the health care continuum, both as an important discharge destination for hospitals as well as providing care and therapies that prevent hospitalizations. In 2018, 3.4 million Medicare beneficiaries received home health services with more than 6 million episodes and nearly 617,000 Medicaid beneficiaries received Medicaid-funded home health services.

Home health agencies must be recognized and reimbursed for their capabilities to coordinate and collaborate with other care providers, ensuring that the patient receives appropriate, high-quality care regardless of the setting or location in the evolving health care delivery system.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of home health services legislation LeadingAge is following in the 117th Congress.

• COVID-19 relief. We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.
• Home health reimbursement. We continue to support legislative efforts that seek to ensure transparent and evidence-based approaches to Medicare reimbursement in the Patient-Driven Groupings Model.
• Reimbursement for telehealth visits. We support legislative efforts that allow virtual visits to be reimbursed by Medicare with appropriate guardrails and visit equivalency between in-person and virtual visits.

Executive Branch

• Extend administrative flexibility. Support continuation of the Public Health Emergency 1135 Blanket Waivers that CMS put in place during the pandemic, including allowing occupational therapists, physical therapists, and speech-language pathologists to conduct initial assessments when therapy is part of the plan of care and the definition of the homebound requirement for home health services. We encourage HHS to add additional flexibilities, particularly around allowing documented verbal orders when obtaining physical signatures is an obstacle for beneficiary access to care.
• Protect staff from COVID infection. Ensure that staff of home health providers, regardless of where the people they serve live, have access to a fully funded national testing program, sufficient PPE, and Coronavirus vaccines and boosters.
• Home Health Prospective Payment System. We will review and provide comments during the CY 2023 Medicare Home Health Prospective Payment System rulemaking process.
• IMPACT Act. We will participate in the Medicare unified post-acute prospective payment system technical expert panel to provide the voice of LeadingAge members regarding possible future payment system design. This includes advocacy to slow the pace of model development work of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to reflect relevant data collection not skewed by the experiences of the COVID-19 pandemic.
• Advocate for the creation of claims codes or modifiers to document home health and hospice virtual visits. Hospice providers are utilizing telehealth for routine home care during the pandemic, and home health providers are allowed to use virtual visits as part of their documented plan of care. We will advocate for the creation of claims codes or modifiers that will allow for the analysis of these encounters for a variety of purposes including quality measurement.
• New models of integrated care. Engage the Center for Medicare and Medicaid Innovation in the further development of a new demonstration or model(s) that would allow post-acute providers and/or LTSS providers to be accountable and financially at-risk for the care of a population or an episode of care.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know you support the home health legislative priorities.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact home health services.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support more opportunities to provide home health services.

ADDITIONAL RESOURCES

• LeadingAge Center for Managed Care Solutions and Innovation

LeadingAge Advocacy Goals

• Ensure that hospice and palliative care providers have access to testing, personal protective equipment, and vaccines to face the challenges of the Coronavirus pandemic.
• Ensure appropriate reimbursement to provide quality end-of-life care.
• Promote access to and use of appropriate palliative and end-of-life care in all health and long-term care settings.
• Work for reasonable hospice regulations to allow quality, community-based care without unnecessary burdens.
• Support the development of policies that support hospice and palliative care providers in their efforts to support their communities as they recover from the trauma of the Coronavirus pandemic through their grief and bereavement programs.
• Work for meaningful inclusion of home care services in Medicare Advantage supplemental benefits with efficient processes and fair payment.
• Promote a vision for the future of hospice and palliative care services and their role in the continuum of post-acute, long-term, and end-of-life care.

THE ISSUE

Hospice and palliative care organizations were on a precipice of change prior to the COVID-19 pandemic. Organizations were focused on opportunities that would facilitate the transition to value-based payment, the coming demonstration of the “carve in” of hospice to the Medicare Advantage program and continued regulatory pressures including how to promote quality care via a revised survey process in the face of the July 2019 Office of the Inspector General reports. Community-based palliative care was finding its footing given the realization by payers and patients alike that an extra layer of support at any point during the course of a serious illness promotes quality and reduces unwanted utilization.

As it did for other services, the Coronavirus pandemic turned hospice and palliative care on its head. Organizations had to scramble for PPE and struggled with obtaining priority in federal and state allocations. Since hospice takes place wherever people call home, hospices had to develop new protocols that balanced the need for hands-on care with the safety of staff, patients, and families. Through flexibilities gained from Congress and CMS, hospices were able to utilize telehealth, including audio-only visits, for much of their care, but hospices struggled with balancing clinically appropriate care with safety and fear. This tension was particularly felt by hospices serving patients in congregate care settings. Hospice and palliative care providers are still struggling for access to adequate PPE and testing and face an uncertain financial future.

The need for robust advance care planning and a workforce trained in palliative care principles was, unfortunately, underscored during a pandemic that took a disproportionate toll on older adults and those with serious illness. Palliative care professionals, especially in inpatient settings, were in high demand and this skillset needs to be ingrained into health care professionals’ training.

Moving forward, the role of bereavement and grief supports services will be critical to communities as they recover from the trauma of this pandemic. Finally, if as anticipated, one result of this pandemic is a surge in the desire for home-based care, hospice and community-based palliative care providers have a large role to play in supporting high quality care at home.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of hospice and palliative care legislation LeadingAge is following in the 117th Congress.

• COVID-19 relief: We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.
• Hospice face-to-face recertification: We support allowing hospice face-to-face recertification to take place via telehealth on a permanent basis.
• Training in hospice and palliative care: We support professional training in palliative care.
• Expanded use of nurse practitioners and physician assistants in hospice: We support seeking a legislative fix that would allow nurse practitioners and physician assistants to certify the terminal prognosis as clinically appropriate. We also support seeking a legislative fix to the statute that does not allow for PAs to provide face-to-face encounters. We also seek to provide clarity around the role of physician assistants in hospice.
• Promotion of a future vision of hospice and palliative care: We seek legislative provisions that would increase access to hospice and palliative care and integrate them more fully into the continuum of care.

Executive Branch

• Extend administrative flexibility: We support continuation of the Public Health Emergency 1135 Blanket Waivers that CMS put in place during the pandemic, including allowing clinically appropriate routine home care to take place via telehealth.
• Protect staff from COVID infection: Ensure that staff of hospice and palliative care providers, regardless of where the people they serve live, have access to a fully funded national testing program, sufficient PPE, and Coronavirus vaccines when they become available.
• Hospice and Medicare Advantage: We will continue to engage with the Center for Medicare and Medicaid Innovation (CMMI) on the Value-Based Insurance Design (VBID) Model – Hospice Track on improvements to the model and provide education for our members.
• Primary Care First and Direct Contracting: We will monitor and engage with CMMI regarding the Primary Care First and Direct Contracting models as well as other models that touch the serious illness and hospice populations.
• New models of integrated care: Engage the Center for Medicare and Medicaid Innovation in the further development of a new demonstration or model(s) that would allow post-acute providers and/or LTSS providers to be accountable and financially at-risk for the care of a population or an episode of care.
• Quality measure development: We will continue to work with CMS and their contractors on the development of Hospice Outcomes and Patient Evaluation (HOPE) tool development and engage in other quality improvement activities.
• Advocate for the creation of claims codes or modifiers to document home health and hospice virtual visits: Hospice providers are utilizing telehealth for routine home care during the pandemic, and home health providers are allowed to use virtual visits as part of their documented plan of care. We will advocate for the creation of claims codes or modifiers that will allow for the analysis of these encounters for a variety of purposes including quality measurement.
• Oversight reforms: We will engage with the CMS Center for Clinical Standards and Quality as they consider oversight reforms.
• Hospice addendum: We will continue to monitor the rollout of the hospice addendum and advocate for changes as necessary.
• Hospice wage rule: We will review and provide comments on the FY 2022 Medicare Hospice wage rule.
• MedPAC: We will monitor and engage with MedPAC as needed regarding their hospice recommendations including a proposal to wage adjust and lower hospice aggregate cap and anticipated future recommendations about the hospice payment system writ large.
• Advocate for inclusion of hospice and palliative care in mental health recovery: Advocate for the development of policies that support hospice and palliative care providers in their efforts to support their communities as they recover from the trauma of the Coronavirus pandemic (e.g., expanded funding for community grief and bereavement programs).

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know that you support quality hospice and palliative care.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact hospice and palliative care.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support more opportunities to provide quality hospice and palliative care services.

ADDITIONAL RESOURCES

• Nonprofit Hospice Services: Where Mission and Community Meet
• Hospice Medicare Margins: Analysis of Patient and Hospice Characteristics, Utilization and Cost
• Opportunities to Strengthen CMS Oversight of Hospice Providers (GAO)
• Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm (OIG)
• Hospice Deficiencies Pose Risks to Medicare Beneficiaries (OIG)
• Registered Nurses Did Not Always Visit Medicare Beneficiaries Homes At Least Once Every 14 Days To Assess The Quality of Care And Services Provided By Hospice Aides (OIG)

LeadingAge Advocacy Goals

LeadingAge Advocacy Goals

(Note: Life Plan Communities (LPCs), also known as Continuing Care Retirement Communities (CCRCs), are multi-level provider systems where independent living, assisted living, memory care, and nursing home care can be found on the same campus.  Many include home care, home health, hospice, and palliative care, as well.  It is critical to note that these communities respond to local need, are regulated by some states, and are not federally regulated. We work closely with LeadingAge state partners to support relevant state-specific advocacy for LPCs.)

• Advocate for Life Plan Communities to have all the resources needed to fight the COVID-19 pandemic, including staff, testing, PPE, and vaccines/boosters.
• Identify and advocate for federal financial protections and supports that stabilize and strengthen the unique expense and revenue streams of the LPC model, such as insurance cost cap protections; cash flow protection loans; liability mitigation and protections; in addition to all the financial relief and protections that are sought for all aging services providers mentioned in these policy priorities.
• Support the LPC model on a federal and legislative level by proactively seeking opportunities to educate lawmakers on its unique strengths and challenges.
• Pursue broad reimbursement policies that ensure adequate funding for nursing home care across payers and actuarial soundness. Advocate for policies to ensure that payments/reimbursements for Medicare and Medicaid services, including those delivered through managed care, adequately cover the services provided.
• Pursue all advocacy goals and initiatives that serve to benefit segments of the LPC service portfolio, including assisted living, nursing homes, HCBS, hospice, palliative care, and managed care.
• On a state and federal level, identify opportunities to improve the regulatory environment for LPCs that seek to diversify their service portfolios to include alternative care options such as HCBS, continuing care at home, and adult day programs.
• Raise legislators’ awareness of the increasing need for behavioral and mental health supports and services for older adults as they age in place in congregate settings.

THE ISSUE

The Life Plan Community (LPC), in many instances, is a representative, micro- cross-section of the aging services continuum of providers. Operating in an increasingly competitive and nuanced environment, LPC providers are adopting a two-pronged strategy of diversification and consolidation to survive and thrive. Already, the LPC model required of its operators a proficiency and versatility in disparate and differently regulated aging services, including independent living, assisted living, nursing homes, and memory care. Some LPC providers have expanded their portfolios into home and community-based services, hospice, and palliative services, managed care programs, adult day programs, and affordable housing.

While facing many of the issues that all aging services providers face—COVID-19, workforce shortages, behavioral and mental health program gaps, inadequate Medicare/ Medicaid reimbursement, and others—Life Plan Communities further struggle with the financial sustainability of their operations because of their multi-faceted nature. Some LPCs have eliminated services, consolidated with other providers, or pursued corporate restructuring or bankruptcy filings.

ADVOCACY ACTION 2022

To review the full array of Congressional and Executive Branch advocacy action that affects Life Plan Communities, see individual service line policy priorities.

117^th Congress

Click here to see the full list of life plan communities legislation LeadingAge is following in the 117th Congress.

• Telehealth: We support legislation to improve access to telehealth services in nursing homes.
• COVID-19 relief: We support immediate House and Senate introduction of legislation that will provide funds and other relief for aging services.
• Vaccine mandates and booster shot distribution. We support and advocate for an adequate budget to enable seamless implementation of rapid, efficient distribution of vaccines and boosters to all aging services workers, including all employees of Life Plan Communities. We encourage HHS to implement consumer education programs to encourage immunization.
• Support liability protection. We will continue to work with a coalition of national associations and state association partners to enact state civil liability protections for aging services providers relating to COVID-19 claims. Nearly half the states have enacted some sort of protections, and we are still advocating for protections on the federal level.
• Strengthen the workforce: Support CNA training, geriatric grant programs, grants to recruit and retain direct care workers, and immigration reforms that will increase the supply of Life Plan Community workers.
• Professionalize the Workforce: We will work with the administration to fill in details of the workforce provisions of the platform’s caregiving proposal to treat LTSS workers with respect and dignity. LTSS settings must feature greater standardization of competency-based training requirements and education needed to prepare the frontline workforce to deliver quality care.
• Address barriers to providing nursing home services. We support legislation that would mandate all time spent in a hospital, regardless of admission status, count toward the three-day qualifying stay required for SNF services under the Medicare benefit.  The waiver of the three-day stay requirement during the COVID pandemic reinforces the lack of rationale for this restriction on Part A eligibility.
• Geriatric social worker education, recruitment, and retention program. We support the inclusion of expanded programs to recruit, educate, and retain geriatric social workers to encourage more social workers to join and specialize in the aging services field.
• Community program to address caregiver needs. We will work with the Biden administration to fill in details of the workforce provisions of the platform’s caregiving proposal to treat LTSS workers with respect and dignity. LTSS settings must feature greater standardization of competency-based training requirements and education needed to prepare the frontline workforce to deliver quality care.
• Adult day coverage under Medicare: We believe Congress should amend the Medicare program to make adult day services available to beneficiaries (e.g., FFS and managed care).

Executive Branch

• COVID-19 policies, guidance, and resources: We will work with HHS to provide feedback on members’ needs for addressing COVID-19, including the need for financial assistance through Provider Relief Funds.
• Various COVID-19 mitigation efforts. As in all other areas of aging services, we support and advocate for: distribution of testing materials; vaccine distribution; extension of the Public Health Emergency; prioritization and delivery of personal protective equipment; streamlined Provider Relief Fund reporting; among many others.
• Survey and certification: We call on CMS to improve consistency and accuracy in the survey and certification process.
• Regulatory waivers: We advocate that CMS continue 1135 regulatory waivers to allow providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and that additional flexibilities be considered.
• Alternative Payment Models: We engage in activities geared toward the development of alternative payment models, such as the Unified Post-Acute Care Prospective Payment System Technical Expert Panel.

ACTIONS YOU CAN TAKE NOW

• Let your Representative and Senators know you support legislation that enables relevant components of Life Plan Communities to provide high quality, consumer-responsive services.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact Life Plan Communities.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support more opportunities to create and sustain high quality Life Plan Community services.

ADDITIONAL RESOURCES

• LeadingAge Ziegler 200 2021
• CARF 2021 Financial Trends and Ratios Report
• Sodexo Survey Review: Dining Services Staffing Shortages
• Savant Wealth Management Survey Review: Retirement Plans of High Net Worth Individuals
• International Council on Active Aging Forum Report: Wellness Attracts the Middle Market
• PositiveAging Continuing Care at Home Webinar
• National Investment Center 2020 Investment Guide
• State of Seniors Housing (ACHA/LA)
• International Council on Active Aging White Paper: Creating a Path Towards the Next Normal in Senior Living

LeadingAge Advocacy Goals

• Federal and state regulatory and payment policies must recognize and accommodate challenges facing rural providers, including the special challenges rural providers face resulting from the Coronavirus pandemic—staffing, access to PPE, lack of affordable housing.
• Ensure that rural aging services organizations have the financial resources to be able to hire and retain enough high-performing staff at all levels, especially given the impact of the Coronavirus pandemic on the health of frontline workers.
• Promote policies that address the lack of affordable transportation for staff in rural areas and that support older persons’ mobility and independence.
• Support improving access to affordable broadband in rural and frontier communities so that aging services providers can better reach the people they serve and provide additional services to older adults.
• Support increased Medicaid funding and Medicare rural add-ons for aging services.
• Replicate programs and models that hold promise.

THE ISSUE

Rural aging services providers face the same financing and policy challenges that all other providers face, but these challenges are magnified by distance and loss of population. All these challenges are exacerbated by the Coronavirus pandemic and its devastating toll on workers, older adults, and rural economies. Transportation, housing, workforce shortages, care coordination, telehealth, technology, and internet challenges, along with inadequate public financing, raise significant public policy challenges in a normal year and extraordinary challenges as we move through the pandemic. As populations shift to urban areas, these problems are exacerbated. Moreover, these problems magnify the challenge of delivering and administering vaccines to protect against Coronavirus. And yet our nonprofit nursing homes and low-income housing and life plan communities form the backbone of many rural areas, providing care, services, and employment. If they close, communities—and the older adults remaining in them—lose

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of rural services legislation LeadingAge is following in the 117th Congress.

• Rural Internet access: We support legislation to help improve high-speed internet access in rural areas.
• Aging services guest worker program: We support the introduction and enactment of a temporary guest worker program for CNA and home care aides.
• J-1 Cultural Exchange Visa changes: We support the introduction and enactment of Cultural Exchange Visa changes to include aging services workers, in addition to child care workers.
• Modify EB-3 visas for nurses: We support expanding and modifying visas to support improvements to increase the quotas for foreign-born LTSS nurses.
• Expand “Religious Occupation” to include aging services: We support modifying the R-1 program to cover temporary workers so it includes aging services settings.
• Increase geriatric academic professionals and clinician educators: We support programs that provide training to students, faculty, providers, direct service workers, patients, and families to address gaps in health care for older adults.
• Appropriations and expansion: We support robust appropriations of the Older Americans Act programs, including provisions focused on the direct care workforce and allowing the SCSEP program to train older workers in LTSS.
• Award grants to recruit and retain direct care workers: We support legislation that awards grants to recruit and provide advancement opportunities to direct care workers.
• Reinstate CNA training programs within SNFs: We support repealing the CNA training “lock-out” and reinstating training programs when SNFs are in compliance.

Executive Branch

• We support finalizing Department of Labor proposed regulation allowing individuals under the age of 18 to operate lifts.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know that you support preserving and enhancing services for older adults in rural areas.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact services in rural areas.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support more opportunities to preserve and enhance services for older adults in rural areas.

ADDITIONAL RESOURCES

• LeadingAge COVID Resources Page

LeadingAge Advocacy Goals

• Aging services organizations must lead the way in fighting ageism and supporting the dignity and agency of older adults, especially as older adults are at greatest risk during the Coronavirus pandemic—in the community as well as in congregate settings.
• Promote affirmative actions to address abuse and neglect and expand support for programs developed by aging services organizations to fight elder abuse and neglect, such as elder abuse shelters and Safe Care for Seniors.
• Support robust funding for programs that protect older persons in the community from abuse and neglect resulting from the social and economic impact of Coronavirus, including adult day, PACE, senior centers, and other programs that can identify and intervene to prevent abuse and neglect.
• Support adoption of the patient safety model for identifying, addressing, and reporting elder abuse in congregate settings and HCBS programs.
• Advocate to include abuse identification and training in educational requirements for nursing home and assisted living administrators, geriatricians, physicians, and RNs.
• Examine ways to incorporate abuse prevention training for home care, case managers, service coordinators, and residential counselors.
• Increase grant funding for training and hiring aging services employees at all levels.
• Collaborate with the Global Ageing Network to coordinate the response to elder abuse and neglect.
• Promote equity in access to elder justice programs.

THE ISSUE

Elder abuse is estimated to affect one in ten older adults; these include our residents, our clients, our tenants, and the people waiting to be served by LeadingAge members. The Coronavirus pandemic has exacerbated conditions that underlie abuse:  isolation, increased reliance on potentially abusive caregivers, fear and loss of independence, along with the increased difficulty that programs designed to prevent elder abuse have experienced.  Elder abuse directly affects providers of aging services when the people we serve are victimized by financial exploitation and physical and psychological abuse. LeadingAge has been a leader in affirmatively addressing elder abuse in the broader community, as well as in our settings. Leading the fight against elder abuse is part of our ethical obligations and underscores our mission to be the trusted voice for aging, our vision of an America freed from ageism, through our promise to inspire, serve, and advocate.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of elder justice legislation LeadingAge is following in the 117th Congress.

• Elder abuse related legislation. We will provide education and assistance to address elder justice issues to House and Senate committees and work with Members of Congress concerned about these issues.

Executive Branch

• ACA Grants: We support the use of CMS fines to help train direct care workers in culture change.
• Elder Justice Coordinating Council: We will provide guidance on integrating work done by LeadingAge providers with Council activities at the local, state, and federal level.
• CMS Training: We will engage with CMS on training in abuse prevention.

ACTION YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know that you support elder justice programs.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies address elder justice concerns.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support elder justice programs and policies.

ADDITIONAL RESOURCES

• Harry and Jeannette Weinberg Center for Elder Justice
• LeadingAge Minnesota Safe Care for Seniors
• Frameworks Institute: Talking Elder Abuse A FrameWorks Communications Toolkit
• Federal Administration on Community Living/Administration on Aging

LeadingAge Advocacy Goals

• We support the House and Senate introduction of legislation that will provide funds and other relief for aging services.
• Achieve LTSS financing reform to ensure that individuals with dementia and family caregivers have access to care and services.
• Aging services organizations must be able to hire and retain a sufficient number of high-performing staff at all levels to meet the needs of individuals with dementia and, specifically, to staff memory care services.
• Ensure full funding for federal programs under the Older Americans Act and financing for Medicare and Medicaid services for people with dementia.
• Advocate for full funding for research into treatments and a cure for dementia with particular attention to African Americans (in trials).

THE ISSUE

One in ten people age 65 or older has dementia and another two in ten has mild to moderate cognitive impairment. Though the incidence of dementia is decreasing, the increase in the sheer number of older adults means the number of people with dementia will rise. Today, approximately 5.8 million Americans live with Alzheimer’s disease or another form of dementia. By 2050, with the projected increased aging of the population, and the fact that people are living longer with chronic conditions, the number is expected to grow to nearly 14 million. The number of people affected by dementia rises considerably when the 16 million unpaid family caregivers are taken into account. All memory care residents, most nursing home residents, and large numbers of people served by other LeadingAge providers, live with dementia.

People over 65 are at very high risk of severe COVID, with 80% of COVID deaths occurring in that age group. A subset of older individuals, people with dementia, are at even higher risk of severe COVID and death.  In June 2020 the Wall Street Journal reported that 15,000 more Americans with dementia died than would have been expected during the first four months of the pandemic. People with cognitive impairments have additional difficulty with public safety measures like wearing a mask and keeping social distance. Isolation and loneliness, a problem for the healthiest people, is compounded in those with dementia.

Since the beginning of the pandemic memory care providers faced the same challenges as other residential care providers—only worse. They need more staff to be able to enforce safety measures; more staff means more PPE and more testing.  Yet they have run into the same PPE and testing supply and cost challenges.  Residents and staff need access to vaccines and boosters.

Government at all levels must attend to the COVID-related needs of informal and formal providers of care to people with dementia.  Further, it is essential that programs serving individuals with Alzheimer’s disease and other dementias be fully funded and that funding is concurrently provided to support diagnosis, care coordination, and research into treatments and a cure.

ADVOCACY ACTION 2022

117^th Congress

Click here to see the full list of Alzheimer’s and dementias legislation LeadingAge is following in the 117th Congress.

• COVID-19 relief: We support immediate House and Senate introduction of legislation that will provide continued relief for aging services.
• Build Back Better:  We support the House-passed Build Back Better legislation, particularly provisions related to HCBS expansions, workforce supports, and additional HUD 202 homes.
• Appropriations for research: We seek fiscal year 2023 appropriations to support federal spending on Alzheimer’s research and to support Alzheimer’s and dementia-related programs of the Administration on Community Living – HHS.
• Bipartisan Task Force: We support the work of the Bipartisan Congressional Task Force on Alzheimer’s Disease and will provide help to inform its work.

Executive Branch

• Vaccine and booster distribution. We support the continued rapid, efficient distribution of vaccines to all individuals over age 65. We encourage HHS to implement consumer education programs to encourage immunization.
• Personal Protective Equipment. We advocate to HHS and the Administration to prioritize nursing homes and aging services providers in the distribution of personal protective equipment to help limit transmission of COVID-19 and protect the staff providing care to vulnerable older adults.
• Required Provider Reporting. We will continue to work with HRSA on streamlined reporting processes for Provider Relief funds.
• Distribution of testing materials. We call on the Administration to ensure that all aging services providers have adequate COVID-19 testing materials and that nursing homes specifically have the testing resources needed to comply with CMS requirements.
• We will track Alzheimer’s related activities of the Administration for Community Living – HHS, including the Alzheimer’s Disease Programs Initiative, the National Alzheimer’s and Dementia Resource Center, and the National Alzheimer’s Call Center.
• Alzheimer’s Advisory Council. We will monitor the implementation of the Advisory Council on Alzheimer’s Research, Care, and Services, which is run by the Assistant Secretary for Planning and Evaluation – HHS. The council includes all federal agencies that work with dementia and meets quarterly to discuss programs that impact people with Alzheimer’s disease and other dementias and update the National Alzheimer’s Plan.
• Family Caregiver Council. We monitor the implementation of the RAISE Family Caregiver Council, which is run by the Administration for Community Living – HHS and is charged with developing a national family caregiving strategy.
• Alzheimer’s Research Summit. We will continue to monitor the implementation of the recommendations of the 2020 Virtual National Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers to identify policy levers and proposals.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know that you support programs and policies that help people with dementia and their family caregivers.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact services for people with dementia.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know you support research and program to address the needs of people with dementia and their families.

LeadingAge Advocacy Goals

• Seek confirmation from the federal government that it will not pursue civil or criminal actions against providers if they allow the use of medical cannabis pursuant to state laws and regulations.
• Support federal legislation or regulations to prohibit any federal agency interference with state medical cannabis laws.
• Work with state LeadingAge affiliates, as requested, to support legislation at the state level to enact medical cannabis statutes and regulations that will allow older adults to access it under appropriate circumstances to alleviate pain and other symptoms of disease.

THE ISSUE

Medical cannabis is legal in 36 states and the District of Columbia. Under federal law, marijuana remains a Schedule I drug and is illegal. There is no clarity from the federal government or agencies on whether they will pursue enforcement activities against those using medical cannabis pursuant to state laws allowing it.

ADVOCACY ACTION 2022

117th Congress

Click here to see the full list of Medical Marijuana legislation LeadingAge is following in the 117th Congress.

Executive Branch

• Medical Cannabis Guidance: We will explore options for regulatory guidance or a memorandum from federal agencies discouraging any civil or criminal enforcement of medical cannabis usage in states where it is legal.
• Cannabidiol (CBD) Guidance: Now that CBD is legal after the passage of the 2018 Farm Bill, we will monitor the Food and Drug Administration’s (FDA) progress on issuing regulations/guidance on the use of CBD in Medicare- and Medicaid-financed settings.

ACTIONS YOU CAN TAKE NOW

• Visit the Advocacy Action Center to let your Representative and Senators know your views on the legal use of medical cannabis by older adults.
• Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies related to medical cannabis affect older adults.
• Mobilize with the Advocacy Champions toolkit and let your Representative and Senators know your views on medical cannabis for older adults.

ADDITIONAL RESOURCES

• Medical Marijuana FAQs: What Providers Need to Know if Legal in Their State
• FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD)
• Map of States that Allow Medical and Recreational Cannabis

LeadingAge Advocacy Goals

• Maintain current nonprofit tax status for our members as 501(c)(3) exempt organizations.
• Enhance Low Income Housing Tax Credit program to broaden its availability for use in developing affordable housing for seniors.
• Support charitable deductions through tax deductions.
• Support the deductibility of medical expenses at 7.5% of adjusted gross income.

THE ISSUE

Federal tax laws have various incentives to support charitable institutions, such as allowing individuals to deduct charitable contributions and a certain amount of medical expenses from their tax returns and encouraging investment in housing through tax credits. Tax-exempt organizations rely on these mechanisms to support their philanthropic outreach and their ability to address low-income housing needs.

ADVOCACY ACTION 2022

117th Congress

Click here to see the full list of tax policy legislation LeadingAge is following in the 117th Congress.

We will support and advocate for tax changes that will positively impact members.  Those efforts will include the introduction of bills similar to those introduced in the prior Congress on the following topics:

• Low-Income Housing Tax Credits: We support the efforts that would increase state LIHTC allocations by 50% and provide a 50% basis boost for LIHTC communities that serve households with extremely low incomes in at least 20% of their apartments. We support the replacement of the current right of first refusal with a purchase option to facilitate the ability of nonprofits to maintain ownership/control of housing credit properties beyond Year 15. We support the establishment of a minimum 4% rate for housing credits used to finance preservation acquisitions and recapitalizations and Housing Bond financed developments.
• Charitable Contributions: We support the universal deduction for charitable giving to maintain the incentive for charitable giving and provide for an “above-the-line” income tax deduction for charitable contributions and thus likely would improve the expected decline in charitable giving because of the increase in the amount of the standard deduction.
• Medical Expense Tax Deduction: We support efforts to permanently lower the medical expense itemized deduction to 7.5% of AGI. The threshold of 10% of AGI negatively impacts seniors.

Executive Branch

• TCJA: We will monitor efforts and/or guidance to provide clarity on tax changes as a result of the 2017 Tax Cuts and Jobs Act (TCJA).

ACTIONS YOU CAN TAKE NOW

• Be ready to contact Congress if legislation on tax issues is addressed this year.
• Continue social accountability efforts to document how your organization gives back to the broader community and fulfills its responsibilities as a tax-exempt entity.

ADDITIONAL RESOURCES

• Low Income Housing Tax Credit Basics
• Charitable Giving – Independent Sector