Expanding the World of

Possibilities for Aging

Federal Update

Marsha R. Greenfield

VP Legislative Affairs

Washington, D.C.

mgreenfield@leadingage.org

September 27, 2013

Keeping Us Awake: 2012

• Payroll Tax Legislation and impact on Medicare

providers

• Deficit Reduction and Budget Control Act of

2011/sequestration/FY 2013

• Challenges to ACA: legal, leg., implementation

• Reconciling reduced/restructured federal and state

funding with improving quality and serving increased

numbers of seniors

Keeping Us Awake: 2013

• Budget, budget, budget/shutdown? – Sequestration = cuts to programs like meals on wheels and

senior housing

– FY 2013 retained cuts

– FY 2014: will there be a budget?

• “Entitlement Reform”: as in, will there be?– Impact on Medicare, Medicaid, Social Security

– Impact on your residents

– Impact on your programs

Still Awake…

• Tax Reform, as in “will there be?”

– Impact on not-for-profit status?

– Charitable contributions?

• Reconciling reduced/restructured federal and

state funding with improving quality and

serving increased numbers of seniors:

– New models, new partners, new ideas…

How Did We Get Here?

• Large and In Charge: 2008-2010 and the focus was health care and affordable housing

– S. 118, seminal legislation to improve Sec. 202 housing development and preservation

– Affordable Care Act/CLASS/HCBS expansion

• The Year of Living Dangerously: 2011 and the focus shifts to budget cutting + repeal

• Election year: 2012 and everything froze till November…

“Meet the New Boss…?”

“John McCain, Chuck Schumer On

Immigration Bill: We Want 80 Votes”

“Same as the Old Boss…”?

Partisan paralysis returns to the Hill By JAKE SHERMAN | 2/3/13 10:47 PM EST

Washington is entering a distinctly familiar situation: a paralyzing legislative stalemate with outsize importance for the nation’s economic and homeland security. In just 25 days, automatic federal spending cuts — the ones Democrats and Republicans say they hate in equal measure — take hold. But once again, rather than working together on a deal, House Republicans and Senate Democrats are on divergent paths — neither of which seem as though they’ll lead to quick resolution.

Read more: http://www.politico.com/story/2013/02/once-again-the-economy-faces-gridlock-87118.html#ixzz2JzXEHVjk

Lame Duck Session

Fiscal Cliff

What was the 2012 Fiscal Cliff?

• Congress is supposed to cut deficit by $1.5 trillion

over 10 years.

• Budget Control Act of 2011:

– Sequestration = 8% cut = pain all around

• Bush-era tax rates expire

• “Tax extenders” expire

• Medicare doc payment rates to plunge

• = Economy spirals downward?

American Taxpayer Relief Act of

2012 (H.R. 8)

• Sequestration postponed to Mar. 1

• Middle class tax relief

• Medicare provisions

• Housing provisions

• CLASS Act repealed

– Oh, oops

– LTC Commission created

And that’s not all!

• Budget bumping up against the debt ceiling,

just like 2011

• No Budget, No Pay Act of 2011

– Last bill for 112th C

– Suspends operation of debt ceiling to 5/19

– No FY 2014 budget, no pay, sort of

9 months into 2013…what happens next?

Budget Issues Dominate

•Senator Murray’s (D-WA) budget for the Senate was the first in 4 years.

•Her goal: balanced approach that includes revenues and entitlement reform as yet unspecified.

•Top line is $1.058 trillion

•House budget similar to Ryan Budget of past years, significantly reduced spending

• $967B (reflecting sequestration)

•No conference between House and Senate

FY 2014 Housing Appropriations• House, Senate Approp Comms moved T-HUD bill to respective floors

• House only $44.1 billion

• Senate $54 billion

• Funding for 202:

• House has $374.6 million

• Senate has $400 million including $20 million in new funding for

new development as a housing and services demonstration

• Both bills: $70 million for service coordinators

• Both bills recapture of unused funding and excess residual receipts for

new development

• Senate includes requirements for housing and services programs,

permits operating expenses (PRAC) only in lieu of capital advances and

PRAC assistance

What Happened to THUD in the House?• House pulled the T-HUD Appropriations bill from the floor

because they did not have the votes.

• None of the House Democrats would vote for the funding starved bill and Republicans were split (most thought the top line was insufficient, minority thought that more spending could be cut.

• Chairman Rogers (KY-5th) of the Appropriations Committee: failure to pass the bill in its current form demonstrated that the limitations of the budget resolution that, in effect, set the funding at only $44 b for T-HUD and that continued sequestration were unrealistic and unsustainable.

• Rogers called for an overall budget deal that reverses sequestration and implements realistic spending caps, a strategy that went no where

What Happened to THUD in the Senate?• The Senate Appropriations bill came to the floor with 6 Republican votes in the Appropriations Committee.

•The cloture vote to proceed to debate the bill on the Senate floor garnered 17 Republicans.

• All the Senate amendments were debated and disposed of one way or another.

•Final cloture vote failed, so no vote on final passage

•Susan Collins (R-ME), ranking THUD Approps Subc, only R to vote for bill

What happens when there is no

budget?

• The battle for Continuing Resolutions

– FY 2013 CR extended sequestration, 2012 cuts

– FY 2014 CR battleground

• Deep divide between House and Senate

• House votes for CR, defunds ACA

• Senate R filibuster

• Will the government shut down?

– Debt Ceiling next battle

What else to look for

• Medicare: Baucus/Camp– PAC Stakeholder request

– Small adjustments vs major?

• Medicaid– President says, “no cuts”

– Administration implementing ACA models

• Housing– Struggle for financing continues

More to watch…

• Older Americans Act

– Reauthorization reintroduced

– Anything on housing with services?

• Taxation: Baucus/Camp collaboration

– Revise entire code?

– Impact on exempt organizations?

– Charitable contributions?

And more!

• LTC Commission

– CLASS Act repealed (publicly administered

insurance program for LTSS)

– 15 person appointed commission to study

LTC/LTSS, Medicare/Medicaid/private LTC

insurance/transitions/coordination/etc.

– Both older persons and younger persons with

disabilities

LTC Commission, cont’d.

• Final report plus dissenting reports just issued

– Nibbling around the edges vs broad-based reform

• LeadingAge new Task Force on LTC Financing

• Advance CLASS, Inc. still active

• Hunt is on for new champions

Other Medicare Legislation– Observation Stay (HR 1179/S. 569) 3 overnight stays = 3

day stay for SNF (all RI MoC sponsor)

– FITT: Fostering Independence Through Technology (S.

596) pilot projects for telehealth (none)

– Home Health Care Planning Improvement Act (H.R. 2504):

allows advance practice nurses and PAs to order home

health (all)

– Medicare Adult Day Services bill to be re-introduced

(creates “certified adult day” category allowing adult day

providers to provide home health services)

Medicare Legislation, cont’d.

• Therapy Caps/Exceptions Process

– H.R. 713/S. 367 bi-partisan repeal bill (all)

– Attempting to find permanent resolution

• “Doc Fix”

– Bi-partisan legislation in House

– E&C passes unanimously

– Who pays?

– Usual omnibus legislation for all things Medicare?

Health Reform

• ACA implementation biggest challenge

– House: 42 votes to repeal

– Senate: threat to hold up CR/debt ceiling

– State resistance to exchanges, Medicaid expansion

• WH moves enforcement of large employer

responsibilities back to 2015

• Demonstrations and pilots proceeding

– Rhode Island MME roll-out

Regulatory Issues

• Corporate Compliance Programs mandated

• Improvement Standard eliminated, waiting for CMS

guidance/revised standards

• HIPAA Compliance extended to business associates

• Quality improvement efforts continue: QAPI not yet

implemented, Advancing Excellence

• SNF hospital readmission requirements waiting for mandate?

• HUD – disparate impact rule, litigation

• DOL – overtime/minimum wage reg for personal care workers

Assisted Living

• Still no federal legislative interest

• HHS rule defining “community” still not

finalized (Medicaid Program; Home and

Community-Based Services (HCBS) Waivers;

CMS-2296-P )

• Ethics and corporate compliance in the news:

just because there isn’t a rule….

LEADINGAGE MEMBER SUPPORT

LeadingAge Resources

www.leadingage.org

• Advocacy and grassroots: – http://capwiz.com/leadingage/home/

• Center for Aging Services Technology (CAST):– http://www.leadingage.org/CAST.aspx

• Center for Applied Research (CFAR):– http://www.leadingage.org/Research.aspx

• Center for Housing Plus Services– http://www.leadingage.org/Center_for_Housing_Plus_Services.aspx

The LeadingAge/CliftonLarsonAllen

Managed Care Toolkit

The tools in the toolkit

• Introduction

• Readiness assessment

• Potential impacts by provider type

• Glossary of terms – need to speak the

language

• Value Proposition

• Quality measures

• Four Knows of Contracting

www.nhqualitycampaign.org

• Advancing Excellence has added a new goal of improving appropriate use of medications – using reduction of inappropriate antipsychotics as the first area of focus.

• CMS Launches Partnership to Improve Dementia Care in Nursing Homes

• Advancing Excellence website is source for provider and consumer resources

Updated 12/19/2012

• (Membership not required to visit.)

LeadingAge Center for Housing

Plus Services• National catalyst for development, adoption and support of

innovative housing solutions that enable low- and modest-

income seniors to age safely and successfully in their homes

and communities.

• Assemble evidence base by rigorously evaluating affordable

housing plus services programs

• Education on development and implementation

• Inform policy at both state and federal level

• Partner with housing and health entities

Learning Collaborative

• LeadingAge, Enterprise Community Partners

and SAHF

• Teams of community partners to support

housing providers as they develop strategies

to coordinate and deliver health and

supportive services to their residents

LTC Financing Cabinet II

• Panel of experts reviewing historic 2006

Financing Cabinet Report in light of repeal of

CLASS

• Reviewing and reaffirming basic principles

• Examining models, scenarios

• Report expected by end of year

What We are Doing

• Larry Minnix testifies to House Ways and Means on Charitable

Deductions Feb 14, 2013

• Successful Briefing on sustaining LTSS to Members of Congress

and staff on Feb 22 and April 8, 2013

• Letters to Congress re: Sequestration and its impact on aging

services; tax reform; Medicare requests

• LTC Financing Cabinet II

• Internal restructuring to focus on NFP, Innovation, Financing,

Housing/Services, Leadership, Tech.

• Innovations Grants

What YOU Can Do

• Your Story

– If your policy makers don’t know who you are

and what you do…

• Your Mission

– If your community doesn’t know your mission

and the value you provide…

• Your Message

– Is vital!

“The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little”

--- Franklin D. Roosevelt