Where Do Aging Services Stand on Capitol Hill

Legislation | October 20, 2017 | by Barbara Gay

As the end of the year approaches, we have achieved some successes on our three main advocacy issues for 2017 - funding for senior housing, the preservation of Medicaid and regulatory relief. More work remains to be done, however.

Overview

Fiscal year 2018 began on October 1, but Congress has not passed a budget or appropriations bills for the new year. A continuing resolution enacted in September suspended the federal debt ceiling and kept federal programs in operation through December 8. The House calendar shows 26 days left in this first session of the 115th Congress, although the targeted adjournment date of December 14 could slip if necessary.

Fiscal 2018 budget/taxes:

The Senate passed a 2018 budget resolution on October 19 that allows for a $1.5 trillion/10 year increase in the federal budget deficit in order to accommodate the tax legislation the congressional leadership plans to take up within the next few weeks. We expect the House to agree to the Senate’s budget resolution next week.

The details of tax legislation are not yet available, but an outline that has circulated on Capitol Hill calls for flattening the tax rate structure from 7 to 3, enlarging the standard deduction and eliminating many credits and deductions. We will focus on preserving the tax deductions for charitable contributions and medical expenses and the tax-exempt status of not-for-profit organizations.

Medicaid:

Affordable Care Act repeal and replacement legislation, H.R. 1628, has dominated the congressional agenda this year. The many iterations of this legislation all contained deep cuts to Medicaid in the form of block grants and per capita capped allotments to the states. These provisions would have reduced federal Medicaid spending by hundreds of billions of dollars over the next ten years and beyond.

We did extensive direct lobbying and grassroots advocacy against this legislation all year. Activities included a Capitol Hill rally, member Hill visits during PEAK, a full-page ad in an influential Capitol Hill publication, a report analyzing the impact of Medicaid cuts, numerous letters to Congress and meetings with legislators and their staff, and strong grassroots activity by LeadingAge members and their residents. This broad-based advocacy succeeded in persuading a majority of senators not to support legislation containing huge Medicaid cuts.

With the Graham-Cassidy ACA repeal bill’s failure to gain sufficient votes to pass the Senate, the repeal effort appears to be off the table for now. Preservation of Medicaid will continue to be one of our top policy priorities.

Senior housing funding for 2018:

The fiscal 2018 budget proposal the Trump Administration submitted in May called for cuts in overall HUD funding of more than 15% below fiscal 2017 levels. In addition to underfunding renewal of Section 202 project rental assistance contracts, the budget proposal also sought policy changes that would be harmful to low income older adults and affordable housing providers.

Save HUD 202 campaign: In May, we launched the Save HUD 202 campaign, a comprehensive, multi-month effort to convince lawmakers to fully fund the 202 program. The campaign included a rally at the U.S. Capitol June 27 at which hundreds of LeadingAge members and residents from all areas of the country, as well as members of other stakeholder organizations, came together in support of housing for elders and people with disabilities.

Status

Rejecting the Administration’s call for funding cuts, both the House and Senate Appropriations Committees approved HUD 2018 spending legislation that would fund Section 202 at $573 million, $70.6 million more than FY17. This amount would fully cover contract renewals and amendments. These provisions were incorporated into the omnibus 2018 spending bill, H.R. 3354, which the House passed on September 14. The 2018 appropriations legislation has not yet come to the Senate floor.

We are continuing our advocacy on senior housing funding for 2018. While we are generally pleased with funding levels in the spending bills, the House measure underfunds Section 8 Project Based Rental Assistance, which undergirds 2/3 of Section 202 communities. We want to make sure that the spending levels achieved so far in the appropriations process are made final for this fiscal year. In addition to funds for preservation, we also will continue to advocate for new construction funds.

Also, both the House and Senate HUD spending bills for 2018 include authority for the agency to expand its successful Rental Assistance Demonstration program to include Project Rental Assistance Contracts which we call "RAD for PRAC." RAD for PRAC would bring new housing preservation opportunities to aging PRAC communities and is a key priority for LeadingAge.

Low-income housing tax credit:

We also support legislation, H.R. 1661/S. 548, to expand and improve the LIHTC program. These measures would expand the LIHTC program by 50% and make many improvements to the program, especially in the determination of tenants’ income eligibility.

Nursing home oversight and requirements of participation (ROPs):

  • Even before President Trump took office and the 115th Congress began, we used every possible opportunity to advocate for delay of Phase II and reconsideration of the new requirements of participation.
  • We sent detailed comments to the incoming Administration and the new Congress and met with CMS Administrator Verma as soon as she was confirmed.
  • We generated a dear colleague letter circulated among House members on the need for delay and reconsideration. We supported a similar letter drafted by the American Health Care Association.
  • We submitted a statement to the Senate Finance Committee on the need for reconsideration of the nursing home requirements of participation.
  • We made ROPs relief a top advocacy issue for member visits to Capitol Hill during PEAK.
  • In commenting on the Medicare payment rule for 2018, we not only urged CMS to rethink the ROPs, but we also disseminated talking points to our nursing home members, encouraging them to comment as well.
  • When Rep. Pat Tiberi (Ohio), chair of the House Ways and Means Health Subcommittee, solicited comments on how the regulatory burden on health care providers could be reduced, we gathered member input and gave him fourteen recommendations, emphasizing the need for relief from the ROPs.
  • We now have the opportunity to participate in a CMS listening session on October 26 to discuss how Medicare regulation could be made less burdensome and more costs-effective.

While Phase II is going into effect as of November 28, our advocacy resulted in a delay in the imposition of civil monetary penalties for any deficiencies cited on the new requirements for the first year. We have posted tools and conducted webinars on the new requirements to assist members in preparing.

Nurse aide training lock-out: At several of the congressional office visits during PEAK, staff expressed interest in the CAN training lock-out issue. Since the automatic loss of training authority is statutory, we are drafting legislative language to make the remedy optional, rather than mandatory and soliciting a sponsor to introduce the measure.

Medicare Observation Days legislation:

We are supporting H.R. 1421 and S. 568, the Improving Access to Medicare Coverage Act. The legislation would resolve the observation days issue by requiring all time Medicare beneficiaries spend in a hospital to count toward the three-day stay requirement for coverage of any subsequent post-acute care. We urge legislators to cosponsor these bills.

Medicare therapy caps:

The therapy caps exceptions process expires at the end of this calendar year. There are on-going negotiations with House and Senate staff to revise the caps and exceptions process but legislation has not been introduced at this point. We support H.R. 807 and S. 253, to repeal the therapy caps, which will likely serve as the “base” bill for final consideration.

Medicare home- and community-based services legislation:

We are advocating in favor of the following measures to improve Medicare coverage of home- and community-based services:

  • S. 309/H.R. 4006, the Community Based Independence for Seniors Act. The legislation would establish a community-based special needs plan that would give low-income Medicare beneficiaries coverage for home- and community-based services. The House bill sets a tighter limit on the number of beneficiaries who may participate.
  • S. 445, the Home Health Planning Improvement Act, introduced by Sens. Susan Collins (R-Maine) and Ben Cardin (D-Maryland). The bill would facilitate Medicare beneficiaries’ access to home health care by allowing physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives to order home health services. These health care professionals are playing increasingly important roles in the delivery of health care, particularly in rural and underserved areas.
  • H.R. 3992, the Rural Home Health Extension and Regulatory Relief Act, which would extend the Medicare payment add-on for home health care providers and delay a Medicare payment change that would have serious consequences for home health care providers around the country.

It’s not yet clear when or how Medicare legislation may be considered this year.

Technology: We support the following measures to advance the application of technology in the long-term services and supports field:

S. 870 – CHRONIC Care Act: bipartisan legislation which is now ready for floor votes in Senate.  Among its provisions to improve Medicare coverage of services people living with chronic health conditions need, the CHRONIC Care Act would authorize payment for telehealth for accountable care organizations and includes “home” in the definition of “originating site”.  In addition, the bill calls for a GAO study to determine how barriers could be removed to enable health and long-term care providers to make effective use of technology for care planning, coordination and documentation. While there is no companion bill in the House, there are a number of bills on specific topics that are incorporated in the CHRONIC Care Act, and these measures could gain House consideration.

S.1016 - CONNECT for Health Act of 2017:  a bipartisan bill to allow Medicare reimbursement for telehealth in a variety of settings and for a variety of conditions, including accountable care organizations and bundled health payments. 

S.787 - Telehealth Innovation and Improvement Act of 2017: Bipartisan legislation allowing CMS to test the use of telehealth and other technologies in improving care for Medicare beneficiaries with certain defined conditions in conjunction with existing evaluations of accountable care organizations, bundled payment models and coordinated care models.