Aging Services Policy Forums: Annual Meeting 2019

Legislation | November 06, 2018 | by Barbara Gay

Policy forums at the LeadingAge annual meeting in Philadelphia gave members the opportunity to hear the latest from policymakers on developments in our field.


The health policy forum offered a presentation from Karen Tritz, director of the Division of Nursing Homes in the Center for Medicare and Medicaid Services (CMS)’ Quality and Safety Oversight Group.  Ms. Tritz focused on the long term care survey process, Phase 3, Requirements of Participation(RoPs), facility-reported incidents, Immediate Jeopardy, Payroll Based Journal (PBJ) audits and time-limited waivers.

Ms. Tritz reviewed the top deficiencies for which nursing homes have been cited, pointing out that in the new survey process the average number of deficiencies has been on par with both the traditional and QIS survey process from year 2017. The traditional and QIS processes averaged 5.8 deficiencies and the new survey process has averaged 6.26 deficiencies.

Other policy issues discussed were the RoPs, Phase 3 Interpretive Guidance and the unfreezing of the Health Inspection Rating on Nursing Home Compare.  Ms. Tritz stated both of these programs and processes will be coming towards the spring of 2019.  She also discussed the revisions to the Immediate Jeopardy, Appendix Q guidance and reviewed clarification of facility-reported incidents, outlining actions.

Although PBJ is not Ms. Tritz's primary responsibility, she did give an overview of the audit process and lessons learned with common errors to avoid.  She ended her presentation by delving into time-limited waivers.

Members attending the forum had the opportunity to ask specific questions of Ms. Tritz and share their comments and thoughts about the long term care survey and certification process.

Home- and Community-Based Services

The home and community-based services (HCBS) policy forum included legislative, policy, and regulatory updates from across the spectrum of HCBS services and speakers from the Administration on Community Living (ACL) and the Centers for Medicare and Medicaid Services (CMS).

Mary Lazare, Principal Deputy Administrator of ACL, who prior to joining ACL had been active within LeadingAge at member organizations in Missouri, spoke of the priorities of Secretary Azar and the Department of Health and Human Services (HHS) as well as work underway at ACL through the administration of the Older Americans Act.

Michael Nardone, Director, Disabled and Elderly Health Programs Group within the Center for Medicaid and CHIP Services, presented on trends in Medicaid HCBS, managed long-term services and supports, and the HCBS settings rule. Of particular note, is forthcoming guidance on the HCBS settings rule, specifically on the heightened scrutiny aspects of the rule which has potential implications for members receiving Medicaid funds for assisted living and adult day services.

Hillary Loeffler, Director, Division of Home Health & Hospice within the Center for Medicare, spoke on geographic spending variation in Medicare home health, the proposed (now final) home health payment rule for calendar year 2019, including the finalization of the Patient-Driven Groupings Model (PDGM), and the review choice demonstration.

Finally, Andrea Price-Carter, Manager of Congressional Affairs with LeadingAge, provided an update on current legislative priorities on HCBS topics for the current Congress.


This year’s Housing Policy Forum featured Lamar Seats, the Department of Housing and Urban Development (HUD)’s Deputy Assistant Secretary for Multifamily Housing, and Linda Couch, Vice President for Housing Policy. The forum included an update on the facts and figures of growth in the older adult population and increasing gaps in affordable supportive housing with services for older adults; current happenings in Congress; and the development of LeadingAge’s housing policy platform for 2019.

Mr. Seats, appointed to his position in May, is responsible for HUD’s multifamily housing portfolio. He endeared himself to the audience by sharing that his father operated a skilled nursing facility and that he grew up in a culture of caring for older adults. Mr. Seats noted the necessity of preserving existing assisted housing, but also acknowledged the “overwhelming need for more product out there.”

Mr. Seats shared his perspective on the growing population of older adults, saying that they will be less financially secure than their predecessors. He also discussed how housing is a platform for services, and how, given the significant capital needs of Section 202 Housing for the Elderly communities, the new expansion of HUD’s successful Rental Assistance Demonstration preservation program will help these communities thrive for the next 20 years. The Notice of Funds Availability (NOFA) for new Section 202 funding will be released by the end of the year, Mr. Seats said, while he also lamented the Section 202 program going from more than $400 million a year for new funding to zero dollars over the last several years.

The Housing Policy Forum also included open discussion where attendees raised topics ranging from service coordination funding gaps to collaborations between HUD and other federal agencies to better address the health needs of older adults.