What Build Back Better & Infrastructure Legislation Mean for Home Care & Hospice

The US House of Representatives is trying to pass its massive “Build Back Better” (BBB) social spending legislative package, as well as the “hard” infrastructure legislation that was approved by the Senate months ago (the Infrastructure Investment and Jobs Act) today, November 5th, 2021. Bill text of the latest version of the BBB can be…

The Better Care Better Jobs Act Means a Stronger Home Care Community

Senator Bob Casey (D-PA), long-time champion of in-home care and sponsor of the Better Care Better Jobs Act, has released a set of nationwide and individual state reports on the projected impact his Better Care Better Jobs Act will have on workers and recipients of care in the home.

These factsheets present a clear and concise picture of the need for Medicaid Home and Community-based Services (HCBS), comparison of cost of care between the home and congregate settings, as well as waitlist length for HCBS Services where applicable. In addition, the factsheets demonstrate the impact the Better Care Better Jobs Act would have on workforce shortages.

“For millions of families, and especially for women, home and community-based services are a bridge to work and a bridge to economic security,” said Senator Casey when introducing the legislation. “The Better Care Better Jobs Act would not only enable more older adults and people with disabilities to remain in their homes, stay active in their communities and lead independent lives, it would also create jobs and lead to higher wages for care workers, who are predominantly women and people of color. This legislation is critical to advancing equity, spurring economic recovery, and improving quality of life for older adults and people with disabilities”

The National Association for Home Care and Hospice is in full support of the Better Care Better Jobs Act and is working with Congress to ensure it is included in the budget reconciliation currently being developed in Congress. President Biden originally called for an investment into the HCBS program to the tune of $400 billion. The most recent house version of the reconciliation package allocated $190 billion, which could be susceptible to further cuts as negotiations work towards a final package.

NAHC encourages members to support robust funding of the Better Care Better Jobs Act andThe reports from Senator Casey can be helpful in these efforts.

The Better Care Better Jobs Act Means a Stronger Home Care Community

Senator Bob Casey (D-PA), long-time champion of in-home care and sponsor of the Better Care Better Jobs Act, has released a set of nationwide and individual state reports on the projected impact his Better Care Better Jobs Act will have on workers and recipients of care in the home.

These factsheets present a clear and concise picture of the need for Medicaid Home and Community-based Services (HCBS), comparison of cost of care between the home and congregate settings, as well as waitlist length for HCBS Services where applicable. In addition, the factsheets demonstrate the impact the Better Care Better Jobs Act would have on workforce shortages.

“For millions of families, and especially for women, home and community-based services are a bridge to work and a bridge to economic security,” said Senator Casey when introducing the legislation. “The Better Care Better Jobs Act would not only enable more older adults and people with disabilities to remain in their homes, stay active in their communities and lead independent lives, it would also create jobs and lead to higher wages for care workers, who are predominantly women and people of color. This legislation is critical to advancing equity, spurring economic recovery, and improving quality of life for older adults and people with disabilities”

The National Association for Home Care and Hospice is in full support of the Better Care Better Jobs Act and is working with Congress to ensure it is included in the budget reconciliation currently being developed in Congress. President Biden originally called for an investment into the HCBS program to the tune of $400 billion. The most recent house version of the reconciliation package allocated $190 billion, which could be susceptible to further cuts as negotiations work towards a final package.

NAHC encourages members to support robust funding of the Better Care Better Jobs Act andThe reports from Senator Casey can be helpful in these efforts.

Private Duty Advocacy in Action

Washington D.C continues to buzz with activity as Congress debates the reconciliation package. One element slated for possible inclusion in the package is the Better Care Better Jobs Act, formally known as S. 2210/ H.R. 4131. In literally seconds and with just a few clicks, you can advocate in support of this legislation at the NAHC Legislative Action Network.

Better Care Better Jobs Act

The Better Care Better Jobs Act (S.2210/ H.R.4131) led by Chairman Bob Casey (D-PA), Chairman Ron Wyden (D-OR), and Leader Charles Schumer (D-NY), with Chair Patty Murray (WA), and Senators Tammy Duckworth (D-WI), Maggie Hassan (D-NH), and Sherrod Brown (D-OH) aims to carry forth President Joe Biden’s vision for investment into Medicaid home and community-based services.

This legislation takes several steps to improve Medicaid HCBS, first through providing funding to state Medicaid programs to ready themselves for the enhanced investment, then through a 10 percent increase to the Federal Medicaid Assistance Percentage (FMAP), specifically for Medicaid HCBS.

To qualify for the enhanced 10 percent FMAP states would be required to

  • provide coverage for personal care services;
  • expand supports for family caregivers;
  • adopt programs that help people navigate enrollment and eligibility;
  • expand access to behavioral health care;
  • improve coordination with housing, transportation, and employment supports; and
  • develop or improve programs to allow working people with disabilities to access HCBS.

In addition, the bill aims to strengthen and expand the HCBS workforce by

  • addressing payment rates to promote recruitment and retention of direct care workers;
  • regularly updating HCBS payment rates with public input;
  • passing rate increases through to direct care workers to increase wages; and
  • updating and developing training opportunities for this workforce as well as family caregivers.

Lastly, the legislation would permanently authorize protections against impoverishment for individuals whose spouses are receiving Medicaid HCBS and make the Money Follows the Person Rebalancing Demonstration permanent

Senator Casey, Chair of the Senate Aging Committee and sponsor of the Better Care Better Jobs Act, has compiled factsheets for every state on the impact of the BCBJ. You can access the fact sheets at the following link: https://www.aging.senate.gov/press-releases/better-care-better-jobs-act-state-by-state-fact-sheets

The full House reconciliation language can be found at the link below with the Better Care Better Jobs Act beginning on page 584: https://docs.house.gov/meetings/BU/BU00/20210925/114090/BILLS-117pih-BuildBackBetterAct.pdf

Become a Private Duty Home Care Advocate

The nation’s private duty home care and nursing community fulfills a unique and essential purpose in modern life. Private duty home care provides critical, quality, home-based care, and living support services for individuals young and old, helping them live full, independent, and connected lives in the comfort of wherever they call home.

NAHC is proud to be the leading and unifying voice for the home care and hospice industries helping to ensure access to the highest quality health care and services at home for all Americans. Advocacy, on behalf of the private duty home care community, is an important part of our commitment to you as our members, but also something you can play an active an integral role in by simply signing up!

Why be a NAHC Private Duty Home Care Advocate?

By signing up to be a NAHC Private Duty Home Care Advocate, you are helping to amplify our voice, strengthen and unify our efforts to help bring access to quality home care and services to center stage and get the support and attention they need to meet the exponentially growing demand.

We encourage you to sign up as an advocate today by visiting the NAHC Advocacy Center

Every Voice, Every Heart, Every Action

#HomeCareFirst #AdvocacyInAction

Senate Approves Budget Reconciliation Guidelines

What this means for home care and hospice How you can help! Earlier this month, the United States Senate approved a $3.5 trillion budget resolution. This resolution will serve as the vehicle for the second part of President Biden and Congressional Democrats’ infrastructure investment, much of which intends to strengthen the social safety net. The…

Home Care & Hospice Advocates: Mobilize for these 4 Priorities!

NAHC advocates for home care, home health, and hospice patients and providers every day, but there is nothing like “people power” to motivate our elected representatives to action. Your phone calls, emails, and social media posts directed at members of Congress really do make a difference. Every congressional office closely monitors messages from constituents and…

“Advocacy in Action”

It is busy time in Washington D.C. with a flurry of activity occurring over the last few weeks. Below, please find a brief “round-up” and update for a few key issues/topics we are actively following.

Choose Home Initiative

The Choose Home legislation continues its course towards introduction in the Senate. This legislation has been created in partnership with several key stakeholders to create a home-based skilled nursing facility benefit available through the Medicare program. All signs indicate an introduction occurring sometime on or around July 21st. We continue to communicate with our lead sponsors on the bill and will trigger grassroots advocacy efforts around the legislation as soon as we have word that it has been successfully introduced.

Draft Legislative Text

Notice of Upcoming Joint Hearing

We received notice this week of an upcoming joint hearing between the House Education and Labor HELP and Higher Education and Workforce Investment Subcommittees on Investing in the Direct Care Workforce. The NAHC Advocacy team is currently working on gathering more information on the hearing at this time. LINK

Better Care Better Jobs Act

The Better Care Better Jobs Act (S.2210) led by Chairman Casey, Chairman Wyden, and Leader Schumer with Chair Murray, and Senators Duckworth, Hassan, and Brown aims to carry forth President Biden’s vision for investment into Medicaid home and community-based services. We are encouraged by this legislation but plan to send comments to Casey’s office about a few key concerns we have including the absence of private duty nursing being included in the provisions for the FMAP increase, and advocating for the inclusion of a direct mention of the agency model of care being included alongside the consumer-driven model, etc. Comments will be reviewed by the Advocacy Council, and we encourage those who have comments or concerns with the legislation to send them (address to erb@nahc.org)  as soon as you are able for review and inclusion in the larger set.

Summary

Legislative Language

WISH Act

The Well-Being Insurance for Seniors to be at Home Act (WISH Act) is being led by Congressman Thomas R. Suozzi (NY-03). This Act is being proposed to create a catastrophic long-term care insurance program for seniors that would be self-sustaining and funded through a .3 percent increase in payroll taxes for both employees as well as employers resulting in the ability for individuals to access the fund after a specified waiting period allotting approximately $3600/month for up to 6 hours per day of paid personal care assistance. Assuming the creating of this program, there would be a 10-year period of contribution before any funds would be paid out. NAHC continues open communication with Souzzi’s office on this proposed program and we look forward to our member’s feedback on it. More information can be found through the links below.

Summary

Legislative Text

Essential Caregiver Act

NAHC is actively following the recently introduced Essential Caregiver Act H.R. 3733. This legislation led by U.S. Representatives Claudia Tenney and John B. Larson, allows essential caregivers access to facilities and other congregate living settings to provide care and support to a resident during any public health emergency. Designated essential caregivers would be assured access to their loved ones in a manner that would be consistent with all applicable health and safety protocols. We continue to review this legislation as it applies to the ability to also designated caregivers who are working with individuals to ensure their continued access during a public health emergency, recognizing of course that access for professional caregivers should always continue to be granted but this Bill may help to reinforce the access given that over the course of the pandemic various accounts have indicated there may have been challenges for some caregivers to access their clients.

Summary

Legislative Language

Become a Private Duty Home Care Advocate

The nation’s private duty home care and nursing community fulfills a unique and essential purpose in modern life. Private duty home care provides critical, quality, home-based care, and living support services for individuals young and old, helping them live full, independent, and connected lives in the comfort of wherever they call home.

NAHC is proud to be the leading and unifying voice for the home care and hospice industries helping to ensure access to the highest quality health care and services at home for all Americans. Advocacy, on behalf of the private duty home care community, is an important part of our commitment to you as our members, but also something you can play an active an integral role in by simply signing up!

Why Become a NAHC Private Duty Home Care Advocate?

By signing up to be a NAHC Private Duty Home Care Advocate, you are helping to amplify our voice, strengthen and unify our efforts to help bring access to quality home care and services to center stage and get the support and attention they need to meet the exponentially growing demand.

We encourage you to sign up as an advocate today by visiting the

NAHC Advocacy Center

Every Voice, Every Heart, Every Action

#HomeCareFirst #AdvocacyInAction

Democrats Introduce Legislation to Invest in HCBS, Increase Worker Pay

Democrats in the U.S. House of Representatives and Senate unveiled legislation, the Better Care Better Jobs Act,  yesterday to implement the Biden administration’s goal of spending hundreds of billions of dollars on home-based care in the coming years. The legislation would give states far more money to invest in and expand home-and-community-based care programs. States…

Democrats Introduce Legislation to Invest in HCBS, Increase Worker Pay

Democrats in the U.S. House of Representatives and Senate unveiled legislation, the Better Care Better Jobs Act,  yesterday to implement the Biden administration’s goal of spending hundreds of billions of dollars on home-based care in the coming years.

The legislation would give states far more money to invest in and expand home-and-community-based care programs. States would be given $100 million, by no later than one calendar year after enactment of the legislation, to create plans to expand access to Medicaid HCBS and “strengthen” the HCBS workforce.

Over 3.5 million older adults and people with disabilities are currently receiving HCBS.

The bills would “strengthen and expand access to HCBS” by expanding financial eligibility criteria for HCBS to federal limits; requiring coverage for personal care services; expanding supports for family caregivers; adopting programs that help people navigate enrollment and eligibility; expanding access to behavioral health care; improving coordination with housing, transportation, and employment supports; and developing or improving programs to allow working people with
disabilities to access HCBS.

In addition, the bills would “strengthen and expand the HCBS workforce” by addressing HCBS payment rates to promote
recruitment and retention of direct care workers; regularly updating HCBS payment rates with public input; passing rate increases through to direct care workers to increase wages; and updating and developing training opportunities for this workforce as well as family caregivers.

The legislation would permanently authorize protections against impoverishment for individuals whose spouses are receiving Medicaid HCBS and make the Money Follows the Person Rebalancing Demonstration permanent.

Under the terms of the legislation, states would become eligible for permanent increases to their Medicaid match funds of 10 percentage points, an expansion of the temporary boost provided in the American Rescue Plan. Eligibility could require states to expand HCBS access, help people utilize long-term care options, and provide additional support to family caregivers.

In addition, states would need “to promote recruitment and retention of direct care workers” by “regularly updating HCBS payment rates with public input.” The goal would be to increase compensation and training for workers to better attract and retain a stable direct care workforce.

Regular reporting by states would be required to demonstrate the legislative goals are being met. The Centers for Medicare & Medicaid Services (CMS) would receive additional funding for oversight.

The legislation is sponsored by Senators Bob Casey of Pennsylvania and Ron Wyden of Oregon, as well as Debbie Dingell of Michigan; all Democrats and all long-time friends of the home care and hospice community.

Interestingly, the same day the Better Care Better Jobs bills were introduced, President Biden and a bipartisan group of legislators announced a compromise agreement to spend almost $580 billion in new money on the country’s creaky infrastructure. That agreement did not include any funding for long-term care, though President Biden originally called for $400 billion in new spending to be part of the country’s infrastructure investment. Republicans balked at that, saying infrastructure does not include long-term care investments.

With this legislation not included in the bipartisan infrastructure agreement and extremely unlikely to attract support from enough Republicans to pass the Senate, the terms of the Better Care Better Jobs Act could be made into law through the reconciliation process. Many Democrats have signaled determination to use reconciliation to pass elements of Biden’s infrastructure agenda that are not included in the bipartisan agreement reached on Thursday, June 24.