NAHC Urges Congress to Not Prohibit GPS & Biometrics in EVV Systems

The National Association for Home Care & Hospice is urging Congress to strongly consider changes to the Cures 2.0 legislation, in particular the proposal to prohibit the use of global positioning systems (GPS) and biometrics within electronic visit verification (EVV) systems. NAHC supported the 21St Century Cures Act (21CC) and is enthusiastic about its next iteration.…

NAHC to Congress: Extend the Acute Hospital Care at Home Waiver Program

The National Association for Home Care & Hospice and a group of likeminded organizations have written to leaders in the Senate and House of Representatives to urge Congress to prioritize extending the Acute Hospital Care at Home (AHCAH) waiver program as part of the next government funding package on February 18th. Many seniors needing acute-level…

House Passes Bill to Improve Health Care Worker Well-Being

The U.S. House of Representatives recently passed the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667), legislation to fund programs to improve the well-being and mental health of health care workers, including proivders of home-based care.

This legislation is motivated at least in part by concern about the unprecedented stress and burnout health care workers have faced as a result of the demands put upon them by the COVID-19 pandemic. The law is named for Dr. Lorna Breen, the medical director of the emergency department at New York-Presbyterian Allen Hospital, who died by suicide in the Spring of 2020.

The bill passed in the U.S. Senate in August, but it will now go back to that chamber since a small change was made to the House version. If it passes, it will then go to President Biden to be signed into law.

The bill would:

  • Establish grants for health care providers and professional associations for employee education, peer-support programming, and mental and behavioral health treatment; health care providers in areas with health professional shortages or rural areas will be prioritized.
  • Establish grants for health profession schools, academic health centers, or other institutions to help them train health workers in strategies to prevent suicide, burnout, mental health conditions, and substance use disorders. The grants would also help improve health care professionals’ well-being and job satisfaction.
  • Seek to identify and disseminate evidence-informed best practices for reducing and preventing suicide and burnout among health care professionals, training health care professionals in appropriate strategies, and promoting their mental and behavioral health and job satisfaction.
  • Establish a national evidence-based education and awareness campaign targeting health care professionals to encourage them to seek support and treatment for mental and behavioral health concerns.
  • Establish a comprehensive study on health care professional mental and behavioral health and burnout, including the impact of the COVID-19 pandemic on such professionals’ health.

The bill calls for $45 million per year for FY 2022-2024 for the above activities.

While the early 2022 legislative calendar remains in flux, it is possible that the Senate will soon consider the legislation and possibly seek passage via the fast-tracked “unanimous consent” process, which would clear the way for President Biden to sign the bill into law.

The pandemic, coupled with historic workforce shortages that have forced providers to work longer and harder than ever before, continue to strain caregiver’s ability to take attend to their own behavioral health needs. The National Association for Home Care & Hospice urges Congress to swiftly cooperate to pass the Dr. Lorna Breen Health Care Provider Protection Act, and we stand ready to work with the Administration and other stakeholders to ensure its successful implementation.

House Passes Bill to Improve Health Care Worker Well-Being

The U.S. House of Representatives recently passed the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667), legislation to fund programs to improve the well-being and mental health of health care workers, including proivders of home-based care. This legislation is motivated at least in part by concern about the unprecedented stress and burnout health care…

President Signs Bill Staving off Medicare Cuts

  • NAHC Advocacy win preserves almost $2 billion in payments

President Joe R. Biden signed legislation into law to delay significant payment cuts to Medicare providers after the bill easily passed the House of Representatives and Senate earlier in the week.

This represents a major advocacy win for NAHC and our members. By staving off the devasting rate reductions that were slated to start on January 1, 2022, Congress and the President recognize that providers of all kinds, including home health agencies and hospices, continue to be historically challenged by the pandemic and unprecedented workforce shortages. This action ensures that Home Health and Hospice providers can continue serving patients and families at a time when high-quality home-based care has never been more necessary.

“NAHC commends the Congress for coming together to address these backward rate cuts. We also thank the President for his swift signature ensuring home-based care providers across the country can continue to serve their communities without a major payment reduction imminently looming over their heads” said National Association for Homecare & Hospice President Bill Dombi.”

Text of the House bill can be found HERE.

The most relevant Medicare payment provisions in the new law include:

  • A three-month delay of the entire planned 2% Medicare sequester payment reductions, to be in effect January 1, 2022 – March 31, 2022 (i.e. no sequester-related payment reductions in effect for first 3 months of 2022)
  • A three-month, 1% reduction in Medicare sequester payment reductions, in effect April 1, 2022 – June 30, 2022 (i.e. a 1% across-the-board sequester-related payment reduction for Q2 of 2022)
  • A one-year delay until 2023 of the entire planned so-called PAYGO sequestration cuts, which were set to go into effect as a result of the budget deficit impact of the last major COVID-19 legislative relief package passed in March 2021. PAYGO cuts were estimated to be around $36 billion for Medicare providers.

Based on 2019 levels of Medicare spending for home health and hospice ($18.1 billion for home health; $20.9 billion for hospice), NAHC roughly estimates that the total savings across the two programs associated with this legislation reaches ~$1.85 billion.

The sequester-related delays in this bill are paid for by bumping up the sequester payment reduction amounts in the year 2030, and the PAYGO cuts are delayed for only one year until 2023. While this particular bill is very welcome news, the annual stress and threat of continued Medicare cuts is an ongoing challenge to home-based providers’ stability and predictability. NAHC is committed to fighting against harmful payment reductions and advancing sensible long-term sequestration relief.

There are other Medicare-related payment policies in the bill as well, including the maintenance of a 3% pay bump for Part B providers through 2022 under the Medicare Physician Fee Schedule, the delay of payment reductions tied to the clinical laboratory fee schedule, and a one-year postponement of CMMI’s radiation oncology payment model demonstration.

President Signs Bill Staving off Medicare Cuts

NAHC Advocacy win preserves almost $2 billion in payments President Joe R. Biden signed legislation into law to delay significant payment cuts to Medicare providers after the bill easily passed the House of Representatives and Senate earlier in the week. This represents a major advocacy win for NAHC and our members. By staving off the…

Congress Expected to Pass Bill to Avert Major Medicare Cuts

The US House of Representatives passed legislation during the evening of Tuesday, December 7, that would delay significant payment cuts to Medicare providers. The Senate is expected to vote on and pass the bill in the next few days, where it would then be sent to the President’s desk to be signed into law. Assuming President Biden receives the bill, he will sign it into law.

This would represent a major advocacy win for NAHC and our members. By helping stave off the devasting rate reductions that were slated to start on January 1, 2022, Congress is recognizing that providers of all kinds, including home health agencies and hospices, continue to be historically challenged by the pandemic and unprecedented workforce shortages. Should the bill become law as expected, the delay in cuts will support the ability of NAHC members to continue serving patients and families at a time when high-quality home-based care has never been more necessary.

“NAHC commends the House for coming together to address these backward rate cuts. We now encourage our friends in the Senate to follow suit and swiftly pass this bill so home-based care providers across the country can continue to serve their communities without a major payment reduction imminently looming over their heads” said National Association for Homecare & Hospice President Bill Dombi.”

Text of the House bill can be found HERE.

The most relevant Medicare payment provisions in the House-passed bill include:

  • A three-month delay of the entire planned 2% Medicare sequester payment reductions, to be in effect January 1, 2022 – March 31, 2022 (i.e. no sequester-related payment reductions in effect for first 3 months of 2022)
  • A three-month, 1% reduction in Medicare sequester payment reductions, in effect April 1, 2022 – June 30, 2022 (i.e. a 1% across-the-board sequester-related payment reduction for Q2 of 2022)
  • A one-year delay until 2023 of the entire planned so-called PAYGO sequestration cuts, which were set to go into effect as a result of the budget deficit impact of the last major COVID-19 legislative relief package passed in March 2021. PAYGO cuts were estimated to be around $36 billion for Medicare providers.

Based on 2019 levels of Medicare spending for home health and hospice ($18.1 billion for home health; $20.9 billion for hospice), NAHC roughly estimates that the total savings across the two programs associated with this legislation reaches ~$1.85 billion.

The sequester-related delays in this bill are paid for by bumping up the sequester payment reduction amounts in the year 2030, and the PAYGO cuts are delayed for only one year until 2023. While this particular bill is very welcome news, the annual stress and threat of continued Medicare cuts is an ongoing challenge to home-based providers’ stability and predictability. NAHC is committed to fighting against harmful payment reductions and advancing sensible long-term sequestration relief.

There are other Medicare-related payment policies in the bill as well, including the maintenance of a 3 percent pay bump for Part B providers through 2022 under the Medicare Physician Fee Schedule, the delay of payment reductions tied to the clinical laboratory fee schedule, and a one-year postponement of Center for Medicare & Medicaid Innovation’s radiation oncology payment model demonstration.

Congress Expected to Pass Bill to Avert Major Medicare Cuts

The US House of Representatives passed legislation during the evening of Tuesday, December 7, that would delay significant payment cuts to Medicare providers. The Senate is expected to vote on and pass the bill in the next few days, where it would then be sent to the President’s desk to be signed into law. Assuming President…

Build Back Better Passes the House of Representatives

  • Here is what it means for NAHC members and their patients

The Build Back Better Act, a signature legislative priority for the Biden administration and its allies in Congress, passed the House of Representatives this morning on a party line vote of 220-213. The legislation now heads to the Senate for consideration.

The Build Back Better Act (BBB) is a roughly $1.7 trillion social spending package that, among other things, creates new Medicare benefits for hearing services and enables the government to negotiate some prescription drug prices to lower the costs that seniors pay for lifesaving medicines such as insulin.

The legislation also contains substantial implications for the future of home and community-based services in the United States, as well as training and development of the direct care workforce.

“Today’s historic vote of support for home care comes at a time when the country needs it more than ever,” said NAHC President William A. Dombi, moments after the vote in the House. “Health care at home is widely recognized as high value, high quality, and highly preferred. From pediatric nursing care to home care aide services for those with multiple chronic illnesses as they age, this legislation will provide improved access to home care. We now look to the Senate to complete the work to protect our families and friends who need this essential care. “

NAHC has analyzed the legislation to see how it will impact our members and the wider home care and hospice community.

  • Bill text can be found HERE
  • A section-by-section overview of the bill’s provisions can be found HERE

The BBB bill is the cornerstone of President Biden’s and congressional Democrats’ domestic agenda. Initially proposed spending targets for the package were around $3.5 trillion, but lack of Democratic consensus on the topline figure and scope, as well as narrow margins for Democrats in both the House and Senate forced lawmakers to shrink the overall size and ambition of the bill. This legislation will impact nearly every sector of American society, and there are a number of policies with direct relevance for home health, home care, and hospice providers, some of which are NAHC advocacy priorities.

Below is background information on some of those most consequential policies included in the House BBB legislation:

Medicaid Home and Community-Based Services (HCBS) Investment (“Better Care Better Jobs Act”)

  • $150 billion investment to bolster Medicaid HCBS, with the goal of increasing access to services, reducing waitlists, and better supporting the direct care workers that provide the bulk of HCBS. Specifically, the approved language would:
    • Provide a 6% FMAP increase for HCBS;
    • Require coverage of personal care services;
    • Require caregiver supports such as respite care;
    • Require updated of payment rates that “support the recruitment and retention of the direct care workforce”;
    • Require an update of HCBS payment rates at least every three years;
    • Make permanent the protections against spousal impoverishment for recipients of Medicaid HCBS;
    • Make permanent the Medicaid Money Follows the Person (MFP) demonstration that helps those in institutional facilities transition back to the community.
      • See the legislative language for this provision HERE
      • See an overview of the provision HERE

Direct Care Worker Training and Support Investments

  • $400 million/yr for FY2023-2026 for a grant-based program that would bolster frontline caregivers’ access to economic and educational supports. These grants would go to states and territories, to be spent on things like worker wage subsidies, student loan repayment or tuition assistance for a degree or certification in a relevant field, childcare for eligible workers, and transportation assistance, amongst other approved activities that benefit direct care workers. The bill makes clear that aides working in home health, personal care, and hospice, as well as LPNs and LCSWs, are eligible to receive support under these grants.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $1 billion over 10 years for a separate program to support the direct care workforce through renewable three-year grants administered by the Dept of Labor. Grants can be used to invest in strategies to recruit, retain, and advance the direct care workforce; implement models and strategies to make the field of direct care more attractive; and improve wages, including through training and registered apprenticeships, career pathways, or mentoring.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $20,000,000 to fund a national technical assistance center through HHS’ Administration for Community Living which will develop and disseminate evidence-based strategies for recruitment, education and training, retention, and career advancement of direct care workers and provide recommendations for activities to further support paid and unpaid family caregivers.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Additional Health Workforce Investments

  • $400 million for the Health Profession Opportunity Grant (HPOG) program, which awards grants to organizations to provide education and training to low-income individuals for occupations in the health care field that are expected to either experience labor shortages or be in high demand. Home care and home health aides are identified as being HPOG-eligible professions.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Paid Family and Medical Leave

  • Starting in January 2024, all workers would be eligible for up to four weeks of paid leave for new parents, workers dealing with their own serious medical conditions, and workers who need leave to care for a loved one with a serious medical issue. Benefits would be progressive, with lower-income workers receiving higher levels of wage replacement. Wage replacement would be about two-thirds for the average worker.
    • See the legislative language for this provision HERE

Increases in OSHA Fine Amounts

  • Amends the Occupational Safety and Health Act of 1970 to:
    • Increase the maximum penalty to $700,000 for willful and repeat violations (current penalty is $136,532);
    • Increase the minimum penalty to $50,000 for willful violations (current penalty if $9,753);
    • increase the maximum penalty for both serious and failure-to-abate violations to $70,000. (current penalties are $13,653);
  • See the legislative language for these provisions HERE

The bill also includes a number of provisions that would:

  • Expand Medicaid coverage;
  • Lower prescription drug costs;
  • Extend ACA marketplace health plan subsidies;
  • Add hearing coverage to the Medicare program;
  • Invest tens of billions of dollars in bolstering public health infrastructure and training;
  • Boost funding by over $1 billion for Older Americans Act (OAA) programs that support older adults and family caregivers;
  • Provide $40 million in funding for programs to support family caregivers’ mental health and well-being;
  • Provide $500 million in new grant funding to support medical-legal partnerships (programs that integrate patient-centered legal services into health care settings to address their patient and families’ health-related social needs).

Major health and care-related provisions that were not incorporated into the House bill include:

  • A separate tax credit for family caregivers (A NAHC policy priority issue);
  • New Medicare dental and vision benefits.

As negotiations over the legislation move to the Senate, NAHC will continue to advocate for polices that will benefit patients, families and the home-based providers that care for them. We are closely tracking the movement on this massive bill, and will be updating members on relevant developments as they arise. Stay tuned to NAHC Report for updates.

NAHC to Congress: Stop Upcoming Medicare Cuts

The National Association for Home Care & Hospice is advancing its advocacy campaign in defense of Medicare by again urging members of Congress (see new letter) to quickly move to head off looming cuts to Medicare. NAHC first wrote to Congressional leaders in late October, urging them to work together to enact legislative proposals by year’s end that will prevent tens of billions of dollars in harmful Medicare rate cuts to health care providers.

Joining NAHC in urging Congress to stop Medicare cuts were the National Hospice and Palliative Care Association and LeadingAge.

We need to add your voices to ours, so NAHC strongly urges you to go to our Advocacy Center and send a message to your members of Congress to stop the massive looming Medicare cuts. The message has been pre-written and it will take you literally only seconds to send it with a few clicks. Please do this immediately!

The joint letter, which was sent to Senate Majority Leader Chuck Schumer (D-NY), Senate Minority Leader Mitch McConnell (R-KY), Speaker of the House Nancy Pelosi (D-CA), and House Minority Leader Kevin McCarthy (R-CA), asks Congress to take action soon to delay or avert scheduled cuts to Medicare that are a result of both the re-imposition of across-the-board sequestration reductions, as well as required cuts due to the budgetary impacts of the American Rescue Plan of 2021, the massive COVID-19 relief package that became law in March 2021 (these are the so-called “PAYGO” cuts). Absent additional congressional action, these combined six percent cuts to Medicare will take effect on January 1, 2022.

Imposing drastic payment cuts on high-quality home-based care providers while we’re still battling a pandemic and cases are rising will decrease patient and family access to critical supportive services at a time when they have never been in higher demand.” Said NAHC President Bill Dombi. “We have appreciated Congress’ swift action in the past to avert these types of cuts, and we call on our champions on Capitol Hill again to delay the impending reductions so that providers can continue to serve vulnerable Medicare beneficiaries in the place they prefer – their own homes and communities.”

America’s front line health care providers continue to struggle through the COVID-19 pandemic, as well as a historically challenging workforce shortage, both of which have placed unprecedented stress on the entire health care system. Home health and hospice providers are working tirelessly to deliver the best care for patients, families and communities, despite battling major operational pressures. Ongoing financial challenges for home care providers include higher expenses for labor and supplies, lost revenues due to forgone routine visits, and increased emergency costs associated with COVID-19 surges, among others.

The pandemic remains a major threat to both patient safety and provider operational capacity. Allowing the combined scheduled Medicare cuts to take effect on January 1, 2022 will reduce access to high-quality home-based medical and social services for those individuals and families who have never needed them more.

NAHC is grateful that Congress has in the recent past taken action to delay scheduled Medicare cuts during the pandemic. This necessary relief has mitigated harmful disruptions in service delivery and access to high-quality home health and hospice care. Sadly, many of the pandemic conditions that justified the waiver of these reductions in the recent past are still with us, impacting home care providers’ ability to fully respond to the needs of the communities they serve. As such, NAHC is respectfully asking that Congress pass legislation before the end of this year that will avert the impending two percent sequestration and four percent PAYGO-induced Medicare reimbursement reductions.

NAHC will continue to advocate on this important issue for Medicare home health and hospice providers and we will update you in future editions of NAHC Report. Please stay tuned.