Hospice Notes for July 13, 2022

Congress is facing a packed few weeks in the lead-up to the monthslong August recess. The potential revival of a slimmed-down reconciliation package sought by Senate Democrats remains top-of-mind for many DC watchers. While nothing is concrete at this point, it unfortunately appears likely that any smaller party-line reconciliation bill will omit major funding investments in Medicaid home-and-community-based services (HCBS). Last year’s House-passed Build Back Better Act included $150 billion for HCBS, seen as a transformative injection of resources that would increase access and better support the frontline home care workforce.

NAHC continues to work with other diverse coalitions to push for the inclusion of HCBS funding in any emerging deal.

Elsewhere on Capitol Hill, the House Appropriations committee recently approved a number of FY2023 government funding bills, including the Labor, Health and Human Services, Education, and Related Agencies (LHHS) package that contains discretionary spending for federal health programs. While it is certain that future Senate-side bipartisan negotiations will ensure any final government funding package that will ultimately become law will differ from what the House Appropriations committee has cleared, it is still instructive to keep track of the Democrat-led House deal, as it provides insight into that group’s policy priorities. A few provisions relevant to home-based care providers, detailed in the bill’s accompany report, include the following (note -many of these are merely signaling in nature, as opposed to explicitly directive):

  • Medicare Coverage of Home-based Extended Care Services.—The Committee encourages CMS to consider options to improve extended care services for Medicare beneficiaries, such as through home-based extended care by home health agencies (bottom of pg 184)
  • Patient Access to Home Health Care.—The Committee supports the intent of the network adequacy rules of CMS for Medicare Advantage organizations and for Medicaid managed care organizations under 42 C.F.R. 438 and 457 to maintain a network of qualified providers sufficient to provide adequate access for covered services to meet the health care needs of the patient population served. The Committee requests a report within 180 days of the date of enactment of this Act on regulatory actions related to network adequacy (bottom of pg. 186)
  • Home Health Aides.—The Committee recognizes that home health aides (HHAs) are the foundation of professional home-based caregiving, and that the growing population of disabled, chronically ill, and elderly Americans receiving home-based care requires a skilled and highly trained HHA workforce prepared to manage complex care needs. The Committee encourages HHS to explore how HHAs are meeting clinical competencies necessary to provide high-quality home-based care (pg. 221)
  • Direct Care Workforce Demonstration.—The Committee provides $3,000,000 for a Direct Care Workforce Demonstration project, to reduce barriers to entry for a diverse and high-quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract or retain direct care workers. (pg. 211)
  • Dementia Care Management Model.—The Committee urges the Center for Medicare & Medicaid Innovation (CMMI) consider how best to test a Medicare dementia care management model. The Committee encourages CMMI to continue working with stakeholders to find a way to test a value-based dementia care management model that could reach dementia patients across the stages and include coordinated care management and caregivers. The Committee requests an update not later than one year after the date of enactment of this Act on the progress for this model. (pg. 180)

The bill also includes several provisions that would help to increase the health care workforce. Among other things, the bill includes: nearly $2 billion in new money for the Department of Labor, including for apprenticeship programs, Workforce Innovation and Opportunity state grants, and Senior Community Service Employment; $15,6 billion in new money for HHS to enhance nursing workforce development and other health care programs; and enhanced funding for targeted programs of the Administration on Community Living.

The Committee also adopted a manager’s amendment from House Appropriations Committee Chairwoman Rosa DeLauro (D-CT), that added language to the committee report that urges the Health Resources and Services Administration  (HRSA) to “address the skilled care workforce needs of seniors through existing workforce education and training programs.”

The most hospice and palliative care-specific bills in Congress right now include the Palliative Care and Hospice Education and Training Act (PCHETA) (S.4260) and the Expanding Access to Palliative Care Act (S. 2565). PCHETA would bolster the serious illness professional workforce and boost palliative and hospice research funding, while S.2565 would require CMMI to test a dedicated community-based palliative care demonstration informed by the recently-ended, hospice-only Medicare Care Choices Model (MCCM). Both bills are currently Senate-only at this point, and we need your continued advocacy and outreach to continue to garner co-sponsors for these important policies. Use NAHC’s grassroots outreach campaigns to ask your Senators to support these bills.

Elsewhere in DC, much of the policy conversation on palliative care in particular is occurring within CMMI. In light of the Innovation Center’s strategic refresh late last year, it has become apparent that leadership there is focused on streamlining their demonstration portfolio and developing ways to better integrate specialty care (which is how they conceptualize palliative care) into broader, population health-style models, primarily the ACO programs.

Recently, CMMI posted a blog that broadly spells out their early vision for this kind of integration. In the piece, they specifically write: “Until more ACOs can assume full risk, collaborative care codes, as currently used in behavioral health, could support integration and co-location of some specialty care, such as palliative care.”

NAHC, in tandem with other members of the National Association of Hospice & Palliative Care, continues to work with CMMI to explore how best to support and scale home and community-based palliative care.

Choose Home Care Act Picks Up Support in Congress

Click Here to Urge Congress to support the Choose Home Care Act! The Choose Home Care Act continues to build support in Congress with the recent addition of new cosponsors in the House of Representatives, including Reps. Sheila Cherfilus-McCormick (D-FL-20), Brian Fitzpatrick (R-PA-1), Al Lawson, Jr. (D-FL-5), and Angie Craig (D-MN-2). We thank the new sponsors of this…

NAHC to Congress: Time for a Big Permanent Investment in HCBS

NAHC and a group of likeminded organizations have written to leaders of Congress, urging them to make a large permanent investment in home and community-based services (HCBS). The American Rescue Plan Act funding allowed states to provide hazard pay to the direct care workforce and maintain access to vital HCBS that have enabled people with disabilities and older adults to remain living safely in their own homes during the pandemic.

However, those rescue funds are temporary and have stopped accruing. Without a large permanent investment in HCBS, the direct care workforce crisis will worsen and HCBS access will decrease. Timely investment is needed to provide greater sustainability for states, individuals who rely on HCBS, their family caregivers, and the paid workforce providing these critical services.

While the House of Representatives passed a $150 billion investment in HCBS last year, the Senate has not yet done so. The Senate should pass the $150 billion HCBS investment as soon as possible. This investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need in our communities. This investment will both increase access to Medicaid HCBS and create more high-quality direct care jobs to support the people who do this work as well as people with disabilities of all ages and their families. HCBS are also more cost effective for states and the federal government than institutional care, making this investment an all-around win for individuals, families, workers, and state and federal governments.

When older adults who want to age in place and people with disabilities who need support to work, live independently, and be a part of their communities are left waiting, the responsibility for care and support often falls on unpaid family caregivers, who also need financial assistance. Over 90% of people with disabilities and aging adults living in the community receive unpaid support. The workforce and earnings losses related to unpaid family caregiving are significant and well-documented. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. For example, family caregivers spend on average 26% of their annual income on caregiving expenses, but the share of income African American/Black and Hispanic/Latino family caregivers report spending is 34% and 47%, respectively.

To address the long-standing inequities the pandemic exposed and exacerbated, this investment is critical to fortify a workforce that must expand to meet a rapidly increasing level of need. The HCBS workforce provides vital services, and yet these workers–who are primarily women of color–have been devalued and underpaid for decades, leading to severe staff shortages that result in crucial gaps in service availability, lengthy waiting lists, service line closures, and additional obstacles to achieving a high quality of life for workers and recipients alike.

This investment is also necessary to help people who are in nursing facilities and other institutions return to the community. Many people are in institutions who do not need to be because persistent underfunding and bias have created an inadequate HCBS infrastructure to meet the demand. The HCBS legislation passed by the House would directly address this issue by making the widely successful Money Follows the Person program permanent. It would also help married individuals who rely on Medicaid to remain living at home with their spouse by permanently extending the federal spousal impoverishment protections to HCBS.

Investing in home-based care has strong bipartisan support. An April 2022 survey of over 1200 likely voters shows that affordable long-term care for seniors and people with disabilities is the most popular provision in the investment package with support from 87% of all respondents and 85% of Republicans. A survey last year of 1,400 voters age 50 and older found that 87% supported increasing resources for in-home care, including 82% of Republicans, and another survey of 800 people age 18 and older found that 89% of Americans support an increased public investment in affordable home care services.

NAHC to Congress: Time for a Big Permanent Investment in HCBS

NAHC and a group of likeminded organizations have written to leaders of Congress, urging them to make a large permanent investment in home and community-based services (HCBS). The American Rescue Plan Act funding allowed states to provide hazard pay to the direct care workforce and maintain access to vital HCBS that have enabled people with disabilities and older adults to remain living safely in their own homes during the pandemic.

However, those rescue funds are temporary and have stopped accruing. Without a large permanent investment in HCBS, the direct care workforce crisis will worsen and HCBS access will decrease. Timely investment is needed to provide greater sustainability for states, individuals who rely on HCBS, their family caregivers, and the paid workforce providing these critical services.

While the House of Representatives passed a $150 billion investment in HCBS last year, the Senate has not yet done so. The Senate should pass the $150 billion HCBS investment as soon as possible. This investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need in our communities. This investment will both increase access to Medicaid HCBS and create more high-quality direct care jobs to support the people who do this work as well as people with disabilities of all ages and their families. HCBS are also more cost effective for states and the federal government than institutional care, making this investment an all-around win for individuals, families, workers, and state and federal governments.

When older adults who want to age in place and people with disabilities who need support to work, live independently, and be a part of their communities are left waiting, the responsibility for care and support often falls on unpaid family caregivers, who also need financial assistance. Over 90% of people with disabilities and aging adults living in the community receive unpaid support. The workforce and earnings losses related to unpaid family caregiving are significant and well-documented. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. For example, family caregivers spend on average 26% of their annual income on caregiving expenses, but the share of income African American/Black and Hispanic/Latino family caregivers report spending is 34% and 47%, respectively.

To address the long-standing inequities the pandemic exposed and exacerbated, this investment is critical to fortify a workforce that must expand to meet a rapidly increasing level of need. The HCBS workforce provides vital services, and yet these workers–who are primarily women of color–have been devalued and underpaid for decades, leading to severe staff shortages that result in crucial gaps in service availability, lengthy waiting lists, service line closures, and additional obstacles to achieving a high quality of life for workers and recipients alike.

This investment is also necessary to help people who are in nursing facilities and other institutions return to the community. Many people are in institutions who do not need to be because persistent underfunding and bias have created an inadequate HCBS infrastructure to meet the demand. The HCBS legislation passed by the House would directly address this issue by making the widely successful Money Follows the Person program permanent. It would also help married individuals who rely on Medicaid to remain living at home with their spouse by permanently extending the federal spousal impoverishment protections to HCBS.

Investing in home-based care has strong bipartisan support. An April 2022 survey of over 1200 likely voters shows that affordable long-term care for seniors and people with disabilities is the most popular provision in the investment package with support from 87% of all respondents and 85% of Republicans. A survey last year of 1,400 voters age 50 and older found that 87% supported increasing resources for in-home care, including 82% of Republicans, and another survey of 800 people age 18 and older found that 89% of Americans support an increased public investment in affordable home care services.

NAHC to Congress: Time for a Big Permanent Investment in HCBS

NAHC and a group of likeminded organizations have written to leaders of Congress, urging them to make a large permanent investment in home and community-based services (HCBS). The American Rescue Plan Act funding allowed states to provide hazard pay to the direct care workforce and maintain access to vital HCBS that have enabled people with disabilities…

Palliative & Hospice Workforce Development Legislation Re-Introduced in the Senate

On Thursday, May 19th, US Senators Tammy Baldwin (D-WI) and Shelley Moore-Capito (R-WV) reintroduced the Palliative Care & Hospice Education and Training Act (PCHETA) (S.4260) (Bill text HERE; 1-pager HERE). Long a priority for NAHC and the broader end-of-life and serious illness care community, PCHETA would authorize funding for major investments to build, support, and…

Choose Home Care Act Picks Up Sponsors in Congress

  • Click Here to Urge Congress to support the Choose Home Care Act!

The Choose Home Care Act continues to build support in Congress with the recent addition of three new cosponsors in the House of Representatives. Reps. Lisa Blunt Rochester (D-DE), John Moolenaar (R-MI), and James McGovern (D-MA) have joined 33 of their colleagues in the House in supporting the legislation.

We thank the new sponsors of this legislation for their leadership on this issue.

The Choose Home Care Act seeks to provide an option to patients in where they receive their post-acute care upon discharge from a hospital within the Medicare program. If deemed a good fit by the hospital and home health agency for the Choose Home model, a patient could elect to continue their recovery at home with enhanced services and supports added onto the traditional home health benefit. The added services could include personal care services, meal delivery, and respite care, among several others.

The Choose Home Act is a top legislative priority for NAHC. In addition, other supporting organizations include AARP, the Partnership for Quality Home Health Healthcare (PQHH), LeadingAge, the National Council on Aging (NCOA), the Moving Health Home Coalition and others.

Imminent legislative activity is not expected as attention will shift towards reelection campaigns during the summer and early fall. In the meantime, NAHC will continue to build knowledge of the legislation on Capitol Hill, as well as add new supporters to optimize the Choose Home Care Act‘s chances of coming up for a vote.

NAHC encourages all members and home care professionals to urge their Senators and Representatives to support the bill. This can easily be done through the NAHC Legislative Action Center here.

NAHC Supports New Bill To Empower Seniors to Stay in their Homes

Our homes are so important to us. It’s not just where we sleep and eat most of our meals, it’s our place to be indepedent. And, since the pandemic, it’s increasingly an office, a gym, a child care center, and, of course, if you need health care, your home is a great place to receive it.

That is why NAHC is thrilled to announce that on Friday, May 6, U.S Representatives Charlie Crist (D-St. Petersburg) and Thomas Suozzi (D-NY) introduced the Home Modification for Accessibility Act (H.R. 7676), legislation that provides tax incentives for home modifications so seniors and those with disabilities can more easily and safely continue living in their own homes.

The Home Modification for Accessibility Act empowers Americans to make decisions about where and how they live by offsetting the costs associated with making home modifications through a penalty free early retirement withdrawal and lifetime tax deduction of up to $30,000. This will reduce injuries and subsequent medical costs associated with falls, as well as drive development and investment in the market and create new job opportunities for skilled laborers and contractors.

“This bill is a step in the right direction towards enabling more seniors to age in place while ensuring they are positioned for many more years of comfortably living in their own homes,” said NAHC President William A. Dombi. “This legislation has the full support of the National Association for Home Care & Hospice.”

Not only is living at home the preferred option for 90 percent of aging Americans, it is also vastly more affordable for people and the country. Having to live in a nursing home where room costs can average anywhere from $6,000 to $8,000 a month.

“Given the option, the vast majority of seniors and people with disabilities want to stay in their own home for as long as possible. It’s more comfortable, less costly, and improves quality of life,” said Rep. Crist. “Unfortunately, many homes lack accessibility upgrades to make this a reality for seniors on fixed incomes and people with disabilities. That’s why I introduced the Home Modification for Accessibility Act – to provide tax incentives so that more Floridians have the option to live and age safely in their own home. It’s the right thing to do!”

“We have a storm coming, with the number of disabled elders expected to double in the coming years. Fewer family caregivers are available for these aging Americans and the market for long-term care insurance is not currently sufficient to address these demographic challenges,” said Rep. Suozzi. “We must do all we can to ensure New Yorkers have the option to live and age safely in the comfort of their own home.”

“This bill will help correct a fundamental injustice in American life. While we’re living longer and healthcare is increasingly conducted at home, the country’s housing stock is not meeting our daily and safety needs,” said Louis Tenenbaum, founder and president, HomesRenewed Coalition. “Incentives outlined in this bill will encourage people to demand building and renovation designs that support aging in place with joy, dignity and independence,” added Tenenbaum. “Over time, these features will become the norm, benefiting individuals, families, the healthcare system and our economy.”

Please join NAHC in supporting this legislation, which will enable aging and disabled Americans to continue to live in their own homes.

Additional Resources:

Choose Home Care Act Picks Up Sponsors in Congress

Click Here to Urge Congress to support the Choose Home Care Act! The Choose Home Care Act continues to build support in Congress with the recent addition of three new cosponsors in the House of Representatives. Reps. Lisa Blunt Rochester (D-DE), John Moolenaar (R-MI), and James McGovern (D-MA) have joined 33 of their colleagues in…

NAHC Supports New Bill To Empower Seniors to Stay in their Homes

Our homes are so important to us. It’s not just where we sleep and eat most of our meals, it’s our place to be indepedent. And, since the pandemic, it’s increasingly an office, a gym, a child care center, and, of course, if you need health care, your home is a great place to receive it.

That is why NAHC is thrilled to announce that on Friday, May 6, U.S Representatives Charlie Crist (D-St. Petersburg) and Thomas Suozzi (D-NY) introduced the Home Modification for Accessibility Act (H.R. 7676), legislation that provides tax incentives for home modifications so seniors and those with disabilities can more easily and safely continue living in their own homes.

The Home Modification for Accessibility Act empowers Americans to make decisions about where and how they live by offsetting the costs associated with making home modifications through a penalty free early retirement withdrawal and lifetime tax deduction of up to $30,000. This will reduce injuries and subsequent medical costs associated with falls, as well as drive development and investment in the market and create new job opportunities for skilled laborers and contractors.

“This bill is a step in the right direction towards enabling more seniors to age in place while ensuring they are positioned for many more years of comfortably living in their own homes,” said NAHC President William A. Dombi. “This legislation has the full support of the National Association for Home Care & Hospice.”

Not only is living at home the preferred option for 90 percent of aging Americans, it is also vastly more affordable for people and the country. Having to live in a nursing home where room costs can average anywhere from $6,000 to $8,000 a month.

“Given the option, the vast majority of seniors and people with disabilities want to stay in their own home for as long as possible. It’s more comfortable, less costly, and improves quality of life,” said Rep. Crist. “Unfortunately, many homes lack accessibility upgrades to make this a reality for seniors on fixed incomes and people with disabilities. That’s why I introduced the Home Modification for Accessibility Act – to provide tax incentives so that more Floridians have the option to live and age safely in their own home. It’s the right thing to do!”

“We have a storm coming, with the number of disabled elders expected to double in the coming years. Fewer family caregivers are available for these aging Americans and the market for long-term care insurance is not currently sufficient to address these demographic challenges,” said Rep. Suozzi. “We must do all we can to ensure New Yorkers have the option to live and age safely in the comfort of their own home.”

“This bill will help correct a fundamental injustice in American life. While we’re living longer and healthcare is increasingly conducted at home, the country’s housing stock is not meeting our daily and safety needs,” said Louis Tenenbaum, founder and president, HomesRenewed Coalition. “Incentives outlined in this bill will encourage people to demand building and renovation designs that support aging in place with joy, dignity and independence,” added Tenenbaum. “Over time, these features will become the norm, benefiting individuals, families, the healthcare system and our economy.”

Please join NAHC in supporting this legislation, which will enable aging and disabled Americans to continue to live in their own homes.

Additional Resources: