Choose Home Care Act is Vital New Bipartisan Legislation to Expand Access to Home Care

The National Association for Home Care & Hospice (NAHC) today commend the introduction of the Choose Home Care Act of 2021, bipartisan legislation designed to increase access to care at home by providing eligible Medicare beneficiaries with an additional care option following hospitalization. This is an important Medicare policy change that will strengthen and modernize…

Hill Hearing Highlights Differing Approaches to Support Direct Care Workers

A July 20 hearing of the House of Representatives Committee on Education & Labor (E&L) revealed sharp differences in preferred solutions to the challenge of building a strong direct care workforce, even as members largely agreed what those challenges are and that the federal government has a role to play in overcoming them. During the…

WISH Act Would Provide Long-Term Care Insurance

Rep. Tom Suozzi (D-NY-3) has introduced the Well-Being Insurance for Seniors to be at Home (WISHActH.R. 4289, in the House of Representatives to create a catastrophic long-term care insurance program.

The WISH Act calls for the creation of a public-private relationship to provide long-term care coverage for older adults. On the public side, the federal government would collect a new payroll tax of 0.3 percent of wages from both employer and employee, or a combined 0.6 percent from the self-employed. On the private side, it is expected that private insurance companies would be unburdened of providing catastrophic levels of coverage and would create more affordable long-term care coverage options.

Eligible beneficiaries would need to either suffer from dementia or require assistance with at least two activities of daily living. Beneficiaries would also be required to have worked and contributed for 40 quarters to a new Long-Term Care Insurance Trust Fund. Upon meeting these requirements, and subject to the applicable waiting period, beneficiaries would be eligible to receive up to approximately $3,600 per month, enough to cover approximately six hours of daily care. The waiting period ranges between one and five years; those with a lower income qualify after one year. The waiting period increases at higher income levels.

Upon announcing introduction of the WISH Act, Congressman Suozzi cited several reasons his legislation is needed,  including:

  • a projected near-doubling of retirees that will be seriously disabled over the next 15 years,
  • most retirees without the means to pay for long-term care, and
  • expensive institutional care as the likely result for those without the means to cover long-term care expenses.

“We have a storm coming, with the number of disabled elders expected to double in the coming years,” said Rep. Suozzi. “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. The WISH Act would save the Medicaid program and millions of Americans from financial ruin, would allow people to age at home with dignity, and would create millions of good-paying, middle class jobs in the home health care industry.”

NAHC has not yet taken a position on this legislation, but we do support the establishment of a long-term care program that expands access to services without requiring beneficiaries to be poor enough to qualify for Medicaid. NAHC look forward to working with Congressman Suozzi as his proposal develops.

Stay tuned to Private Duty Source for updates on this legislation.

WISH Act Would Provide Long-Term Care Insurance

Rep. Tom Suozzi (D-NY-3) has introduced the Well-Being Insurance for Seniors to be at Home (WISH) Act, H.R. 4289, in the House of Representatives to create a catastrophic long-term care insurance program. The WISH Act calls for the creation of a public-private relationship to provide long-term care coverage for older adults. On the public side, the…

New Bill Aims to Support Direct Care Workforce, Family Caregivers

A bipartisan group of Senators led by Sen. Tim Kaine (D-VA) have introduced the Supporting Our Direct Care Workforce and Family Caregivers Act (S. 2344), a bill to provide $1 billion in grants to states and other eligible entities to support innovative projects and programs focused on recruitment, retention, and training for direct care workers,…

NAHC to Congress: Protect Medicare, Don’t Use Funds to Pay Non-Health Care Costs

The National Association for Home Care & Hospice (NAHC) and a group of like-minded organizations representing America’s health providers have written a letter to Senate Majority Leader Charles Schumer (D-NY) and Senate Minority Leader Mitch McConnell (R-KY), asking them to oppose an extension of mandatory Medicare sequestration as a pay-for in any infrastructure package; and…

Medical Innovation Legislation Includes Hospice, Telehealth & Caregiver Support

Last week, as a long-awaited follow-up to the transformative 2016 21st Century Cures Act, Representatives Diana DeGette (D-CO) and Fred Upton (R-MI) released text of a discussion draft for what is being referred to as CURES 2.0 legislation. (Bill text is HERE; summary is HERE.) While the bill’s primary focus is on advancing the country’s biomedical…

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…

HHS Secretary Defends HCBS Priorities to Congress

Department of Health and Human Services (HHS) Secretary Xavier Becerra recently testified to three key Congressional committees, discussing a wide variety of health care issues, including issues related to home and community-based services.

Consistent with past practice, the Biden Administration has released a proposed budget for what they deem necessary to carry out the various policies and programs under their authority. The President’s budget does not carry the weight of law, as Congress holds the power of the purse, but it does give a useful insight into what the President is prioritizing and how he views various issue areas. Following the release of the budget cabinet secretaries head to Capitol Hill for hearings before the relevant committees.

During these hearings Secretary Becerra fielded a wide range of questions spanning the 340B drug discounts to migration along the southern border. Though a specific focus never presented itself during the series of hearings, several issues of interest to home care and hospice providers were addressed.

House Ways and Means Committee

Rep. Ron Kind asked about extending the reporting deadline of the Provider Relief Fund (PRF). Sec. Becerra responded that they wanted to provide flexibility but wanted to maintain accountability as well. Following the conclusion of the hearings HHS issued revised deadlines based on when funds were initially received.

Kind also inquired as to the Secretary’s interest in innovative payment models, to which he responded that he is committed to innovation.

Rep. Carol Miller asked several questions on the PRF. Sec. Becerra did not respond to how much was left in the fund, again cited the need for both accountability and flexibility in determining reporting deadlines and ensured that the Department would be transparent in future disbursements.

Senate Appropriations Committee

Senator Roy Blunt commented there was around $50 billion left in the PRF.

Senator Brian Schatz asked about the importance of Medicare beneficiaries receiving telehealth services in their homes. Sec. Becerra responded that it is important to make sure the reimbursement for services is being applied towards those services citing the need for accountability in care delivery and payment.

Senate Finance Committee

Senator Pat Toomey offered critical remarks on the recent 10% increase to the federal share of the Medicaid program for home and community-based services (HCBS). He inquired if this increase should be ended. Sec. Becerra responded with appreciation for Congress ensuring the states did not go under, is currently implementing the law as Congress passed it, and would work with Congress going forward on the issue.

Senator Bob Casey offered the Secretary commendation for prioritizing HCBS.

Senator Sheldon Whitehouse discussed an end-of-life care model he is advocated the Centers for Medicare and Medicaid Innovation (CMMI) to develop and implement through waivers to current regulations. He expressed his frustration with CMMI not acting on it yet despite his commitment and continued advocacy. Sec. Becerra gave his commitment to work with the Senator on it.

With the President’s proposed $400 billion investment in home and community-based services in mind, further discussion on HCBS during these hearings by Secretary Becerra is an encouraging sign the Administration is still committed to this transformational investment. NAHC will continued to work with the Congress and Administration on the importance of care in the home and the need for further investment ensuring for a patient’s right to choose where they receive care.

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.