Report: Big Investment in HCBS Needed to Support Long-Term Care Needs

A new report from the Bipartisan Policy Center, Bipartisan Solutions to Improve the Availability of Long-term Care, calls for significant investment in expansion of home and community-based services (HCBS) in order to expand access to long-term care, which will become increasingly necessary in a rapidly aging society.

“For decades, policymakers have sought to improve access to long-term services and supports (LTSS) and to strengthen these services’ financing,” reads the report. “Today, about half of 65-year-olds will need LTSS at some point in their life. This need will grow as baby boomers age and require more care.”

About 14 million U.S. adults reported a need for LTSS in 2018, according to the American Association of Retired Persons.

More than 800,000 senior and disabled Americans are on waiting lists for HCBS, though most observers believe the true number is far higher than that. The average wait time for HCBS is about three years.

“The cost for facility and in-home care services has on average increased faster than the rate of inflation since 2004,” the report reads. “Long-term care providers saw significant cost increases from 2019 to 2020 as demand rose and caregiver shortages in facilities and in the community worsened. The median for the national annual cost of LTSS in 2020 ranged from $19,240 for adult day health care to $105,850 for a private room in a nursing home.”

The report contains five important recommendations for how to achieve a system of LTSS.

I. Expand Access to Home and Community-Based Services

“Congress should make HCBS available for individuals with long-term care needs who are ineligible for Medicaid,” reads the report. Services should be available through fully integrated care models, including improved fully integrated dual
eligible special needs plans (FIDE-SNPs), Programs of All-Inclusive Care for the Elderly (PACE), or other models approved by the secretary of HHS, and would include sliding-scale subsidies.

In addition, the report recommends that Congress develop a transitional program to support the expansion and development of integrated delivery models where they are unavailable, and should build caregiver capacity until the new HCBS program is fully implemented.

II. Address Disparities in the Delivery of HCBS

Congress should direct the secretary of HHS to collect data and issue an annual report on disparities in access to HCBS and make recommendations to Congress to address inequities.

III. Create a Caregiver Tax Credit

The report suggests Congress establish a refundable tax credit for caregivers to help with out-of-pocket costs for paid LTSS-related care.

IV.Improve the Viability of Private Long-Term Care Insurance

The authors recommend Congress standardize and simplify private long-term care insurance to achieve an appropriate balance between coverage and affordability, through “retirement long-term care insurance (LTCI).”

Furthermore, the report urges Congress to incentivize employers to offer retirement LTCI and to auto-enroll certain employees (age 45 and older with minimum retirement savings), with an opt-out like many employer-sponsored retirement savings accounts.

Congress should slso permit early penalty-free withdrawal from retirement savings accounts to pay retirement LTCI premiums and ask NAIC to modify model laws and regulations to accommodate products that convert from life insurance to long-term care, write the authors of the report.

V. Establish a Public Education Campaign for Long-Term Care

The Bipartisan Policy Center report calls for the Financial Literacy and Education Commission and partnering federal agencies to coordinate to strengthen educational resources on LTC and incorporate LTC planning into retirement
education topics.

“No single solution will address the needs of those who require LTSS,” write the report’s authors. “Improving access to these services will require a combination of public- and private-sector options, and an investment of federal resources.”

Report: Big Investment in HCBS Needed to Support Long-Term Care Needs

A new report from the Bipartisan Policy Center, Bipartisan Solutions to Improve the Availability of Long-term Care, calls for significant investment in expansion of home and community-based services (HCBS) in order to expand access to long-term care, which will become increasingly necessary in a rapidly aging society. “For decades, policymakers have sought to improve access to…

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…

Key Home Care Spending Approved by House of Reps

On a party line vote, the U.S. House of Representatives advanced the annual appropriations for the Department of Health and Human Services for fiscal year 2022, approving $119 billion in discretionary spending, an increase of $23 billion over the previous year.

(Discretionary spending does not include Medicare and Medicaid care related expenses, as that is considered mandatory spending and not subject to the annual appropriations process.)

Following is a summary of the provisions holding impact on home care and hospice providers.

Administration for Community Living

  • Home and Community-based Services: $550 million, an increase of $158 million over FY2021
  • Family Caregiver Supports: $249 million, an increase of $61 million
  • Respite Care: $14 million, an increase of $7 million
  • Falls Prevention: $5 million, consistent with FY21
  • Aging and Disability Resource Centers: $23 million, an increase of $15 million
  • State Health Insurance Assistance Program: $57 million, an increase of $5 million
  • Independent Living Centers: $148 million, an increase of $32 million
  • Assistive Technology: $44 million, an increase of $6.5 million.

Office of Medicare Hearings and Appeals

  • $196 million, an increase from $192 million from FY21

Centers for Medicare and Medicaid Services Program Management

  • State Survey and Certification: $472 million, an increase of $75 million from FY21

Centers for Medicare and Medicaid Services Health Care Fraud and Abuse Control Account

  • $109 million to carry out HHS OIG fraud and abuse activities
  • $113 million to the Department of Justice to carry out fraud and abuse activities

The Senate has yet to act on their appropriations responsibilities, but current speculation suggests it is unlikely the normal appropriations process will be achieved in 2021. In that event, to stave off a government shutdown, a continuing resolution (CR) will need to be agreed to by Congress and signed by the President prior to September 30. Continuing Resolutions typically maintain current funding levels for the various programs and policies already in place.

Stay tuned to Private Duty Source for important updtes on how the appropriations process will impact home care and hospice providers and patients.

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…

Key Home Care & Hospice Spending Approved by House of Reps

On a party line vote, the U.S. House of Representatives advanced the annual appropriations for the Department of Health and Human Services for fiscal year 2022, approving $119 billion in discretionary spending, an increase of $23 billion over the previous year. (Discretionary spending does not include Medicare and Medicaid care related expenses, as that is…

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.

Policymakers Debate $400 Billion Boost to HCBS

While it is impossible to determine with certainty whether President Biden’s proposal to increase funding for Medicaid home and community-based services (HCBS) by $400 billion will ultimately be included in one of a number of expected large legislative packages, NAHC is encouraged by recent signaling that the HCBS boost continues to be a priority for the Administration.

The latest indication of support for the increased HCBS funding was its inclusion in the President’s FY2022 budget, released on Friday, May 28th. The budget asks Congress to appropriate the $400 billion investment in HCBS over 10 years, the same proposal Biden has been pushing for as part of his infrastructure-focused American Jobs Plan.

The HCBS proposals currently lack detail, but much of the public positioning on the plan emphasizes supporting the direct care workforce by increasing wages, benefits, and career ladder opportunities. The President’s budget states “The President’s plan makes substantial investments in the infrastructure of America’s care economy, starting by creating new and better jobs for caregiving workers. It would provide home and community-based care for individuals who otherwise would need to wait as many as five years to get the services they badly need.”

While the President’s budget is not a binding document, and Congress is under no obligation to craft legislation that tracks the budget’s requests, it does typically have more influence when there is unified control of Congress and the Presidency, as there is now with the Democratic party. Many observers expect that the President’s budget will serve as the blueprint for congressional leaders’ efforts to craft their own budget resolution, which would be the first step in the process towards passing a massive infrastructure package along party lines using the complex process called “budget reconciliation”.

However, President Biden has not yet definitely signaled that he supports the “reconciliation” route at this time. He continues to engage with a group of Republican lawmakers in an effort to determine if there is a bipartisan deal to be had on an infrastructure bill.

Notably, the latest Republican counterproposal to Biden’s plan, released on May 27th, does not include any HCBS provisions. In an earlier memo from the Administration to the group of GOP negotiators, Biden again called out HCBS as a critical component of an infrastructure vehicle.

While timelines remain fluid, it is expected that if significant progress is not made within the next week or two on a bipartisan compromise, Democratic lawmakers will begin the reconciliation process in earnest, working under the assumption that a large infrastructure package will need to pass with Democratic votes only.

NAHC continues to advocate with policymakers to support HCBS proposals that will benefit our members, their workforce, and the patients and families they serve in every community across the country. We will update our membership as the negotiations unfold and a clearer path on major legislation emerges.