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.

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…

Biden’s Choice for CMS Admin Confirmed

The United States Senate confirmed President Joe Biden’s choice to be the next administrator of the Centers for Medicare & Medicaid Services (CMS) on a mostly party-line vote of 55-44. Republicans Roy Blunt (MO), Richard Burr (NC),  Susan Collins (ME), Jerry Moran (KS), and Lisa Murkowski (AK) voted with the Democrats to confirm.

Ms. Brooks-LaSure becomes the first African-American woman to run CMS, the largest component of the Department of Health & Human Services (HHS), with ten offices around the country, more than 6000 employees, and over $1 trillion in annual expenditures.

CMS has regulatory oversight of most health care providers in the country and it administers Medicare, Medicaid, the Affordable Care Act (ACA) marketplaces, and the Children’s Health Insurance Program (CHIP), covering at least 145 million people around the country.

“Chiquita Brooks-LaSure brings solid experience to a very difficult job,” said NAHC President Bill Dombi in reaction to her confirmation as CMS Administrator. “Over the years, she has demonstrated a high degree of capability and the versatility to handle the wide range on matters that occur in Medicare and Medicaid. We look forward to working with her to expand access to home and community-based services and make the home the center of health care.”

Ms. Brooks-LaSure graduated from Princeton University in 1996 and earned a Masters of Public Policy from Georgetown University in 1999, before beginning her career as aprogram examiner and Medicaid analyst at the Office of Mangagement & Budget (OMB). She has worked for the Democratic staff on the Ways & Means Committee in the House of Representatives, working on issues like the ACA and the Medicare Improvements for Patients and Providers Act (MIPPA). Ms. Brooks-LaSure moved on to CMS, where she worked in the Center for Consumer Information and Insurance Oversight (CCCIIO), leading ACA implementation on insurance reform. Like many other Biden appointees, Ms. Brooks-LaSure is a veteran of the Obama administration.

Ms. Brooks-LaSure has stayed very busy since leaving government and she is currently the Manging Director of Manatt Health, consulting on health care financing. She serves on the board of directors of FAIRHealth, a non-profit working for health care cost transparency, and she has been a consultant to The Commonwealth Fund, that works for improved access, efficiency, and quality in health care, particularly for the poor and uninsured. Virginia Governor Ralph Northam named Ms. Brooks-LaSure to the Virginia Health Benefits Exchange Advisory Council last September.

Crucially, Ms. Brooks-LaSure ran the HHS agency review team during the Biden transition period, so her familiarity with the administration’s health care plans is complete.

Ms. Brooks-LaSure testified before the House Ways & Means Committee on “Pathways to Universal Health Coverage,” defending the ACA record, calling for more Medicaid expansion, and creating a Medicare buy-in option, particularly for people just shy of the age qualifications and above the ACA subsidy level. Ms. Brooks-LaSure spoke favorably of such a buy-in, stressing that it could expand coverage and still keep the current very popular Medicare program intact.

Ms. Brooks-LaSure worked on a Medicare buy-in presentation to the state of New Mexico in 2018 and, authored an issue brief with her colleagues at Manatt Health on the subject of Medicare buy-in. The brief also covered Medicaid buy-ins, calling it “chief among the emerging state-based solutions.”

During the presidential campaign, the Biden campaign promoted creating an option “like Medicare,” but not exactly the sort of Medicare buy-in Ms. Brooks-LaSure favored in her 2019 testimony. However, her proposal is not unlike H.R. 1346, the Medicare Buy-In and Health Care Stabilization Act of 2019 in the previous Congress. Fifty-one Democrats co-sponsored that bill, including several members of the responsible committee.

In her 2019 testiony to Congress, Ms. Brooks-LaSure seemed open to a public option in health care, suggesting it could lower premiums and increase affordability and access to quality health insurance.

Ms. Brooks-LaSure’s career has been marked by a determination to make health care more accessible and affordable, with a particular focus on the poor and women’s health. She has been one of the leading Democratic thought leaders on these subjects and, thus, her likely appointment to CMS is not a surprise.

Biden’s Choice for CMS Admin Confirmed

The United States Senate confirmed President Joe Biden’s choice to be the next administrator of the Centers for Medicare & Medicaid Services (CMS) on a mostly party-line vote of 55-44. Republicans Roy Blunt (MO), Richard Burr (NC),  Susan Collins (ME), Jerry Moran (KS), and Lisa Murkowski (AK) voted with the Democrats to confirm. Ms. Brooks-LaSure becomes…

Key Telehealth Bill Introduced in Senate

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NAHC Supports the Protecting Married Seniors from Impoverishment Act

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New Bill Addresses Nation’s Shortage of Nurses, Doctors

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Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

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