Legislative Update in Tumultuous Times Current State of Affairs - PowerPoint PPT Presentation

Legislative Update in Tumultuous Times – Current State of Affairs & Action Steps Panelists Marsha Greenfield Richard Schwalberg Deborah Winn-Horvitz Molly Forrest

Federal Update Marsha Greenfield

So – we know how that turned out…

What was in the ACA repeal bill that concerned LeadingAge and AJAS? • Impact on older Americans? – Age rating changed to 5:1 – Essential Health Benefits could be eliminated – Medicaid expansion effectively eliminated • Impact on Medicare? – Taxes on various industries repealed – Life of Trust Fund cut short • Impact on Medicaid?

Comparing Medicaid Proposed Changes

Just a Reminder What’s at Stake Estimates 1 TRILLION dollars decrease in Medicaid Funding over 10 years

What Next? Are we out of the woods? • CMS has the power… – State waivers could include block grant (e.g., RI) – Other “experiments” possible – Medicaid expansion waivers will look like Indiana – Starve the exchanges • Other Medicare bills in the works could see poison pill amendments

What else are we working on? • FY 2017 appropriations – CR expires April 30 – Administration asks for $ 18B additional cuts – Appropriators negotiating – Complicated dance with defense/non-defense parity, administration defense increases, etc. • FY 2018 appropriations – Expect a budget resolution with reconciliation instructions for tax reform? – President’s “skinny budget” probably DOA but the battle between defense and non-defense will be fierce • $54B cut to low income programs and PBS with corresponding increase in defense

Housing • Ongoing work on current fiscal year 2017 funding for HUD programs, given need for increases and securing RAD for PRAC authority. • Analyzing skinny budget request seeking 13% cut to HUD and a leaked non-final budget document suggesting HUD contemplating not asking to renew more than 23,000 Section 202 units in next fiscal year.

Medicare • Observation Stay – Legislation to count all nights in the hospital toward 3-day stay requirement reintroduced in House (H.R. 1421) and Senate (S. 568) • Therapy Caps – Legislation to repeal caps reintroduced in House (H.R. ) and Senate (S. ); exceptions process returns 12/31/17 • Value-Based Purchasing – Unclear; expect last year’s legislation to be reintroduced • Certified Nursing Assistant Training – Proposing amendment to OBRA – discretionary rather than mandatory

Home Health and HCBS • Professionals allowed to order home health – Expands to include nurse practitioners, clinical nurse specialist, physician assistant (S. 445) • Incorporating LTSS into Medicare Advantage programs – Medicare Advantage Community-Based Special Needs Plan demonstration reintroduced (S. 309)

Regulatory Relief • Administration’s anti - regulatory agenda • Focus on nursing home and home health requirements of participation, HCBS settings • Congressional interest? • CMS advocacy

Advocacy: New Administration, New Congress • Organizational Letters to Congress and to the Administration – LeadingAge – LCAO and other national organizations • Grassroots Campaign – Contact Congress letters (lots) – Member-generated letters (thousands!) – Call-ins (ours and other groups) • Meetings – AJAS/LeadingAge Ohio Delegation – In-district/state • LeadingAge’s PEAK Conference – 400 participants; 300 meetings – Follow-up at home and in DC

Importance of Grass Roots Advocacy – The Time is Now Richard Schwalberg

Federal Advocacy Focus – March 9, 2017 Concerns About Medicaid Program Restructuring • Changes to the Medicaid Program, both financing and structure, will result in a federal reduction of Medicaid funding to states. • Seniors who receive services covered by Medicaid are the frailest and most financially vulnerable members of their communities. They have no other resources to cover the cost of critical services. • Under Per Capita or block grants, states would receive a fixed amount of federal Medicaid funding, as opposed to the increased federal allocation states receive when their own spending rises. • Therefore, care of the elderly who receive Medicaid services in nursing home and community-based settings will be jeopardized. • In summary, our request is twofold – To maintain the current structure of the Medicaid Program – To not restructure Medicaid into block grant or per capita system – To reduce regulations which will not impact quality and will save dollars

Impact of Federal Cuts on our Elderly • Elaine Miller Letter: Ken Bravo • The Hebrew Home at Riverdale: Dan Reingold

Innovative Programs that save the Government Money • Jennings Center for Older Adults: Allison Salopeck • McGregor P.A.C.E: Tangi McCoy • Montefiore: Mark Weiss • Jewish Home Rockleigh: Sunni Herman

State Advocacy Visits March 22, 2017 Columbus, Ohio

Concerns About Governor Kasich’s Proposed Medicaid Budget: Mark Weiss A. Do Not Cut Medicaid Services • Negative impact on service provision for the frail and sick elderly in Ohio’s nursing homes and in the community • Financial Impact B. Do Not Expand Managed Care in Ohio • MyCare Ohio demonstration project • Taking Ohio Medicaid into full managed care system

• Human Touch Impact • Innovative Programs & Ways We Save Medicaid Dollars

PPLG – Position Statement Questions • What role we play in advocacy back home? • How do we “educate” our legislators?

Packaging for Impact: How to present programs to legislators Deborah Winn-Horvitz, President & CEO Jewish Association on Aging Pittsburgh, PA

In our experience…. Treat a legislator like a donor • Give them both – powerful data – individual stories of impact

Two programs making a difference • HomeMeds ℠ • AgeWell at Home, Care Navigator

HomeMeds ℠ – What is it? • Partners in Care Foundation • Evidence-based, in-home, medication review and intervention – Computerized risk assessment and alert process – Pharmacist review and recommendation • Approved Disease Prevention and Health Promotion program • Included in the National Registry for Evidence-based Programs and Practices • Strong evidence rating on the US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange

HomeMeds ℠ – The Data • 11,000+ older adults have had their medications screened – 40-50% of those screened had potential problems – 25% of all harmful adverse drug events caused by medication errors are preventable • Adults 65+ are 2x as likely as others to go to the ED for adverse drug events – Potential savings associated with avoided ED visits due to prevented adverse drug events: $1,485,000

HomeMeds ℠ – The story of Norman • 84 years old, residing alone in a low-income senior high-rise • HomeMeds ℠ assessment completed by our Nurse: immediately noticed the name on the various medication bottle labels were not Norman’s name – Norman was recently discharged from the hospital and was given prescriptions that were not for him/his conditions • Norman cannot read so he was unaware he was taking incorrect medications – Blood pressure and cholesterol meds he did not need – Nurse alerted the appropriate medical professionals • Potential adverse health event avoided through HomeMeds ℠ assessment • Norman remains independent today

AgeWell Pittsburgh • Collaboration between Jewish Association on Aging, Jewish Community Center of Greater Pittsburgh and Jewish Family & Children’s Service of Pittsburgh • Mission: Helping older adults continue to live independently in their own homes • Goal: Identify seniors at risk of losing their independence and help them connect to services • 8,000+ clients served to date

AgeWell at Home – What is it? • Care Navigator coordinates wrap around services: – HomeMeds ℠ – JAA Home Health – Home Safety Assessment – DPA/Options – Adult Day Services – DME – Private Duty – Veteran’s Services – Holocaust Benefits – AAA, JF&CS, JCC – Hospice – Meals on Wheels – Alert Systems – Transportation – Long-term Care Policy Assistance – Placement/Housing

AgeWell at Home – The Data • Progression of hospitalization prevention Hospitalization Cases Rate CY 2015 53 28.3% CY 2016 109 12.8% CY 2017 Annualized 152 5.3% • Savings associated with avoided hospitalizations due to AgeWell at Home: $888,000

AgeWell at Home – The story of Marion • Lives alone in a condo, socially isolated • Frequent falls, was non compliant with medications and nutrition • Referred to Care Navigator by her Rabbi • Care Navigator initiated the following: – Established a trusting relationship with both Marion and her children – Provided an Elder Alert Emergency Response System – Reviewed Long-Term Care policy for coverage limitations, activated policy – Obtained Private Duty service – Obtained an order for JAA Home Health service • Marion sees Care Navigator as her “go - to” contact for any changes in condition/symptoms  Care Navigator assembles necessary resources to keep Marion safe in her home