As of March 10, the Senate and House have passed (on March 6 and March 10, respectively) the American Rescue Plan Act. President Biden is expected to sign the bill quickly. The bill is based on his Administration’s own American Rescue Plan outline and is replete with funds and programs critical to aging services providers and the older adults they serve as the nation continues to grapple with the devastating impact of the COVID-19 pandemic.

Months of advocacy by LeadingAge members successfully secured the bill’s relief for aging services providers. Not all of our requests were included in the bill, namely Provider Relief Funds for non-rural healthcare providers and $1.2 billion to support affordable senior housing providers with COVID-19 costs and services. These will remain priorities for LeadingAge.

The relief provided by the ARP will now flow through federal, state, and local governments to buoy most every aspect of the American economy and national safety net. Aging services providers will have continued ability, and responsibility, to shape whether and how certain flexible pools of ARP funds distributed to state and local governments will be used to meet the needs of older adults and aging services providers.

Below are short summaries of key ARP aspects of importance to aging services providers. LeadingAge will continue to analyze the massive bill and provide updates.

Vaccines

The bill contains $7.5 billion dollars in funding for the Centers for Disease Control and Prevention (CDC) to prepare, promote, administer, monitor, and track COVID-19 vaccines. While all of the money is allocated to the CDC, the money can be utilized for a wide variety of purposes including distribution and administration of vaccines and ancillary supplies, support for state, local, tribal, and territorial public health departments, community vaccination centers, mobile vaccination units, information technology and data enhancements, facility enhancements, and public communications related to where, when, and how to get a vaccine. The funds are flexible enough that the CDC can utilize them for national support or target them to states, localities, or providers to help with the vaccination effort.

Also critical to a comprehensive vaccine strategy is funding to continue to develop and purchase vaccines and therapeutics. The legislation addresses the supply chain for both vaccines and therapeutics by allocating $5.2 billion dollars to HHS to support research, development, manufacturing, production, and purchase of vaccines, therapeutics and ancillary medical products used for the treatment and prevention of COVID-19 and any variants as well as $500 million dollars for the FDA to be able to review new vaccines and therapeutics and track their use.

Finally, an additional $1 billion dollars is specifically set aside for CDC to strengthen vaccine confidence, further information and education with respect to authorized or licensed vaccines, and improve vaccination rates. This aligns with President Biden’s commitment to vaccine education and also with LeadingAge efforts to reduce hesitancy amongst employees of our members.

Testing and PPE

LeadingAge has advocated for a national testing strategy for a year and we are pleased to see this legislation propose to fund that strategy. The bill allocates $47 billion to HHS to detect, diagnose, trace, and monitor COVID-19 infections, and for other activities necessary to mitigate the spread of COVID-19. Specified activities include implementing a national strategy for testing, contact tracing, surveillance, and mitigation of COVID-19; guiding state and local public health departments in their work to implement the national strategy; support developing, manufacturing, procuring, distributing, and administering tests, personal protective equipment (PPE), and other supplies necessary for COVID-19 testing; establishing and expanding federal, state, or local testing and contact tracing capabilities, including investments in laboratory capacity, community-based testing sites, and mobile testing units; and sustaining our nation’s public health workforce.

Nursing Home Provisions

The ARP contains two provisions specifically for nursing homes. The bill authorizes $250 million to states for strike teams for nursing homes with COVID-19 outbreaks to assist with clinical care, infection control, or staffing for up to a year after the public health emergency ends. In addition, $200 million is appropriated for quality improvement organizations (QIOs) to provide infection control and vaccination uptake support to nursing homes during the public health emergency.

Provider Relief Fund

The final bill added $8.5 billion to the Provider Relief Fund for rural health care providers who are enrolled in Medicare or Medicaid and provide diagnosis, testing or care for individuals who may or do have COVID-19, including home health, hospice and long term services and supports providers as well as nursing homes. The bill passed by the House did not have any provisions adding to the provider relief fund so this is a victory for our advocacy, albeit limited to rural providers.

Housing Aid

While Congress did not provide additional housing funds specifically for HUD-assisted affordable senior housing providers for COVID-19 costs and services, the bill does include $41.22 billion affordable housing, which LeadingAge strongly supports. The housing funds in the ARP are focused on maintaining or securing stable, affordable housing for the millions of households for whom the pandemic has wreaked havoc on their ability to keep up with rent and mortgage payments or to climb out of homelessness. These funds, which for the most part will be distributed by state and local governments and public housing agencies, will help millions of older adults and aging services staff alike.

The bill includes $21.55 billion for Emergency Rental Assistance and $9.96 billion for homeowner assistance; $10 billion for people experiencing homelessness and for emergency housing vouchers for them to access permanent housing; the first COVID-19 relief for USDA rural rental assistance ($100 million) and for rural homeowners with USDA-backed loans ($39 million); $100 million to housing counseling agencies to help households navigate programs and protect their housing; and, $20 million for fair housing organizations to identify and combat housing discrimination.

Funding for Medicaid Home and Community-Based Services

The Senate bill includes a one-year, 10 point increase in the federal share of Medicaid spending for home and community-based services (HCBS). The text includes state plan home health and personal care, PACE services, and waiver services (like adult day) as services eligible for this increased federal match. The money will go to state agencies, who would then have discretion over how to use the dollars. Critically, however, the American Rescue Plan requires that states actually use these dollars for their HCBS programs and not for other purposes. Specifically, the text requires states to use the funds to “supplement, and not supplant, the level of State funds expended for home and community-based services for eligible individuals through programs in effect as of April 1, 2021.“

State and Local Aid

The American Rescue Plan also includes $350 billion for state and local (city and county) governments. These dollars are separate from and in addition to the CARES Act state and local dollars. The American Rescue Plan offers states and localities more flexibility with how to use the dollars relative to the CARES Act money, and providers may be able to receive additional relief from this appropriation.

Many states supported aging services providers using the CARES Act dollars. While there is no requirement that states/localities do so with any of the COVID-19 relief dollars they received or would under this bill, these dollars may be an avenue through which aging services providers are able to access direct financial support.

Paycheck Protection Program

While the December relief bill created a second draw loan program and added $284 billion to the PPP fund, the American Rescue Plan makes some additional changes to the program that could expand eligibility to some aging services providers, particularly those part of larger nonprofit organizations.

Under current PPP rules, most organizations must employ 500 workers or fewer to be eligible, regardless of how many locations they operate. The American Rescue Plan would shift this policy for not-for-profit organizations and allow larger not-for-profit organizations to receive a PPP loan if they have 500 workers or fewer in each physical location they operate.

So for example, a not-for-profit multisite aging services organization that has a nursing home with 300 workers, an adult day services program with 20 workers and a home health agency with 350 workers currently cannot get a PPP loan because it has 670 workers. Under the American Rescue Plan, however, it would be eligible because each of its locations has fewer workers than the limit of 500.

Older Americans Act (OAA)

OAA programs will get about $1.4 billion from this package. About half of the dollars are targeted to senior nutrition programs, and about a half billion dollar would go to supportive services, which can include HCBS. States can also use the half billion dollar allocation for COVID-19 vaccine outreach, education and transportation specific to older adults as well as activities to mitigate the virus itself and its implications for older people, including social isolation.

While many LeadingAge members do not directly receive OAA dollars, this round of funding may be an important resource toward getting the people our members serve connected to vaccines and ultimately connected back to the community.

Workforce-Related Provisions

Public Health Workforce

The bill provides $7.7 billion to HHS to establish, expand, and sustain a public health workforce to help respond to the current pandemic, including through awards to state and local public health departments. Specifically, HHS must use the funds to increase the number of contact tracers, social support specialists, community health workers, public health nurses, epidemiologists, lab personnel, disease intervention specialists and communications personnel. Funds could also be spent on technology and supplies needed and used by the public health workforce, such as PPE.

It provides a separate $100 million to support the Medical Reserve Corps, which is a network of volunteers (including medical and public health professionals) who support emergency response efforts and community health activities. The ARP also provides $800 million for the National Health Service Corps.

Worker Safety

The bill provides $200 million for Department of Labor worker protection activities, including $100 million for the Occupational Safety and Health Administration (OSHA) and $12.5 million for the department’s inspector general. Of the OSHA funding, $10 million is reserved for Susan Harwood occupational health and safety training grants for nonprofits, and $5 million for coronavirus-related enforcement activities at high-risk workplaces, including healthcare facilities.

Child & Family Services

The ARP includes $39 billion for the Child Care and Development Block Grant Program for grants to states to support child care, including $24 billion to help child care providers respond to the pandemic and $15 billion to help provide direct child-care aid to low income families.

Mental Health

The bill recognizes the toll that the pandemic has had on health care providers, with millions of dollars in funding for mental health services to states and local governments and other entities, specifically including $40 million for grants to health care providers and provider associations to “establish, enhance, or expand evidence-informed programs or protocols to promote mental health among their providers, other personnel, and members.”

State and Local Recovery Funding Allows for Premium Pay

Of the $350 billion for state and local aid, above, these funds could be used by state and local governments to provide premium pay of up to an additional $13 an hour to “essential” workers, or grants to their employers for such pay. An individual essential worker could receive no more than $25,000 in such pay.

For a closer look at the ARP’s HCBS, OAA, PPP, state and local aid provisions, see this article.