Adult Day Services

Part of LeadingAge's 2021 Policy Priorities

LEADINGAGE ADVOCACY GOALS

  • Secure funding to stabilize the adult day services field and make sure providers are able to sustain through and beyond the COVID-19 pandemic.
  • Promote the ability of states to provide relief to safety net adult day providers through their Medicaid programs.
  • Ensure that any LTSS models from the Center for Medicare and Medicaid Innovation is inclusive of all settings in the home and community (e.g., home health and personal care, adult day other day-based services, PACE services) and provide the supports (e.g., transportation) needed to facilitate these.
  • Advance policy that promotes the availability of adult day services across funding streams, including Medicaid, Medicare, and Veterans Affairs.
  • Promote federal rulemaking that ensures access and quality HCBS for beneficiaries while minimizing provider burden.
  • Oppose block grant and per capita cap policies.

LeadingAge members are saying:

  • “We’ve seen the negative impacts adult day closures have had on our clients: they feel isolated, often lose weight and their health statuses decline.”
  • “Without relief funds, whether its from the state or the federal government, I don’t know that my center and others like mine can survive.”
  • “Adult day services provide critical supports to middle income families that want to keep their loved ones at home”

THE ISSUE

Home and community-based services (HCBS) providers are at an inflection point, and adult day services providers, in particular, are at risk. Over the last decade, significant improvement has been made in the availability of and public investment in these critical LTSS providers, however, the COVID-19 pandemic has put these resources at risk both at present and over the long term.

Since March, many adult day centers closed either by mandate or voluntarily, and many saw most of their revenue streams evaporate overnight. Those that have since reopened have done so at reduced capacity and with fewer participants attending. This has led to centers closing across the country, jeopardizing the availability of these services over the long run. Federal funding, as well as flexibilities from payers like Medicaid and the VA, continue to be sorely needed.

Through CMS, states have been allowed to offer some relief to adult day providers participating in Medicaid, including the ability to provide remote services and to make retainer payments. The retainer payments provided useful funds, however are time-limited to 90 days and most states that took this option have exhausted that time period. Telehealth and remote services have opened new doors for adult day providers, but care through these means may not reach all participants.

All the while, workers and participants of adult day services providers have not been prioritized for COVID-19 PPE, testing or vaccination distribution. Ensuring that HCBS is included in these critical allocations is fundamental to making sure they are available for older people over the next decade and beyond.

ADVOCACY ACTION 2020

117th Congress

  • COVID-19 Relief: We will continue to advocate for the inclusion of adult day services providers in COVID-19 relief provisions, including HCBS grant making, provider relief funding, or other dollars and/or equipment allocated to health and long-term care providers (e.g., testing, PPE).
  • Medicaid FMAP: We support an increase in the Federal Medical Assistance Percentage (FMAP) for Medicaid HCBS by ten points to ensure states have the funds needed to sustain these services.
  • Benefit categories: We ask Congress to revise Medicaid and put HCBS (including waiver and state plan services and PACE) on equal footing with nursing homes and make HCBS a mandatory Medicaid benefit.
  • Protecting access: We support making permanent key provisions that ensure access to HCBS, including the federal spousal impoverishment protections for Medicaid HCBS and the Money Follows the Person program.
  • Adult Day Coverage under Medicare: We believe Congress should amend the Medicare program to make adult day services available to beneficiaries (e.g., FFS and managed care). See H.R. 4063 from the 116th Congress.
  • Appropriations: We support increasing funding for key provisions that support HCBS, including Older Americans Act services.

Executive Branch

  • COVID-19: We support high prioritization of workers and participants of HCBS of all types in federal allocations of COVID-19 vaccination, testing, and PPE. Federal agencies should recommend that state-level decision-makers place a high priority to this group.
  • Retainer Payments: We continue to request that existing guidance to state agencies be amended to expand access to retainer payments to HCBS providers affected by the pandemic, including on a retroactive basis.
  • Telehealth: We continue to advocate for revisions to CMS guidance documents to broaden access to telehealth services for PACE participants and Medicare Advantage enrollees. In addition, we ask CMS to encourage states to make telehealth available as a meaningful option for Medicaid HCBS providers unable to deliver in-person services.
  • Provider Relief Fund: We will advocate that any additional allocations made from the Provider Relief Fund (or similarly situated future funding streams) be inclusive of adult day services providers.
  • Protect Medicaid financing: We oppose any Medicaid waiver or rulemaking that reduces federal funding to the program, as these could ultimately jeopardize HCBS access. To that end, CMS should not approve and/or rescind waivers that allow per capita caps/block grant financing, work requirements and unnecessary coverage/enrollment barriers. CMS should not propose rulemaking similar to the 2019 Medicaid Fiscal Accountability Regulation (MFAR).
  • Innovation Center models: We will closely monitor CMMI action to ensure that home and community-based services of all types are included as part of the proposed LTSS Innovation Fund and in other models.
  • VA Coverage of Adult Day Services: We will closely monitor developments with the VA Community Care Network program and other VA initiatives that provide HCBS and advocate for our members and the veterans they support.
  • Transportation and Medicaid: We support the maintenance of current rulemaking that assigns non-emergency medical transportation (NEMT) as a mandatory Medicaid benefit.
  • Supplemental Services under Medicare Advantage: We will encourage CMS to continue broadening adult day services available in Medicare Advantage and work with plans on implementation.

ACTIONS YOU CAN TAKE NOW

  • Visit the Advocacy Action Center and help your members of Congress understand how policies they make impact Home and Community Based Services.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact HCBS providers and residents.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to create and sustain home and community-based services.