Medicare and Medicaid

Part of LeadingAge's 2021 Policy Priorities
 

LEADINGAGE ADVOCACY GOALS

  • Advocate for the availability of aging services across the continuum in Medicare and Medicaid.
  • Ensure that regulations governing the Medicare and Medicaid programs promote high-quality care and are not burdensome to providers.
  • Pursue legislative and regulatory reforms to support aging services providers throughout and beyond the COVID-19 pandemic.
  • Expand and make permanent telehealth flexibilities enacted during the pandemic.
  • Extend the Medicare sequestration moratorium through the end of the Public Health Emergency.
  • Oppose block grant and per capita cap policies in Medicaid.
  • Ensure that state Medicaid rates paid to nursing homes and to HCBS providers are sufficient to cover the costs of care.
  • Ensure appropriate reimbursement to provide quality end-of-life care.
  • Advance policy that promotes the availability of HCBS across funding streams, including Medicare and Medicaid.
  • Advance managed care arrangements, reimbursement, and operational policies that enable aging services providers to meet their mission of serving older adults

THE ISSUE

Medicare and Medicaid are critical revenue sources for most aging services providers and provide coverage to older adults who need post-acute care and/or long-term services and supports. These programs provide coverage to over 100 million Americans, including millions of older Americans. The COVID-19 pandemic has underscored just how critical Medicare and Medicaid are, and have unearthed challenges providers and consumers alike face as they interact with both. As detailed in other sections of these policy priorities, many provider types interact with Medicare and/or Medicaid differently and have their own needs. Across the board, however, preserving, strengthening and improving these systems are vital to realizing an aging services system that meets the needs of every older adult. To achieve that, LeadingAge supports specific policy actions from both Congress and the Executive Branch as described below.

ADVOCACY ACTION 2020

                                                                       117th Congress

  • CNA Lock-Out: We support the reintroduction of the Nursing Home Workforce Quality Act and Ensuring Seniors’ Access to Quality Care Act that would allow reinstatement of a nurse aide training program once a nursing home has been determined by CMS to be in substantial compliance. The ability of nursing homes to provide in-house training is especially critical given the uncertainty about educational offerings available post-COVID in colleges.
  • Observation Stays: We support the reintroduction of the Improving Access to Medicare Coverage Act that would mandate that all time spent in a hospital, regardless of admission status, would count toward the 3-day qualifying stay required for SNF services under the Medicare benefit. The waiver of the 3-day stay requirement during COVID reinforces the lack of rationale for this restriction on Part A eligibility.
  • Medicare Home Health Reimbursement: We continue to support legislative efforts that seek to ensure transparent and evidence-based approaches to Medicare reimbursement in the Patient-Driven Groupings Model.
  • Reimbursement for Home Health Telehealth Visits: We support legislative efforts, such as the Home Health Emergency Access to Telehealth (HEAT) Act, to allow Medicare reimbursement of virtual home health visits, with appropriate guardrails and visit equivalency between in-person and virtual visits.
  • Sequestration: We support an extension of the Medicare sequestration moratorium through the end of the PHE.
  • Keeping key pandemic flexibilities: Support making key pandemic related telehealth provisions a permanent part of the Medicare program: permanently removing the geographic restrictions on telehealth; allowing the home to be an originating site of care beyond the public health emergency; and permanent expansion of the providers who can furnish telehealth services in both the physical and mental health arenas. We support the reintroduction of the Creating Opportunities NOW for Necessary and Effective Care Technologies (CONNECT) Act, the Telehealth Modernization Act, and others with changes that reflect the learnings of the pandemic. Other Medicare telehealth changes we would like to see can be found on our Technology and Telehealth priorities page.
  • Medicaid FMAP: We support an increase in the general Federal Medical Assistance Percentage (FMAP) by 12 points and an additional FMAP increase for Medicaid HCBS of 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 to Medicaid HCBS: 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.
  • Medicaid Rates: We will continue to work with state partners and members to ensure that state Medicaid rates paid to aging services providers are sufficient to cover the costs of care.

                                                               Executive Branch

  • Rules, Guidance, Other Federal Policy Documents: We will work with CMS on Medicaid and Medicare rules and guidance documents relevant to providers across the continuum- nursing homes, PACE, home health, hospice, HCBS waiver services.
  • Accelerated and advance payment program: We will continue to monitor the accelerated and advance payment program repayment to ensure repayment will not deleteriously impact providers’ finances.
  • Extend administrative flexibility: Support continuation of the Public Health Emergency 1135 Blanket Waivers that CMS put in place during the pandemic allowing providers the flexibility to focus their resources on preparing for and responding to COVID-19 outbreaks in their communities and that additional flexibilities be considered.
  • IMPACT Act: We will participate in the Medicare unified post-acute prospective payment system technical expert panel to provide the voice of LeadingAge members regarding possible future payment system design. This includes advocacy to slow the pace of model development work of the Department of Health and Human Services and the Center for Medicare and Medicaid Services to reflect relevant data collection not skewed by the experiences of the COVID-19 pandemic.
  • Medicaid Retainer Payments: We continue to request that existing CMS guidance to state Medicaid 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 state Medicaid agencies to make telehealth available as a meaningful option for Medicaid HCBS providers unable to deliver in-person services. See Technology and Telehealth section for more executive branch recommendations.
  • 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.
  • 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 HCBS availability in Medicare Advantage and work with plans on implementation.

ACTIONS YOU CAN TAKE NOW

  • Visit the Advocacy Action Center to let your representative and senators know that you support the expansion and preservation of home and community-based services for older adults.
  • 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 HCBS.

ADDITIONAL RESOURCES