LeadingAge

On April 16, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). The U.S. Senate had voted 92-8 to approve, followed by the U.S. House of Representatives approving the bill 392-37. 

The measure -- also called the "doc fix" -- is a permanent reform of the badly flawed Medicare physician payment system that has been in place since 1997.

LeadingAge members and advocates played a critical role in pushing the “doc fix” bill over the finish line. From meeting with 270 congressional offices during our PEAK Leadership Summit last month to sending more than 2,000 letters to Capitol Hill, LeadingAge members sent a clear message to lawmakers: Take the “doc fix” bull by the horns, and permanently solve the problem in a bipartisan way.

On April 21, the White House invited LeadingAge CEO Larry Minnix to a bipartisan reception to honor all those who worked to get the legislation passed. You can see some of Larry's photos on our Facebook page.

How H.R. 2 Affects You

First of all, part of our Medicare reimbursement is tied to the physician payment formula. Since 2002, we have faced the annual prospect of increasingly large cuts in this reimbursement, which have only been averted by temporary “doc fixes.”

There have been 17 of these temporary measures so far; H.R. 2 will make future ones unnecessary.

In addition, the nonpartisan Congressional Budget Office “scores” reform of the physician payment formula as a significant cost to the Medicare program and the federal budget in general.

Sponsors of reform legislation therefore have had to come up with significant cuts elsewhere in the Medicare program to offset the cost of the payment reform.

Because the post-acute care sector has already taken several cuts in Medicare payments, we have advocated strongly against further cuts in our reimbursement as an offset for a permanent doc fix.

We have argued against post-acute care payment cuts both in our direct advocacy on Capitol Hill and in the grassroots messages our members have given their legislators.

Our voices have been heard.

The bill the House and Senate voted on and passed provides a 1% payment update in 2018 for post-acute care providers.

Although this percentage may turn out to be somewhat smaller than the market basket increase the Centers for Medicare and Medicaid Services might have computed and our payments still will be subject to sequestration, this is a 1-time, 1-year provision, not the ongoing, cumulative and larger payment reductions we had anticipated.

Considering the reimbursement cuts with which we previously were threatened, we consider this provision to be good news for our sector.

Medicare Therapy Caps

The doc fix legislation extends the current Medicare therapy caps exceptions process for another two years, through December 31, 2017. We will continue to work with Congress on a bipartisan basis to resolve this issue.

Medicare Home Health Rural Add-On 

Section 210 of H.R. 2 extends a 3% add-on to payments made for home health services provided in rural areas through January 1, 2018. 

This provision will be especially important to LeadingAge home health care provider members in rural areas of Iowa, South Dakota, Montana, Nebraska and Kansas.

There was opposition to H.R. 2 in both houses because it does not completely offset the cost of permanent physician payment reform.

The Medicare Adult Day Services Act of 2015 (H.R. 1383) was introduced in the U.S. House of Representatives by Rep. Linda Sanchez (D-CA) on March 16.

The measure, which LeadingAge strongly supports, was referred to both the U.S. House Ways and Means Committee and the Energy and Commerce Committee for consideration. 

If passed, the legislation would:  

• Expand Medicare beneficiaries care options by adding skilled nursing, rehabilitation and social services in a Medicare Certified Adult Day Services Center. 
  
   
• Allow patients who qualify for home health services or nursing homes under Medicare to use a Medicare Certified adult day services center as an option for care. It does not expand eligibility. It simply allows qualified patients to choose a Medicare Certified Adult Day Services Center.
  
   
• Save Medicare dollars, cover more services. 
  
   
• Not expand the number of people using Medicare services. Eligibility to use the services in a Medicare Certified Adult Day Services Center is the same as the eligibility criteria for Medicare certified home health.
  
   
• Require Medicare Certified Adult Day Services Center to meet the standards of nationally recognized accrediting agencies. 
  
   
• Require Medicare Certified Adult Day Services Center to comply with all applicable State and local building and fire codes. 
  
   
• Ensure that Medicare and Medicaid integrity is maintained with high standards to prevent fraud and abuse. 
  
   
• Require Medicare Certified Adult Day Services Center services to be ordered by a physician who approves the plan of care.

Adult day health programs are already providing skilled care through Medicaid and Medicaid waivers. The diversity of services provided in adult day centers are critical for frail older adults and persons with disabilities to obtain the holistic, person-centered services that meet their individual care needs. 

The legislation also recognizes the importance of adult day services as a means of reducing the stress on caregivers.

Please contact your members of the U.S. House of Representatives and ask them to co-sponsor this legislation.

The bill currently has 11 co-sponsors: 

• Reps. Grace Meng (D-NY).
• Matt Cartwright (D-PA).
• Lois Frankel (D-FL). 
• Alan Lowenthal (D-CA).
• Steve Cohen (D-TN).
• Michele Lujan Grisham (D-NM).
• Lucille Roybal-Allard (D-CA).
• John Conyers (D-MI).
• Eleanor Holmes Norton (D-DC).
• Janice Schakowsky (D-IL).
• Yvette Clarke (D-NY). 

On Feb. 26, Kathy Greenlee, administrator of the Administration for Community Living, testified to the U.S. House of Representatives Committee on Appropriations Subcommittee on Labor, Health and Human Services,Education, and Related Agencies hearing on the president's FY 2016 budget. 

She made the case for improved funding for Older Americans Act programs, such as congregate meals, meals on wheels, adult day services, transportation and programs that combat elder abuse.

Greenlee stated the importance of the Older Americans Act and Developmental Disabilities Act Programs.  

"By 2020, there will be more than 77 million people over the age of 60, and as many as 2/3 of them will at some point need assistance with dressing, showering, or similar tasks," Greenlee said. "In addition, nearly 57 million people live with disabilities in non-institutional settings, and about 20% of them need assistance with daily living tasks." 

She gave the example, that the the $42.8 million increase for senior nutrition programs in the president's budget, together with state and local funding, will help provide 213 million meals to over 2 million older adults and help halt recent declines in services. 

The Administration for Community Living (ACL) also is requesting an additional $38.5 million to help states provide over 28 million hours of support to older adults needing assistance with daily activities; more than 23 million rides to doctors, pharmacies, grocery stores and other critical activities; and nearly 8 million hours of adult day services. 

ACL will invest an additional $13.9 million in Aging and Disability Resource Centers, which work with states to develop better systems of information; provide one-on-one, person-centered counseling; and streamline access to resources. 

Greenlee noted that the current funding, because of inflation, forces many Area Agencies on Aging to serve fewer congregate and home-bound meals. 

Rep. Cole, the chair of the committee, praised the work of the Administration for Community Living.  

Rep. Rose DeLauro, ranking member of the committee, thanked the Greenlee for her work on elder abuse. Rep. Delauro cares for her 101 year old mother in her home, and she emphasized the importance of having a well trained home care work force. 

Rep. DeLauro is concerned about senior nutrition, noting that there has been a decline in these services due to the budget cuts over the years. 

Rep. Lucille Roybal-Allard said she has concerns over the stress on family caregivers. 

Greenlee said she shares her concern, and pointed out that it is a priority for ACL. She mentioned that adult day services have been especially useful in helping family caregiver who work and need a full day of services for their loved ones. 

We urge LeadingAge members to reach out to their members of Congress to provide adequate funding for these important programs.