Hot Topics for Assisted Living Lilly Hummel Senior Director of Policy & Program Integrity National Center for Assisted Living May 1, 2018 Learning Objectives Attendees will learn about the following: Current activity on the Hill Regulatory and legislative developments that affect assisted living Current quality initiatives and data collection efforts to support assisted living professionals succeed now and in the future NCAL Membership 1
What We Do Federation model 50 AHCA state affiliates 43 NCAL state affiliates Members 1 million SNFs beds 230,000 ALs beds Voice in Washington Leader on Quality AHCA/NCAL Membership 13,600 member facilities SNF Beds DD Beds AL Beds Ways to Engage Convention & Conferences Congressional Briefing (June 2018) AHCA/NCAL Annual Convention (Oct 2018) NCAL Day AL Education Track Quality Summit (March 2019) Independent Owners Conference (March 2019) Constituency Groups Senior Living Executive Council Largest assisted living companies in the country Independent Owners Council for AL Assisted living operators or owners with 10 buildings or less The View from Washington 2
Current Congressional Makeup Why Should Long Term Care Care? Conventional wisdom Republicans less regulation, but may cut programs like Medicare & Medicaid Democrats more regulation, but usually protect Medicare & Medicaid Divided Congress and White House: little gets accomplished Why Should Long Term Care Care? Federal regulation of assisted living: SNF federal regulations could be copied by the states for AL Requirements for HCBS Medicaid providers could be copied for state licensure requirements Ongoing monitoring of other legislative efforts Including where Medicaid could be a pay-for 3
Current Climate Republicans in control Democrats in constant opposition, but with little power Still, Republicans need Democrats in the Senate 60 vote threshold Mid-Term Election Year Little happening in DC after Memorial Day weekend Democrats may take House; Senate is a harder path AHCA/NCAL Political and Lobbying Activity 150+ fundraisers per year Last Cycle: $13.3 million in activity Who s who of lobbyists Government Accountability Office Report on Medicaid in AL GAO: Government Watchdog 2015 request by 4 Senators (Reps and Dems) on the Senate Aging Committee Descriptive statistics on Medicaid coverage of services in assisted living Evaluation of state monitoring and CMS oversight 4
GAO Findings: Improved Oversight and State Reporting Needed Findings not focused on increasing federal regulation of AL or changing structure of Medicaid oversight 3 recommendations focused on CMS guidance to states to strengthen monitoring and more timely reports from states on their monitoring efforts Hill concern that states cannot report critical incidents by setting (broader issue than AL) GAO Focused on CMS and State Oversight Responsibilities States monitor Medicaid providers Providers States Providers surveyed by and report critical incidents to state CMS oversees states CMS States submit annual reports and assures to CMS beneficiary health and welfare Potential Impact? CMS guidance to states about reporting deficiencies CMS oversight of states submitting reports on time Increased state monitoring of providers reporting deficiencies CMS freeze waiver enrollment for states with insufficient monitoring More CMS requirements for HCBS oversight (e.g., national definition of critical incidents, or survey requirements) Legislative activity to strengthen HCBS oversight 5
NCAL Response Met with all 4 requestors offices, E&C staff, Senator Casey s staff Creating policy brief on innovative quality and compliance programs Request for meeting with CMS Medicaid Director Coordinating with other senior living associations Other Things We re Watching Emergency preparedness Wasserman-Shultz (D-FL) & Walberg (R-MI) bill o Ensuring AL doesn t get tied into a federal regulatory program Medicaid fraud and abuse Increase CMP fines, more state authority to investigate/prosecute Immigration reform Monitoring policy debate Developing a long term care guest worker proposal NCAL s Plan Continue to monitor all committees/key members of Congress with potential threats to assisted living Continue our political and lobbying activity Educate members of Congress about assisted living o Develop relationships o Discuss state regulation Reinforce our quality message Coordinate with other stakeholders 6
How You Can Help Grassroots - Become an advocate http://cqrcengage.com/ahca/home Host a community tour for your member of Congress For tips, contact AHCA s Matt Smyth: msmyth@ahca.org Come to Congressional Briefing June 4-5, 2018 Washington, D.C. No registration fee for AHCA/NCAL members www.ahcancal.org/events/congressionalbriefing The Role of the Administration Agencies That Can Impact Assisted Living Medicaid/ Community Services CMS ACL Labor DOL NLRB OSHA Fraud and Abuse OIG DOJ Other HUD - Financing EPA - Medication disposal FDA 7
We have to knock out two regulations for every new regulation. So if there s a new regulation, they have to knock out two. -President Trump, January 2017 Where This Has Helped Department of Labor overtime rule 3-Year Delay of the HCBS Final Rule Arbitration for SNFs (spillover affect for assisted living) Mandatory bundles HCBS Final Rule Medicaid Waiver Program 8
Quick Review of the 2014 HCBS Rule Defines qualities of HCB settings where Medicaid-covered HCBS may be provided: Integrated Selected by the individual Ensures an individual's rights Optimizes individual initiative Facilitates individual choice Medicaid HCBS cannot be provided in settings that do not have all the qualities of a HCB setting Applies to Medicaid Waiver Programs: 1915(c) 1915(i) 1915(k) HCBS Rule Timeline Jan 2014 CMS releases Medicaid HCBS rule -2016-2022 -Transition period Mar 17, 2015 State Transition Plans (STP) due Mar 17, 2022 NEW full compliance with the rule deadline Concerns for Assisted Living Stemming from HCBS Rule Secured dementia units Co-location with nursing home AL communities located at the edge of town or in a rural area that could be considered isolated Status of heightened scrutiny review process Licensure conflicts New construction 9
NCAL Advocacy 4 New NCAL Policy Briefs: Co-location Individual Choice and Privacy Licensure Memory Care https://www.ahcancal.org/ncal/advocacy/pages/medicaid.as px Several CMS meetings and letters Collaborating with other advocates Quality Improvement AHCA/NCAL Quality & Data Solutions 10
Staff Stability Customer Satisfaction ORGANIZATIONAL EXCELLENCE Hospital Readmissions Off-Label Use of Antipsychotics RESIDENT OUTCOMES http://qualityinitiative.ncal.org How to Measure? www.ltctrendtracker.com Quality Award Program Provides a pathway for providers of long term and post-acute care services to journey towards performance excellence Based on the core values and criteria of the Baldrige Performance Excellence Program Member communities may apply for three progressive levels of awards: Bronze - Commitment to Quality Silver - Achievement in Quality Gold - Excellence in Quality http://qa.ahcancal.org 11
Looking Ahead High quality care will always deliver long range success. Data matters more than ever before. Value-based payment models are replacing fee-forservice. Your leadership matters. Treat your staff the way you want them to treat your residents and patients. Embrace change. It is the only constant we have. 12