Federal Policy: A Look Ahead to 2017
December 30, 2016
Fiscal 2017 budget and appropriations outlook
Federal agencies now are operating under a fiscal 2017 continuing resolution which will last through April 28, 2017.
Congress did not complete work on the 2017 appropriations bills that fund senior housing or Older Americans Act programs. We do not expect these bills to be revived in the new Congress, so our work on appropriations will be geared to fiscal 2018.
Senior housing: We succeeded in getting provisions included in the fiscal 2017 Department of Housing and Urban Development spending bill to expand the Rental Assistance Demonstration to include project-based rental assistance contract properties, with $4 million in funding.
Because that measure never was enacted, the RAD for PRAC provision expired and will need to be renewed next year. This provisioncould help preserve affordable properties, and we will work to have it included in fiscal 2018 spending legislation.
Other provisions for which we will advocate in future housing appropriations measures:
- Sufficient total funding for Section 202 housing to cover 12-month renewals of all project-based rental assistance contracts;
- Renewal and expansion of theservice coordinator program;
- Full funding for the renewal of all project-based rental assistance contracts under Section 8 and for all Section 8 rental assistance vouchers;
- Funding to develop new affordable housing.
Older Americans Act/Home- and Community-Based Services: these home- and community-based programs also are level-funded under the current continuing resolution.
For fiscal year 2018, we will work for increased funding in line with the growth of the senior population and costs of providing essential services like meals and caregiver support.
Medicaid
The leadership of the incoming Congress has indicated that repeal of many parts of the Affordable Care Act will be their top priority. We expect the Medicaid expansion to be part of this repeal initiative. We have contacted the congressional leadership urging them to leave the expansion in place.
A separate proposal may be considered later next year to restructure the Medicaid program into a block grant or per capita capped grant to the states. Either of these changes would cut Medicaid funding to every state relative to the amount of funding states would receive under present law. We have urged Congress not to pursue restructuring of Medicaid.
Medicare
“Reform”: The incoming House congressional leadership has proposed restructuring the program to put it on a premium support basis. We have concerns about the potential impact of this proposal on long-term care providers. Our current understanding is that the majority of House and Senate members do not see restructuring Medicare as a top priority.
“Observation stays”: The legislation we supported to correct the problem did not move out of committee in either the House or the Senate, and the bills are therefore dead.We expect the sponsors to reintroduce legislation in the new Congress to count any time a Medicare beneficiary spends in the hospital toward the three-day stay requirement.
Home health: The measures we supportedto facilitate Medicare coverage of home health care – by allowing health care professionals other than physicians to prescribe home health services and by creating a demonstration program for Medicare coverage of non-medical services beneficiaries need to remain in the community – were not considered and are therefore dead. These measures will have to be reintroduced in the new Congress with new bill numbers.
Therapy caps exceptions process: The exceptions process that allows Medicare coverage of medically necessary therapy exceeding statutory fixed dollar amounts expires December 31, 2017. In the next Congress, we will advocate for extension of the exceptions process, or preferably repeal of the caps.
Value-based purchasing: We oppose legislation to replace the present system of nursing home value-based purchasing with a new initiative that would include a larger payment withhold. We expect this measure to arise again in the new Congress.
Chronic care: The Senate Finance Committee’s chronic care work group drafted and introduced legislation to improve Medicare coverage for beneficiaries with chronic health conditions. This measure will have to be reintroduced in the new Congress to receive any further consideration.
Regulatory
We have forwarded a list of federal regulations which we would like to see reconsidered to the incoming Trump Administration and to members of Congress.
The list included the CMS final rule on nursing home oversight, the payroll-based journal staff reporting system, the home health prior authorization reporting initiative, the rule that hampers residents of campus-based housing from receiving Medicaid-covered home- and community-based services, the 5-star nursing home rating system, and the automatic loss of CNA training because of penalties imposed under the nursing home survey process.
Long-Term Services and Supports
Wewill continue working withCongress to develop a more sustainable, healthy and affordable means of financing long-term services and supports for the future, as recommended by LeadingAge’s seminal report, PATHWAYS: Perspectives on the Challenges of Financing Long-Term Care Financing.