Home & Community-Based Services Policy Forum March 17, 2015 Peter Notarstefano, Director of HCBS

114 th Congress and the President Budget Deficit

President’s 2016 Proposed Budget Pilot Comprehensive Long-Term Care State Plan Option Expand Eligibility Under the Community First Choice Option Improve and extend the Money Follows the Person A president’s budget isn't usually passed in full by Congress. This is even less likely when a majority of legislators belong to the opposite political party. Create Pilot to Expand Programs of All Inclusive Care For the Elderly (PACE) Eligibility to Individuals between Ages 21 and 55. Proposed home health co-payments.

Funding Increased funding Title III B Home and community- based supportive services, Title III E National Family Caregiver Program, Title III C Homebound meals, Lifespan respite care program, Aging and Disability Resource Centers (ADRC) and Elder Rights Support Activities President’s 2016 Budget

30% traditional/ fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2016, and tying 50 percent of payments to these models by the end of percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018

IMPACT Act Improving Medicare Post-Acute Care Transformation Act Passed the House under suspension, passed Senate under unanimous consent No prior committee consideration or mark-up

IMPACT Act - Provisions Standardized assessment data From SNFs, home health, IRFs, long-term care hospitals by 2016 Data to include patient functional status, cognitive function, special services needed, physical impairments, comorbidities Standardized format to compare across settings Build on existing assessment tools, MDS and OASIS

IMPACT Act - Provisions Quality measure reporting – Functional status changes – Skin integrity – Medication reconciliation – Falls Begins October 1, 2016 All reporting requirements effective 1/1/2019 – Risk adjusted

IMPACT Act - Provisions Resource use measures from claims data: – Estimated per-beneficiary Medicare spending – Discharge to the community – Potentially preventable re-hospitalizations – All to be risk-adjusted Begins 1/1/2017 for home health agencies

HCBS Characteristics rule What should be paid under 1915c, 1915i and 1115 Medicaid waivers? What is HCBS? What is not HCBS?

What constitutes HCBS? Exploratory Questions to help determine HCBS: General and Non-residential specific Starts off with the conflict free person- centered plan of care Focuses on Participant choice of multiple options of integrated services, privacy, freedom, dignity, respect and independence Characteristics of the setting, not the location

HCBS Transition Plans Residential regulation Non-residential States needs to submit a transition plan including benchmarks and timeframes for each Medicaid waiver c, 1115, 1915 i CMS will allow states up to 5 years to be in full compliance with their approved transition plan. Provider survey Onsite visits Heightened Scrutiny

Possible Remediation Institution? HCBS

Medicaid 1915 i Money Follows the Person Health Homes Community-First Choice Balancing Incentive Program Medicaid Pay For performance? Medicaid Per-Capita Cap? Medicaid Block grants? Improving efficiencies within the existing Medicaid model?

Adult Day Center Enhancement Act (H.R.263) Medicare Adult Day Services Act?

Reauthorization Older Americans Act Older Americans Act Reauthorization Act of 2015 (S. 192) Funding formula

Home Care Regulation October 1, 2013: DOL issues final rule that narrows the definition of “companionship services” under the FLSA exemption and prohibits third- party employers, such as agencies, from applying the companionship exemption to its employees-eligible for minimum wage and overtime December 2014: D.C. federal court strikes down the portion of the new regulation that would have prevented third-party employers from relying on the companionship and live-in exemptions and issues a temporary stay to prevent the narrowed definition of “companionship services” from going into effect on Jan. 1. January 14, 2015: D.C. court vacated in its entirety the DOL regulation defining the “companionship exemption.” January 22, 2015, the U.S. Department of Labor (DOL) appealed the U.S. District Court for the District of Columbia's two orders that vacated provisions of the DOL's Home Care Rule.

Veterans Administration Provider Agreements “Use of Medicare Procedures To Enter Into Provider Agreements for Extended Care Services" proposed rule Impacts rate setting Increased access for Veterans for Adult Day Services and Home Health Legislation needed to finalize the regulation

Home Health Fostering Independence Through Technology Home Health Improvement Act Bipartisan support

PACE Last Congress- PACE Pilot Act Bipartisan support 108 Programs of All Inclusive Care for the Elderly (PACE) nationwide. PACE expanded into its 32nd state Regulatory changes to increase the flexibility within the model

Contact Information Peter Notarstefano, Director of HCBS LeadingAge