1. NASUAD Public policy discussion and prioritization DRAFT UNFINALIZED VERSION
Bea Rector Director, Washington State
Home and Community Services Division
Damon Terzaghi Senior Director, NASUAD

2. Background
Every few years NASUAD works to update its public policy platform in order to include the most current and relevant information and legislative/regulatory recommendations
Now that the new Congress and State Administrations have been seated, we believe it is an appropriate time to update the platform
These recommendations will likely remain in effect as the official platform for the next two years
This is your chance to weigh in:
Be loud and be proud!
And be proud to be loud…

3. Process Overview
NASUAD Staff review prior recommendations with NASUAD’s Public Policy Committees:
Two committees:
Aging and Disability (focus on discretionary programs);
Medicaid and LTSS (focus on entitlements including Medicaid/Medicare/duals);
Committee membership is open to any interested state (Sign up today!)
Committees make recommendations for modification to platform
Board of Directors reviews resulting draft platform, provides additional recommendations, and moves to recommend approval
Membership provides feedback, additional comments, and moves for final approval to the platform
NASUAD takes these recommendations and builds formal narrative booklet
We Are Here

4. Recommendations Reauthorize the Older Americans Act
Note: NASUAD issued specific OAA Reauthorization platform in August based on membership recommendations
Increase Flexibility for States
Combine Title III-C1 & C2 into one program
Establish a demonstration program that allows states to evaluate providing OAA supports in a targeted, person-centered way
Support Programs that Assist Individuals to Age in Place:
Community Services Block Grant
Social Services Block Grant
Low Income Home Energy Assistance Program
HUD Housing Programs, particularly with a focus on affordable, accessible housing
Specific interest in III-B sustainability

5. Recommendations Promote Elder Justice and Adult Protective Services:
Support the ACL APS Recommendations by establishing authorizing Federal Legislation and funding for APS
Enhance support for Ombudsman program
Support Research and Evaluation in the OAA and Aging Services
Establish/strengthen research arm under ACL to address both Aging and Disability
Either expand NIDILRR to encompass aging and disability; or
Establish corresponding aging-focused research entity in ACL
Support the NWD/ADRC initiative:
Continue to advocate for ongoing, increased appropriations for NWD
Allow III-B funding used to support NWD to serve individuals under 60

6. Recommendations
Align current policy allowing Tribal AAAs to set their own age eligibility threshold for Title VI services with Title III eligibility
Address workforce issues:
Increase allowable options to support caregivers under Medicaid HCBS
Provide grants and other funding sources to help develop innovative recruitment/retention models, including expanded telemedicine
Improve HCBS settings implementation
Allow new constructions subject to heightened scrutiny to enroll as Medicaid providers based upon approved plans that demonstrate compliance to address challenges with capacity
Provide timely responses and approvals to states that submit heightened scrutiny packages

7. Recommendations Clarify person-centered planning requirements
Ensure that CMS applies consistent requirements nationally
Clarify that only essential hands-on providers are required to sign the plan and be included in plan distribution to reduce burden/red tape and protect privacy
Provide clarification on conflict of interest requirements, including a statement that entities are not conflicted from Medicaid case management if they deliver OAA services
Continue to allow Medicaid 1115 waivers to include HCBS/LTSS innovations
Provide employment supports for older workers and individuals with disabilities:
Programmatic improvements to Medicaid Buy-in programs
Expanded support via interagency workgroups
Increase availability of supports to older workers
Move SCSEP and ODEP to ACL
Increase Tribal VR appropriations to account for inflation

8. Recommendations
Improve electronic visit verification policy and issue clarifications regarding important issues, such as:
Shared living
Self-direction
APD approval
MECT processes
Error rates
Ensure that the EVV FMAP penalty only applies to specific services that are noncompliant

9. Recommendations Medicare:
Expand policy allowing for short-term LTSS to be provided via Medicare Advantage plans to FFS
Provide states with flexibility to assure access to necessary DME
Expand Medicare billing standards related to professional certification to expand provider pool and align with state Medicaid programs (one such example could be licensed mental health professionals)
Include a Medicare dental benefit
Establish a demonstration project in CMMI that allows interested states to manage the Medicare funding for dual eligible individuals

10. Additional Discussion
Things we missed?
Concerns with proposed recommendations in the platform?
Modifications/edits to proposals discussed?

11. For additional information: Damon Terzaghi dterzaghi@nasuad.org
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