In The News

Provider Groups Optimistic About Retooled HCBS Bill

McKnight’s Home Care / By DIANE EASTABROOK

Provider groups are cautiously optimistic that Congress this year will pass a newly introduced Better Care Better Jobs Act that would expand home- and community-based services.
“I have to believe this particular bill does have traction,” Home Care Association of America CEO Vicki Hoak told McKnight’s Home Care Daily Pulse on Thursday, the day the bill was introduced. “We got so much attention the last time it was introduced. I’m hoping with a fresh look and more people advocating on behalf of this, it has a real possibility.”

Earlier this week, National Association for Home Care & Hospice President and CEO William Dombi expressed optimism at the Home Care 100 conference in Orlando that HCBS funding would become a priority in Washington this year.

In an email to McKnight’s Home Care Daily Pulse Thursday, Dombi said Better Care Better Jobs would have “the full support of NAHC and our citizen advocates.”

The trimmed-down version of  Better Care Better Jobs Act would enhance Medicaid funding and potentially help an estimated 650,000 Americans get off of wait lists for in-home caregivers. A spokesperson from Casey’s office told McKnight’s Home Care Daily Pulse on Thursday the Congressional Budget Office estimates its price tag at $300 million. When the bill was first introduced in 2021, the National Association for Home Care & Hospice estimated its worth at $400 billion and then revised the price tag to $150 billion

The legislation would make permanent the 10% increase in Federal Medical Assistance Percentage (FMAP) to states; encourage states to develop innovative models that help states build their direct care workforce; provide additional funding to CMS to monitor and support state HCBS programs; provide funding to states to build out HCBS infrastructure; and make permanent the Money Follows the Person demonstration, which supports state efforts to rebalance long-term care support systems.

Thirty-seven other Democratic lawmakers have co-signed the legislation.
LeadingAge President and CEO Katie Smith Sloan said Thursday the legislation could go a long way in helping to fill the estimated 7 million direct care jobs the U.S. needs by the end of the decade.

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Year-End Funding Package Includes Medicare and Medicaid Policies

Medicare Rights Center / By Lindsey Copeland

In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal year (September 30, 2023) and makes several important changes to Medicare and Medicaid.


Medicare Telehealth

PHE Waiver Extension—The bill extends most of the COVID-19 public health emergency (PHE) Medicare telehealth flexibilities through 2024 and directs the Department of Health & Human Services (HHS) to study telehealth utilization and assess potential fraud.

Medicare Mental Health Care

Provider Expansions—Medicare mental health coverage has known gaps, which the spending bill helps close. One long-sought change will allow Medicare Part B to cover services provided by marriage and family therapists and licensed professional counselors beginning January 1, 2024.

Intensive Outpatient Services—To further ease access, the package revises Medicare’s partial hospitalization benefit to establish coverage of intensive outpatient services beginning January 1, 2024.

Crisis Psychotherapy Services—It also increases payments for mobile crisis care (crisis psychotherapy services furnished by a mobile unit or in other non-facility settings) starting on January 1, 2024.

Workforce Development—It provides for 200 new Medicare-supported graduate medical education (GME) residency positions, half of which are allocated for psychiatry and psychiatry subspecialties.

Provider Outreach—To promote uptake, the omnibus requires HHS to educate providers on the availability of crisis psychotherapy services, behavioral health integration services, and opioid use disorder treatment services under Medicare.

COVID Treatments—The bill temporarily (through December 2024) allows Part D plans to cover oral antiviral treatments that have an emergency use authorization (EUA). This update will permit Medicare to cover COVID-19 treatments like Paxlovid once the PHE ends and those products shift to the commercial market.

Medicare Coverage Changes and Extenders

Lymphedema Compression Garments—Under the bill, compression garments for the treatment of lymphedema will be covered under Part B as durable medical equipment (DME) starting in January 2024.

In-home intravenous immune globulin services (IVIG)—It also provides permanent Medicare coverage for items and services related to the administration of IVIG, beginning on January 1, 2024.

Durable Medical Equipment—The omnibus continues the blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non-competitive bid areas through 2023.

Hospital at Home Waiver—It extends (through December 31, 2024) the Acute Hospital Care at Home initiative.


Medicaid Home- and Community-based Services (HCBS)

Money Follows the Person and Spousal Impoverishment—The bill continues the Medicaid Money Follows the Person program and protections from spousal impoverishment for people receiving HCBS through September 30, 2027. These critical Medicaid policies that we have long supported help older adults and people with disabilities live with choice, dignity, and independence.

Medicaid PHE Coverage

Continuous Coverage Requirement—The omnibus sunsets the Medicaid continuous coverage requirement. Created in 2020 by the Families First Coronavirus Response Act (FFCRA), this provision has allowed states to maintain their Medicaid rolls in exchange for a 6.2% federal match rate (FMAP) bump. The FFCRA tied this coverage policy to the duration of the PHE; it will now end on April 1.

At that time, the enhanced FMAP will begin to reduce gradually, eventually reaching zero on December 31, 2023. The maintenance of effort (MOE) requirements tied to the FMAP increase—that states may not make eligibility standards, methodologies, or procedures for determining Medicaid eligibility more restrictive than they were on January 1, 2020—will continue to apply during the phase-down period.

Medicaid Eligibility and Funding

Enhanced Eligibility Postpartum and for Children—The bill also requires states to give children (under the age of 19) 12 months of continuous coverage in Medicaid and CHIP and permanently extends the American Rescue Plan policy allowing states to provide 12 months of postpartum coverage to pregnant individuals in Medicaid and CHIP.

Funding for the U.S. Territories—The omnibus extends Puerto Rico’s higher federal Medicaid match (76%) through September 30, 2027, and permanently extends a higher federal match (83%) for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. These updates will provide much-needed consistency and fiscal stability.


NAHC President: 2022’s Workforce Initiatives More ‘Aspirational’ Than ‘Productive’

Home Health Care News / By Joyce Famakinwa
Looking back at Congress’ role in improving home-based care workforce issues in 2022, the industry saw more of an “aspirational” year than a “productive” one.
That’s according to Bill Dombi, president of the National Association for Home Care & Hospice (NAHC). He expressed this sentiment during a presentation at the Home Care 100 conference in Orlando, Florida on Monday.
Unsurprisingly, workforce challenges were top of mind during Dombi’s rundown of legislative, regulatory and advocacy updates.
“We expect to see, in 2023, the reintroduction of legislative proposals that will help increase the health care workforce,” Dombi said. “We have a multi-dimensional, highly integrated need for solutions on the workforce side of it.”
On the legislative side, 2023 will see the return of the Better Care Better Jobs Act, which would pump $150 billion into Medicaid for home- and community-based services. The funds will be earmarked for workforce stabilization efforts.
Still, Dombi admits that there may be a rough road ahead for this legislation.
“It will come back in 2023, it’s not going to be an easy climb to success for that,” he said.
NAHC is also supportive of the Credit for Caring Act, which is also championed by AARP. The legislation would provide a non-refundable federal tax credit of up to $5,000 to eligible family caregivers. The aim is to help address the financial challenges that come with family caregiving.
Immigration is an area that Dombi suggested providers keep an eye on. However, he also urged them to utilize internal solutions, such as creating career opportunities, offering caregiver support and implementing technology.
“Part of the supply issue is tied to immigration, so we expect Congress to be focusing on these issues, but I encourage all of you to look to some of the solutions you heard earlier, because Congress itself is not going to solve this problem that we have in terms of the workforce shortage,” Dombi said.
He also turned his attention to the end-of-year spending bill.
“When we first looked at it, we said we didn’t get what we wanted,” he said. “When we started looking at it, there were a lot of elements that continued to fuel the belief that Congress, the regulators and the health care world itself is focusing more and more on concentrating health care in the home.”
Notably, the legislation postpones an across-the-board 4% rate cut related to PAYGO requirements through 2024, extends Medicare sequestration and strengthens Patient-Driven Groupings Model rulemaking transparency.
With the expansion of the Home Health Value-Based Purchasing (HHVBP) Model underway, Dombi also briefly pointed out how vital the program was to the Medicare program and its patients.
“There’s so many reasons why you need to keep people out of hospitals and the Medicare program says that the value-based purchasing program for home health services has done that and saved the Medicare program billions of dollars in that process as well,” Dombi said.
Ultimately, Dombi stressed the importance of breaking free of silos when it comes to industry advocacy efforts.
“The pitch that we all need to offer in our advocacy efforts is: We are not looking at silos of Medicare home health, Medicare hospice, private-pay personal care services of private-duty services in Medicaid, etcetera,” he said. “We are looking at a need to have a highly-integrated strategy to support health care services at home. While these may be victories of sorts and baby steps forward, we still need much more to happen on a going-forward basis.”


Elimination Of Non-Competes Would Have ‘Major’ Effect On Home-Based Care World

Home Health Care News / By Andrew Donlan
In early January, the Federal Trade Commission (FTC) proposed a ban on non-compete agreements nationwide.
The rule is likely to be finalized. When and if it does, it is also likely to have a massive effect on the home health and home care industries.
Such a move would not just hurt companies by allowing leaders to jump ship, but it would also muddy the waters on a slew of contractual agreements between caregivers and clients.
“I definitely think it’s major. It’s extraordinarily significant,” Angelo Spinola, the chair of home care, home health and hospice at the law firm Polsinelli, told Home Health Care News. “If you can’t stop a key executive from leaving and competing against you, that will have a significant impact on the industry.”
The proposed rule can be traced back to the Biden administration’s Aug. 2021 request to the FTC to take a longer look at restricting or banning non-compete agreements. Broadly, the idea was that non-competes restricted workers’ mobility and ability to make a livable wage.
It seemed at the time that President Biden was referring to low-wage workers specifically. And while this would have an effect on, for instance, the caregiver-provider relationship, it would also be a major shake-up in what home-based care leadership could do when looking for new opportunities.
For instance, Spinola offered up the example of a home health administrator. They could be trained up by a home health organization, promoted and given access to all the patient data and pricing of an organization.
“Now that individual says, ‘You know what, I’ve got all the relationships. And I’ve been collecting a salary from the owner. But now I’m just going to go across the street, and I’ll open my own agency. I’ll wait for those clinicians to call me and start working with me. And the relationships I’ve developed with the facilities and those referral relationships, I’ll just bring those over,” he said.
Home-based care leadership has already been in disarray, to a certain extent. Big-time executives have either left their posts or been forced out in the wake of COVID-19 and other unfavorable market conditions.
If the FTC ruling becomes final, that could become even more so the case.
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US Health Officials Propose Annual COVID-19 Vaccination for Most Americans

Associated Press
WASHINGTON — U.S. health officials want to make COVID-19 vaccinations more like the annual flu shot.

The Food and Drug Administration on Monday proposed a simplified approach for future vaccination efforts, allowing most adults and children to get a once-a-year shot to protect against the mutating virus.
This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster.
The proposal comes as boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August.
The FDA will ask its panel of outside vaccine experts to weigh in at a meeting Thursday. The agency is expected to take their advice into consideration while deciding future vaccine requirements for manufacturers.
In documents posted online, FDA scientists say many Americans now have “sufficient preexisting immunity” against the coronavirus because of vaccination, infection or a combination of the two. That baseline of protection should be enough to move to an annual booster against the latest strains in circulation and make COVID-19 vaccinations more like the yearly flu shot, according to the agency.
For adults with weakened immune systems and very small children, a two-dose combination may be needed for protection. FDA scientists and vaccine companies would study vaccination, infection rates and other data to decide who should receive a single shot versus a two-dose series.
FDA will also ask its panel to vote on whether all vaccines should target the same strains. That step would be needed to make the shots interchangeable, doing away with the current complicated system of primary vaccinations and boosters.
The initial shots from Pfizer and Moderna — called the primary series — target the strain of the virus that first emerged in 2020 and quickly swept across the world. The updated boosters launched last fall were also tweaked to target omicron relatives that had been dominant.
Under FDA's proposal, the agency, independent experts and manufacturers would decide annually on which strains to target by the early summer, allowing several months to produce and launch updated shots before the fall. That’s roughly the same approach long used to select the strains for the annual flu shot.
Ultimately, FDA officials say moving to an annual schedule would make it easier to promote future vaccination campaigns, which could ultimately boost vaccination rates nationwide.

The original two-dose COVID shots have offered strong protection against severe disease and death no matter the variant, but protection against mild infection wanes. Experts continue to debate whether the latest round of boosters significantly enhanced protection, particularly for younger, healthy Americans.

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