Scope of COVID-19 Funding Cuts Emerges as Debt Limit Flashpoint

Roll Call / By Aidan Quigley
 
Veterans health care funding clawback becomes a top Democratic talking point; GOP denies plan to cut benefits
 
​Democrats are jumping on the House GOP plan to recoup unspent pandemic aid in their debt limit bill, charging that the move will harm agencies counting on that funding, including the Department of Veterans Affairs. 
 
The bill, which Speaker Kevin McCarthy, R-Calif., is hoping to get on the floor this week, would rescind $72 billion in unobligated pandemic relief aid.
 
A new analysis compiled by House Appropriations Committee Democrats tallied up the major sources of untapped COVID-19 cash.
 
Nearly $17 billion is sitting in Department of Health and Human Services coffers for things like research and testing of vaccines and therapeutics, payments to hospitals and nursing homes, and genomic sequencing of COVID-19 samples to identify variants. Almost $6 billion would come out of unspent Transportation Department funds for highway, aviation and transit agencies.
 
“Rescinding this funding would eliminate critical resources for mayors and governors to keep their airports open, trains running, and buses operating to get their essential workers to and from their jobs to keep our economy and people alive,” the Democrats' memo states. 
 
But few issues carry the political resonance as potential cuts to veterans benefits, and Democrats have been aiming their fire particularly at over $2 billion sitting in VA health accounts that the debt limit bill would cancel.
 
Rescinding that money would “dramatically limit the ability for VA to provide healthcare services both within and outside of VA by clawing back needed funding for medical care,” according to the Democrats' memo.
 
“I do not understand what my House Republican colleagues are doing, and I am not sure they do either,” House Appropriations ranking member Rosa DeLauro, D-Conn., said in a statement.
 
Rep. Marie Gluesenkamp Perez, D-Wash., introduced an amendment to the debt limit bill Tuesday that would exempt VA funds from the rescission. Under her amendment, the funding would remain available through September 2024.
 
Perez is a freshman who flipped a GOP-held seat last November, winning the heavily contested race by less than 1 percentage point in a district former President Donald Trump carried by about 4 points two years earlier. Inside Elections with Nathan L. Gonzales rates her 2024 reelection bid a "Toss-up."
 
Republicans, however, see recouping the money as a layup opportunity to cut spending.
 
House Appropriations Chairwoman Kay Granger, R-Texas, said during the Rules Committee’s consideration of the debt limit bill that the pandemic spending is not needed and should be directed to other priorities.
 
“Now that the national emergency is officially over, we should be able to take back those resources,” Granger said.
 
'Serious questions'
 
Republicans are pushing back, vowing that veterans health care will be protected in the appropriations process despite the bill’s tight spending caps. They say they already had concerns about the VA’s handling of remaining pandemic funds, which were appropriated in 2020 and 2021. 
 
House Republicans “have serious questions about VA’s spending of this money in the first place,” House Veterans’ Affairs GOP spokeswoman Kathleen McCarthy said. . .

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Hoak Announces Resignation from HCAOA at End of 2023

Late last week, Home Care Association of America CEO Vicki Hoak announced her resignation. She will continue to lead the organization until her last day, October 24, 2023, after the National Home Care Conference. After three years at the association full of growth and many accomplishments, Hoak intends to focus on other areas of interest and spend time with her family.

 
“I look forward to the next six months to ensure a smooth and thoughtful transition,” Hoak said. “We will concentrate on continuing our strong advocacy efforts in Washington, D.C. as well as our state chapters’ advocacy efforts. [I am also focused] on making this year’s national home care conference in Chicago, the biggest and best yet.  No other home care conference has the breadth of excellent and relevant education, superb information that focuses on technology and business opportunities and of course, productive networking opportunities with both providers and HCAOA’s associate members.” “Vicki has been an excellent leader and advocate for home care for the Home Care Association of America. She stepped into the role just before the pandemic hit and both led and grew the organization during incredibly challenging times,” said HCAOA Board President Jeff Wiberg.
 
“My time with HCAOA will remain one of the highlights of my entire professional career,” Hoak continued. “While this position has been challenging, I have learned so much. I will cherish the many relationships I have developed with so many of our members and leave at a time when the future of this industry looks so bright.”

“Under Vicki’s guidance, HCAOA has become the strongest it has ever been. Thanks to her passionate advocacy and strong leadership, the organization is primed for greater success under new leadership,” said Wiberg. “For the past twenty years, Vicki’s voice, expertise and charisma have raised awareness of the value of home care. With the current political climate and how she has positioned HCAOA at the table, I am excited to see what the association will do in the future.”

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Expanded Home Health Value-Based Purchasing (HHVBP) Model HHVBP Newsletter – April 2023

The HHVBP Newsletter provides home health agencies (HHAs) with the latest information about the expanded HHVBP Model as well as important tools, news, and timely insights from the Centers for Medicare & Medicaid Services (CMS) and the HHVBP Model Technical Assistance (TA) Team. Please consider sharing this newsletter within your organization.

Information in this edition of the newsletter includes the following:

HHVBP Model Highlights. 1

Available in iQIES: April 2023 Pre-Implementation Performance Reports (PIPRs) 1

Measure Exclusions for Patients Transferred or Discharged to Hospice (1/1/2023) 2

Strategies for Success. 2

Strategic Practices for Maintenance Coverage. 2

Literature Link. 3

How CMS and its Stakeholders Are Addressing Inequities in Healthcare. 3

Contact Us. 4

Providers On Biden’s Executive Order, Home-Based Care ‘Drumbeat That Won’t Be Ignored’

Home Health Care News | By Andrew Donlan
 
The Biden administration has made mention of home-based care regularly and intentionally during its tenure in the White House. It did so again [last] Wednesday this time through 50-plus directives for government agencies, many of which were home care-related. 
 
Though still just directives, the sitting president making this sweeping of an executive order focused on senior care – in part – is worth plenty of weight. 
 
Home- and community-based care (HCBS) providers believe there will be short- and long-term effects of the directives, as well as tangible and intangible results. 
 
“There’s certainly some symbolism in there that is favorable,” Darby Anderson, chief strategy officer for Addus Homecare Corporation (Nasdaq: ADUS), told Home Health Care News. “It certainly puts a greater wind at our backs, shining a spotlight on home- and community-based services and the overarching caregiver issues. And that’s very good.”
 
The Frisco, Texas-based Addus is an at-home care provider with a heavy focus on Medicaid-driven HCBS. The company has over 200 locations across 22 states.
 
Broadly, the directives from the White House included: a path for more home-based care availability for veterans, of the personal care and primary care variety; a path to uplift the caregiver workforce, utilizing Medicaid funds to do so; and further support for the concept of self-directed care.
 
“There’s real concrete actions that [President Biden] has put into this executive order that are directed at different parts of of the government,” Anderson continued. “We’ll have to see how those are implemented at the end of the day. But there could be some real concrete improvements, hopefully to the services we provide and for the workers in [this space].” 

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The following excerpts were taken by HHAC of pertinent Executive actions taken last week and as described in a White House Fact Sheet:

• Improve access to home-based care for veterans. VA is directed to consider expanding its Veteran Directed Care program to all 172 VA Medical Centers by the end of Fiscal Year 2024. This program provides veterans with a budget to hire personal care assistance including from family members. VA will also consider piloting a new self-directed care program in no fewer than 5 new sites that provides veterans with a budget for personal care assistance while reducing administration burdens related to managing care. Further, VA will consider adding 75 new interdisciplinary teams to its Home-Based Primary Care program to serve an additional 5,600 veterans in their homes.

• Enhance job quality for long-term care workers.  To advance the President’s long-term care priorities, the Executive Order directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.

• Support family caregivers. To provide greater support to family caregivers, the Executive Order directs HHS to consider testing a new dementia care model that will include support for respite care (short-term help to give a primary family caregiver a break) and make it easier for family caregivers to access Medicare beneficiary information and provide more support to family caregivers during the hospital discharge planning process. Additionally, VA will consider expanding access to the Program of Comprehensive Assistance for Family Caregivers and provide more mental health support for caregivers enrolled in that program. These actions build on the 2022 National Strategy to Support Caregivers.

• Advance domestic workers’ rights. Care workers should be supported, valued, and fairly compensated, and care workers should have the free and fair choice to join a union. In particular, domestic workers providing care for our loved ones are often underpaid and subject to discrimination and abuse. To provide greater protection for these workers, the Department of Labor will publish a sample employment agreement so domestic child care and long-term care workers and their employers can ensure both parties better understand their rights and responsibilities.