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Member Update

Posted By Jennifer Gill, Friday, December 20, 2019
Updated: Thursday, December 19, 2019
December 20, 2019

The LeadingAge North Carolina Member Update is published twice monthly. Click on a section header to view that section.

Advocacy & Policy | On the Road | Strategic Thinking
Position Papers  |  News & Notes   | Volunteer Spotlight
*NEW Leadership Academy  | Value First

Increased HUD Funding Approved
The final fiscal year 2020 appropriations package was released by House and Senate leaders on December 16. The bill is expected to pass the House and Senate and be signed into law by the President by midnight December 20. For HUD’s Section 202 Housing for the Elderly account overall, the bill provides $793 million, a 17% increase over FY19’s funding level for the account. Funding for the Section 202 account is $115 million above the 2019 enacted level and $149 million above the President’s budget request for FY20. The bill provides $90 million for new Section 202 homes, a key LeadingAge priority. Click here for more information about the spending bill and related provisions.

Medical Expense Tax Deduction Preserved
The spending bill preserves the 7.5% adjusted gross income threshold for deducting medical expenses not covered by insurance for another two years. Without this provision, the threshold would have risen to 10% on January 1, reducing the amount of medical expenses that could be deducted and making the deduction available to fewer taxpayers. We have urged Congress to extend the 7.5% threshold because long-term services and supports are the largest single category of medical spending for which most people have no coverage. In addition, the deduction makes life plan communities more affordable by enabling residents to deduct the portion of fees that prepays their potential long-term care expenses. We will continue working to make the 7.5% threshold permanent.

Senators Address Legislation to Address CNA Training Lockout Issue
Sen. Mark Warner (D-VA) and Sen. Tim Scott (R-SC) introduced bipartisan legislation (S. 2993) in the Senate that will end the mandatory 2-year CNA lockout for nursing homes if they have been fined over a certain threshold amount. This legislation will provide relief and help to ensure that our members can provide quality care for residents. Click here to contact your Members of Congress and share your support on this important issue.

Public Policy Committee Sets Meeting Dates
The LeadingAge North Carolina Public Policy committee has finalized their meeting schedule for the first half of 2020. The committee will meet on January 10, February 11, March 10, April 30, May 26, June 18, and July 16.

CMS Proposed Rule Could Impact Nursing Home Provider Taxes and Supplemental Payments
CMS has published the Medicaid Fiscal Accountability Regulation (MFAR) Proposal on the Federal Register. This proposed rule would make significant changes to key parts of state Medicaid financing structures for nursing homes and hospitals and would, among other items, preclude CCRCs from being exempted from North Carolina’s provider tax.

For nursing homes, including CCRCs with nursing homes/health centers, the most significant proposed changes are to provider taxes and supplemental payments. Listed below is a summary of key provisions of the MFAR proposal as they relate to nursing homes. A full crosswalk comparing current policy to the proposal is available from LeadingAge national here.

Provider taxes would not be banned outright under the proposed rule. CMS is, however, proposing to set new criteria for which revenue generated by provider taxes would or would not receive federal matching funds, and state provider taxes would face new scrutiny under the proposed regulation. Current policy requires that provider taxes be broad-based and uniform (or, in other words, be applied to providers equally), and that if states want more targeted tax structures, like a bed tax, it must receive a CMS waiver to do so. This process would not change under the proposed rule, and states would still be able to receive these waivers from CMS, but the considerations of what would be allowed under those waivers would change. Specifically, states would be disallowed from receiving federal funds for taxes that “impose undue burden” on the Medicaid program. Such “undue burdens”, per the proposal, include:

  1. Taxing providers that provide less Medicaid services at lower rates than those that provide relatively more Medicaid services.
  2. Medicaid services, in general, being taxed more than non-Medicaid services (except when excluding Medicare/Medicaid revenue).
  3. Not taxing, or taxing at a lower rate, groups of providers with no Medicaid services compared to other groups (e.g., those that take Medicaid).

In addition to these cases, the proposal also says that a tax would impose an undue burden if it,

“excludes or imposes a lower tax rate on a taxpayer group defined based on any commonality that, considering the totality of the circumstances, CMS reasonably determines to be used as a proxy for the taxpayer group having no Medicaid activity or relatively lower Medicaid activity than any other taxpayer group.”

In other words, CMS would have significant latitude determining whether a provider tax and any provider tax exclusions or “discounts” would comply with the proposal if finalized. This could very well mean that exclusions or lower taxes for CCRCs, for example, could be determined disallowable. Further, current policy does not allow providers to be guaranteed to be held harmless under provider taxes. This means taxes can’t be levied with the understanding that any funds a provider pays will eventually circle back to them. CMS proposes new language in MFAR that would allow CMS to more closely look at arrangements between providers, states and other relevant entities – including arrangements not in writing or legally enforceable – to determine if providers have “reasonable expectation that the taxpayer will receive a return of all or any portion of the tax amount.” If CMS reaches that conclusion, provider taxes could be further jeopardized.

LeadingAge North Carolina, in concert with LeadingAge national and other organizations, will work aggressively to provide CMS with information about the detrimental impact to residents of the proposed changes.

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LeadingAge North Carolina staff travels the state offering education, advocacy, and networking. Here’s where we've been recently:

  • Direct Care Workforce Meeting - Raleigh
  • LeadingAge NC Public Policy Committee conference call
  • Member visit - The Cypress of Raleigh, Raleigh

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A Recession Hasn’t Arrived (Yet). Here’s Where You’ll See It First.
The New York Times; December 12, 2019
Five months after last summer's recession, the situation has improved, but risks remain. Here are key indicators to watch for signs of trouble.

What the “Best Companies to Work For” Do Differently
Harvard Business Review; December 12, 2019
What makes a company culture great? To explore this question, the authors spent three years researching 21 of the best places to work in the United States. They offer five general principles about why what they do is so successful.

New Tech Ideas for Aging Well
Kiplinger's Retirement Report; December 16, 2019
These products were highlighted at AARP's Innovation Labs Grand Pitch Finale for their ability to offset difficulties aging adults face with everyday tasks while also helping caregivers.

Would You Let a Robot Take Care of Your Mother?
The New York Times, December 13, 2019
Robotic companions are being promoted as an antidote to the burden of longer, lonelier human lives. At stake is the future of what it means to be human. Read this opinion piece.

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Thanks to LeadingAge North Carolina Platinum business members CliftonLarsonAllen, WeaverCooke, and BB&T Capital Markets for sharing their position papers. Click on a title below to download a PDF.

These papers are also available from our website by clicking here. Or visit www.LeadingAgeNC.org and under the Resources tab, select Position Papers.




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2020 Event and Education Calendar Now Available
Mark your calendar for these LeadingAge North Carolina events and programs in 2020.

Health Care Spending Jumps Again
A new study from the U.S. Centers for Medicare and Medicaid Services found a small one percent decrease in American retail drug prices in 2018 — the first decline in more than 40 years — but a significant jump in the cost per person for private health insurance. The study, which was published in the journal Health Affairs, says that last year health care spending overall grew by 4.6 percent to a total of $3.6 trillion, or an average of $11,172 per person. If you felt like you were spending more on out-of-pocket fees such as insurance deductibles and co-payments in 2018 , those also increased last year by 2.8 percent.

Check Out the New W-4 Tax Withholding Form
The New York Times; December 13, 2019
The first major redesign since 1987 is simpler and reflects tax code changes, the I.R.S. said. Workers should make sure it also reflects what they owe.

PDPM Readiness Available at LeadingAge National Learning Hub
Check out the latest on PDPM readiness at the LeadingAge national Learning Hub.

In addition, for your reference conference recordings are now available from the LeadingAge Annual Meeting in San Diego on topics such as fundraising, Medicare Advantage, Ageism, Design, Dementia, behavioral health and more. If you have questions or feedback, please contact Kevin Bradley.

Meet the New Director of LPC Services & Policy at LeadingAge National
Dee Pekruhn joined LeadingAge this month as Director of Life Plan Communities Services & Policy. Dee brings years of experience with LeadingAge and three of its member communities to her new position. Read more.

Have Job Openings?
Contact Jennifer Gill with the job title, description, and how to apply and she will post it for you under the Careers tab on the LeadingAge NC website. It's free!

In Case You Missed It
Click below to read newsletters from the past two weeks.

Follow @LeadingAgeNC on Social Media
Stay connected through the busy holiday season. Be sure you are following LeadingAge NC on Twitter, Facebook, and Instagram. You'll be up-to-date when the new year starts!

2019-20 LeadingAge NC Member Directory
The updated member directory is now available online! Go to http://LeadingAgeNC.org and click on the Directory tab.

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Board members of LeadingAge North Carolina volunteer their time and expertise to enrich the field of aging services. We are grateful to welcome Chip Cromartie to the board this year. Read on to learn a little more about Chip, who is executive director at Well-Spring Solutions in Greensboro.

1. How did you get into the field of aging services and what was your first job?
In my early years, I spent a lot of time with my grandfather, who taught me about life, the value of hard work and how to age gracefully. My outlook from the very start was that older adults are a valuable resource, and they can provide us with experience, knowledge and warmth. In college I volunteered in long-term care, which further supported my interest in working with older adults. I was naturally drawn to aging services right out of school and started my career as the Assistant Program Director for an adult day health center in Greensboro, NC.

2. If you could wave a magic wand, what is the one thing you would like to do for the population we serve?
In his book, Faces of Aging, Dr. Nader Robert Shabahangi asks wouldn’t it be great if we looked forwarded to growing older like a child looks forward to growing up? I think we would be a lot closer to making this a reality if we could wave a magic wand and create a society in which all older adults are appreciated, treated with dignity and viewed as valuable resources to be cherished.

3. If you could swap jobs with a staff member for a day, what would you want to try and why?
The lifeblood of every aging services provider is the front-line staff. They are the direct link to quality care. These staff members deserve our best in leadership and support. To truly walk in their shoes for a day would be an honor.

4. What makes LeadingAge NC’s mission meaningful to you and what factors do you believe will affect the Association’s mission in the months and years to come?
The breadth of LeadingAge NC’s mission is inspiring because it recognizes we can strengthen our members not only by providing them with direct value, but also by developing our future leaders and broadening the possibilities of aging. I firmly believe our focus on advocacy, education, innovation and collaboration positions our association and its members well for the coming years as we face increased regulation, workforce challenges, a seemingly ever-changing health care system and evolving consumers. Together, we can drive positive change and outcomes for older adults.

5. When you are not working, what do you do to relax and recharge your batteries?
I enjoy spending time with my family, riding my motorcycle, Scouting, exercise and reading.

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Applications for the LeadingAge North Carolina
Leadership Academy Class of 2021 are now open!


Build tomorrow’s leaders and invest in our field's workforce.
Apply to the LeadingAge North Carolina Leadership Academy.
Applications are due online by January 31, 2020.

Selected Academy fellows will:

  • Read, reflect, and discuss leadership principles
  • Engage with emerging leaders across the state
  • Visit the General Assembly and the Department of Insurance
  • Meet leaders in the field 
  • Tour other communities
  • Present an action learning project
  • Grow under the guidance of our coaches and facilitator
  • Become even stronger contributors at their communities
  • Gain confidence
  • Question established thinking
  • And much more!

One applicant per community, please, from any department with any amount of experience. A nomination from your community must be approved by your CEO/Executive Director.

Academy fellows meet four times a year, starting and ending with the LeadingAge NC Annual Conference. Kick off for the 2020-21 class is this May 18-21, 2020 in Asheville. Tuition for the program is $2,000 and includes conference registration. Scholarship assistance is available.

For more information, check out our updated Academy webpage which includes:

  • Application and Letter of Commitment
  • Brochure
  • Curriculum
  • 2020-21 Meeting Schedule
  • Core Themes
  • Faculty
  • Action Learning Projects
  • Alumni
  • Testimonials
  • Current Fellows

Please feel free to contact us at 919-571-8333 with any questions. Enrich your leadership skills and apply today! We look forward to hearing from you.

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Value First

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LeadingAge North Carolina
222 N. Person Street Suite 205 | Raleigh, NC  27601
Ph. 919.571.8333 | Fax 919.869.1811 | www.LeadingAgeNC.org


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