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Advocacy in Action September 13, 2019

Posted By Jennifer Gill, Friday, September 13, 2019
Updated: Thursday, September 12, 2019
September 13, 2019

North Carolina House Votes to Override Governor’s Budget Veto
In an early-morning move earlier this week that shocked and confused many, the North Carolina House of Representatives voted to override Gov. Roy Cooper’s veto of the state budget. Just over half of the 120 members were present to vote. All 55 Republicans present voted in favor of the override. Just 15 Democrats were in the Chamber and all voted against the override. The Senate is scheduled to take up a vote on the override next week. If the Senate votes to override, the budget passed nearly two months ago by Republican majorities will go into effect and the long session will, in all probability, wind down quickly.

North Carolina Special Elections Tab Murphy, Bishop for US House Seats
North Carolina voters went to the polls earlier this week in two special elections. Republican Greg Murphy was elected in Congressional District 3 and Republican Dan Bishop was elected in Congressional District 9. Both were members of the North Carolina General Assembly and their seats will now need to be filled.

CMS Releases Final Version of MDS 3.0
CMS has posted the final version (V3.00.1) of the MDS 3.0 Data Specifications for Skilled Nursing Facilities, which take effect Oct. 1. They also released the file of the allowable ICD codes in item I0020B of the MDS. Click on download files to access the final version of the specifications. You will find the files in the download section at the bottom of the page. Revisions can be identified by looking for “post-errata” in the version notes for the items and edits.

RAD for PRAC Notice Issued
Effective immediately, HUD providers of Section 202 Housing for the Elderly with Project Rental Assistance Contracts (202/PRACs) can now begin to leverage private capital to preserve their affordable housing over the long-term.

What Have We Done for You Lately?
LeadingAge national has been busy working on your behalf. Click here for a look at their August 2019 activities.


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

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Advocacy in Action August 23, 2019

Posted By Jennifer Gill, Friday, August 23, 2019
Updated: Thursday, August 22, 2019
August 23, 2019

CON Reform Update
It appears that our efforts around CON reform — and particularly an exemption for CCRCs around Medicare-certified home health — are over for this year’s long session. It is our understanding that House Bill 126 (which contained CON reform language) has been gutted and will be used for another purpose as we get closer to the end of the long session. After coming so far this year - with passage for the first time by the Senate - it’s tremendously disappointing. However…if we’ve learned anything over the past six years in moving this issue forward, it’s that we can’t give up. The bill is still alive and eligible for consideration during next year’s short session. Your hard work and persistence are getting us closer to our goal every year and we remain committed to getting this thing over the finish line.

Medical Care Commission Legislation Advances to Conference Committee
Senate bill 537 – legislation that would provide a seat for an individual affiliated with a nonprofit CCRC on the North Carolina Medical Care Commission – remains alive in this session of the General Assembly. A number of other issues are contained within the bill, which now sits in a conference committee of House and Senate conferees.

Arbitration Agreements
On July 18, CMS published a final rule on arbitration agreements in nursing home settings. The final rule repeals the prohibition against pre-dispute, binding arbitration agreements while strengthening the transparency of arbitration agreements in long-term care settings. LeadingAge national advocated for many of the provisions contained in the final rule, which goes into effect Sept. 16, 2019. Read a summary of the rule.

LeadingAge Responds on “Patients Over Paperwork” Initiative
LeadingAge national recently responded to CMS’s second Request for Information on the “Patients Over Paperwork” initiative. The initiative, first launched in 2017, aims to reduce unnecessary burden, increase efficiency, and improve the beneficiary experience by streamlining regulations and subregulatory guidance. CMS has received over 3,000 comments since that time, classified into nine categories. LeadingAge national’s comments, available here, centered around documentation requirements and quality measures.


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

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Advocacy in Action August 9, 2019

Posted By Jennifer Gill, Friday, August 9, 2019
Updated: Thursday, August 8, 2019
August 9, 2019

Medical Care Commission Legislation Approved by North Carolina House
The North Carolina House of Representatives approved Senate bill 537 earlier this week. The bill includes language providing for a formal seat on the North Carolina Medical Care Commission for an individual affiliated with a nonprofit continuing care retirement community. Finding a formal seat for a CCRC representative on the Commission is a key part of our 2019 Public Policy Priorities. There was no opposition to the bill. The legislation is now back on the Senate side where it awaits appointment of a conference committee to take up differences between the House and Senate versions.

Certificate of Need Legislation Continues to Await House Action
House Bill 126, approved two weeks ago by the Senate and which would grant an exemption to CCRCs from the Certificate of Need review process for Medicare-certified home health, awaits consideration by the House and appointment of a committee of House and Senate conferees to attempt a compromise.

Retirement Savings Bill Awaits U.S. Senate Action
The SECURE Act – Setting Every Community Up For Retirement Enhancement – approved by a vote of 417-3 in the U.S. House, still awaits action by the U.S. Senate.  The bill makes significant changes that will impact most Americans who are preparing for retirement. There are three important changes: required minimum distributions can start at age 72 instead of 70½, stretch IRAs will be shortened, and individuals can continue to make tax deductible contributions until 72.  Other provisions in the bill will benefit families. Up to $10,000 can be withdrawn from a 529 plan to pay down student loans which will help make a dent in the nation’s student loan debt epidemic. The bill also allows new parents to withdraw up to $5,000 without being penalized from their IRAs or 401k plans to help defray birth and adoption expenses. A major change is the ability of employers to now offer annuities as an investment option in their employer sponsored 401k plans. This change gives participants a way to protect capital and provide a guaranteed income for life, once they retire. The bill will no longer allow IRA holders to pass their IRAs to heirs over the heirs‘ lifetime (spouses and minor children are excluded).  Additionally, the bill stipulates that upon death, the IRA must be liquidated within ten years. The Senate is expected to soon take up this bill for discussion. Assuming they pass a comparable bill, it will go through a reconciliation committee and then will be sent to the President for signature. At this point, most people believe the Senate and President support these changes.  To learn more about this, click here.

CMS Publishes Final Rule on Arbitration
CMS published a final rule on arbitration agreements in nursing facilities on July 18, 2019.

ROP Phase 3 Revisions: Side-by-Side Comparison
LeadingAge National has created a handy document to walk you through how the new proposed ROP rule impacts implementation of Phase 3, which is scheduled for November.

LeadingAge National Provides Information on PPS Final Rule
This week, CMS released the final rule updating the Medicare skilled nursing facility prospective payment system (PPS). This includes the final payment update based on current data as well as the wage index.

Registration Opens for NC Coalition on Aging Annual Meeting and Luncheon
The 2019 annual meeting and luncheon of the NC Coalition on Aging will take place on Friday, September 27, at the NC State University Club Raleigh, with the program beginning at 12:00 noon. This year’s keynote speaker is Governor Roy Cooper. Registration information is posted on the Coalition’s website.

What Have We Done For You Lately? – July 2019
With Washington, DC, temperatures hovering in the 90s for most of July, you’d think the month of November would be the last thing on the minds of LeadingAge team members. Click here for an update on all the things LeadingAge national did for us in July.

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

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Advocacy in Action July 26, 2019

Posted By Jennifer Gill, Friday, July 26, 2019
Updated: Thursday, July 25, 2019
July 26, 2019

Senate Approves Compromise CON Reform Legislation
On Wednesday this week, the North Carolina Senate approved House Bill 126, which would grant an exemption from the Certificate of Need review process for continuing care retirement communities. Its passage marks a milestone in the six-year effort to obtain this exemption that is so important to many CCRC residents.

Passage of the legislation by the Senate now sets up consideration of the bill by the House of Representatives. Without getting too far down in the sausage-making weeds, the House will in all likelihood vote to not concur with the bill…this is a procedural reality that will result in the formation of a conference committee of appointed Senate and House members. The conference committee will work to come up with a version that both chambers can vote on…if that happens – and if both chambers vote to approve the bill that comes out of the conference committee – it will go to the Governor for his signature.

At this point it appears the Senate and House will run skeletal sessions next week. We are carefully monitoring the potential appointment of members to the conference committee and will provide more information as it becomes available.

Analysis of Major Changes in RoPs
Last week, CMS announced proposed rules that would delay key components of the Phase 3 Rules of Participation. CMS proposed delaying until November 28, 2020, requirements pertaining to compliance and ethics, as well as Quality Assurance Performance Improvement plan (QAPI) stipulations. As promised, here is LeadingAge national's complete analysis of the proposed rule. We’ll be providing more information as the rulemaking process continues.

LeadingAge Works to Fix CNA Training Penalty
Nationally, LeadingAge advocates have been out in force to lobby for H.R. 1265, the bipartisan Nursing Home Workforce Quality Act. When a nursing home gets fined more than $10,000 — despite the reason – it cannot train staff to be certified nursing assistants for 2 years. The bill would change the law to give CMS the choice to decide which penalty makes sense when a problem is found.

  • Want to keep up the momentum over the August recess? Go to LeadingAge national's “Make Your Voice Heard” webpage beginning August 1st. Send a letter asking your representative to support the bill – or, visit him or her in a district office.
  • If your Member is on the bill already – list follows – thank him or her! Sean Duffy (R-WI) and Colin Peterson (D-MN) introduced the bill, and Greg Gianforte (R-MT), Glenn Grothman (R-WI), Jim Banks (R-IN), Roger Marshall (R-KS), Steve Watkins (R-KS), Liz Cheney (R-WY), Lance Gooden (R-TX), Pete Stauber (R-MN), Tom Cole (R-OK), Kevin Hern (R-OK), and Adrian Smith (R-NE) are cosponsors.

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

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Advocacy in Action June 14, 2019

Posted By Jennifer Gill, Friday, June 14, 2019
Updated: Friday, June 14, 2019

June 14, 2019

Senate Health Care, Finance Committees Move Forward with CON Exemption for CCRCs

Earlier this week, the Senate Health Care and Senate Finance committees each passed Senate Bill 361. Included in the bill is a provision exempting CCRCs from CON review for Medicare-certified home health. The bill now goes to the Rules and Operations Committee of the Senate. During Wednesday’s Senate Health Care Committee hearing, Sen. Joyce Krawieck (the bill’s primary sponsor and co-chair of the Health Care committee) indicated that she had heard from “so many staff and residents of continuing care retirement communities over the past several days.” At the same time that the Senate is hearing Senate Bill 361, a conference committee made up of a select group of Representatives and Senators has been meeting to hammer out a compromise on the budget. Contained in the budget bill (House Bill 966) is a provision that mirrors the language in Senate Bill 361 on our exemption from CON for Medicare-certified home health (included on page 144 of the bill that was available at press time).

General Assembly in Final Negotiations Over State Budget
The North Carolina House of Representatives and Senate have formed a conference committee to negotiate a final version of the state’s two-year budget. Once the two chambers have reached agreement, their version of the budget will go to Governor Roy Cooper. It is widely believed that Cooper will veto the budget if it does not contain Medicaid expansion. The budget continues to honor the state’s longstanding tax policy provisions affecting nonprofits, including the property tax exemption and the sales tax refund. While the Senate Health Care committee has approved a bill (Senate Bill 361) exempting CCRCs from the CON need determination process for Medicare-certified home health (see article above), the Senate’s budget proposal also includes the language. The North Carolina Center for Nonprofits has prepared a helpful comparison chart highlighting many key nonprofit provisions in the House and Senate versions of the budget.

LeadingAge NC Participates in PACE Final Rule Information Sharing
Earlier this week, LeadingAge NC participated in a call with LeadingAge national and PACE sites from around the country to discuss the impact of the final rule for PACE recently announced by CMS. Brendan Flinn, Director of Home and Community-Based Services for LeadingAge national, provided information and context for those participating. As a reminder, late last month CMS announced a new final rule for PACE programs. The final rule increases flexibility for PACE programs and may have the effect of expanding access to PACE among consumers. LeadingAge has prepared a summary analysis of the final rule (also in PDF). Members with questions or comments about the Final Rule are encouraged to reach out to Brendan.

Hill Action on Spending, Medical Expense Deduction, and Housing Credit
Congress is abuzz with activity. The House is considering a package of spending bills, including its fiscal year 2020 (FY20) HHS appropriations bill. Next week, the week of June 17, the House will consider its FY20 HUD appropriations bill as part of another spending package. In addition to these appropriations measures, three non-appropriations issues are also in motion.

First, LeadingAge national is supporting H.R. 2073 and S. 110, bi-partisan legislation to make permanent the 7.5% threshold for the medical expense deduction. LeadingAge national has joined over 50 other consumer and aging services organizations in a letter supporting these bills. Second, national is pouring over the Senate Health, Education and Labor (HELP) Committee's bipartisan discussion draft to reauthorize the Older Americans Act (OAA). Of note, the draft does not address any changes to Title V, the SCSEP Programs, that are a priority for LeadingAge and were included in the recommendations of the Leadership Council of Aging Organizations to the HELP Committee. Third, we were thrilled to see the June 4 introduction of Senate and House bills to expand and strengthen the Low Income Housing Tax Credit program. The bills would expand state Housing Credit allocations by 50% and make several improvements, including clarifying some year-15 issues to help nonprofits attain communities after investors absorb their tax benefits and a basis boost for communities serving extremely low-income households.

New Edition of Research Update Now Online
The LeadingAge LTSS Center @UMass Boston just released the latest edition of Research Update, their regular online newsletter about recent developments in the long-term services and supports world. Check out articles on what we can learn from state efforts to finance LTSS, family caregiving from a distance, and the home-care workforce.

LeadingAge National Webinar
RoPs Overview: Compliance and Ethics Enforcement

Tuesday, June 18
2-3 p.m. ET

How did you become involved in LeadingAge North Carolina?
I met the previous executive director down in New Bern as we were both sailors. I was fortunate when Tom Akins came on board that we hit it off and have had a great working relationship ever since.

What makes our mission meaningful to you?
The options that our community residents (and not quite residents) have in choosing how they want to spend their later years, knowing that the CCRC/LPC staff will be there in good times and trying times. That has to be such a gift of peace of mind.

If you had a magic wand, what is the one thing you as our lobbyist would like to do for the population we serve?


If you could share one gold nugget of information with the LeadingAge North Carolina membership, what would you want them to know?
Although, I am at the legislative building everyday they are in session and a lot of days they are out, the LeadingAge NC membership has a more powerful voice collectively than I do. They should use it more often.

What do you do to relax, to get away, to recharge your batteries?
Ride my horse, sailing, hiking and a really good glass of Bourbon, Pinot Noir or Cabernet.

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

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Advocacy in Action May 24, 2019

Posted By Jennifer Gill, Friday, May 24, 2019
Updated: Thursday, May 23, 2019

May 24, 2019

North Carolina House Approves Budget Proposal; Senate Plan Expected Soon
The House approved its $23.9 billion budget proposal (HB 966 – 2019 Appropriations Act) earlier this month and sent it on to the Senate which is expected to release its own budget plan soon. A conference committee of House and Senate members will be charged with ironing out the differences in the two documents, hopefully in time for final approval of the budget before the current fiscal year ends June 30.

A Quick Recap of Where We’re at with Key Legislative Items

S 646 - Certificate of Need Reform and Medicare-certified Home Health: This is a small step forward in CON reform, but a large step in helping control healthcare costs for NC citizens. In addition to other CON reforms, this bill would exempt continuing care retirement communities from the need determination process for Medicare-certified home health. This has been one of the Association's key public policy priorities for the past five years. The controversy over Certificate of Need healthcare regulations is a perennial one at the legislature, but Sen. Ralph Hise, R-Mitchell, said May 15 at a press conference with fellow House and Senate Republicans who want to repeal or scale back CON regulations that, "I predict there will be large movements in CON laws in this session." According to the State Medical Facilities 2020 plan, it would only affect two-tenths of one percent of the total population that would receive home health care in 2020…but it’s so important to North Carolina seniors who live in our state’s nonprofit continuing care retirement communities (a group of communities that has an estimated $2 billion impact on the state’s economy each year).

HB 410Require Generators in Nursing Homes and Adult Care Homes: This bill was amended from what was originally introduced to create the House Select Committee on Emergency Electrical Service for Nursing & Adult Care Homes. The Committee is to study the feasibility of requiring all nursing homes, combination homes, and adult care homes, to provide emergency electrical service for use in the event of failure of the normal electrical service. The legislation would require the Committee to report its findings and recommendations to the Joint Legislative Oversight Committee on Health and Human Services no later than March 1, 2020. The bill passed the House and is in the Senate Rules Committee.

Special Care Unit Moratorium: The budget plan approved by the House includes a provision extending the moratorium on special care units until June 30, 2021. There are some exceptions to this moratorium contained within the legislation.

HB 708 – Legislative Research Commission –  Study Affordable Housing: This bill directs the legislative research commission to study the availability of affordable housing in North Carolina. The LRC is to report its findings, together with any proposed legislation, to the 2020 Regular Session of the 2019 General Assembly upon its convening. The bill passed the House and is in Senate Rules Committee.

HB 724 – Truth in Caller ID Act: This bill would prohibit the use of misleading telephone identification methods for telephone solicitations by voice or text. The practice, known as "spoofing" or "cloning," is commonly used by scammers posing as tax collectors or kidnappers.  Even some legitimate telemarketers often use what's called "neighbor spoofing" to make their calls or texts appear to be coming from local numbers. Under this bill (which passed the House unanimously and is now in the Senate Rules Committee), telemarketers who use misleading information to hide the origin of their calls could be sued by a citizen or fined from $500 to $5,000 by the state attorney general. 

Revenue Surplus: Much of the surge in North Carolina income tax collections this spring cannot be counted on to repeat in 2020 and 2021, state government economists said on May 14. That could limit options on further spending or tax breaks in the upcoming two-year budget.  An updated examination of April tax collections by legislative staff and Gov. Roy Cooper's budget office forecasts a $643 million surplus for the year ending June 30, according to separate memos from the executive and legislative branches. That's 2.7% above what was anticipated last summer when the current-year state budget was finalized. The figure is slightly below the $700 million the legislature's top economist, Barry Boardman, said earlier this month was possible when all April collections were examined. But it still marks the largest state government surplus since the Great Recession, and a surplus for the fifth consecutive year.  In February, state economists projected a $151 million surplus this year, but it grew because individual income tax payments in April were 46% higher compared to last year.  (Gary D. Robertson, THE ASSOCIATED PRESS, 5/14/19)

State of Washington Leads the Way in Innovative Approach to LTSS Funding
John O’Connor, McKnight’s editorial director, offers his take on Washington state’s innovative new program to help pay for long-term care expenses for individual consumers.

Time to Comment on DOL Overtime Proposed Rule
May 21
 is the deadline for nonprofits, employees, for-profit businesses, and interest groups to provide real-world context to the Department of Labor (DOL) about proposed changes to the overtime rules. In March, the Labor Department proposed, among other things, adjusting the minimum salary level that exempts white-collar employees from overtime pay by raising the threshold to $679 per week ($35,308 per year) from the current level of $455 per week ($23,660 per year) set 15 years ago. The salary level is one step of a three-part test for determining whether a person is properly treated as an executiveadministrative, or professional worker, and thus exempt from overtime pay. Learn more about what’s being proposed by reading this brief abridged version of the draft regulations and the Council of Nonprofits’ updated analysis.

LeadingAge National's Bill Tracker
LeadingAge national’s Regulatory Roundup 2.0, is a quick and easy tracker to help members find pertinent rules and federal regulations, with timelines for submitting comments and links to any comments LeadingAge may have submitted.

LeadingAge North Carolina | 222 N. Person Street, Raleigh, NC 27601
919-571-8333 | |

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Advocacy in Action April 26, 2019

Posted By Jennifer Gill, Friday, April 26, 2019
Updated: Thursday, April 25, 2019

April 26, 2019

And the Crystal Ball Says…

With the caveat that “those who live by the crystal ball soon learn to eat ground glass,” our quick and unscientific survey of leading voices at the North Carolina General Assembly forecasts adjournment of the “long session” perhaps as early as late July. As with most sessions involving the first year of the two-year biennium, key to legislators heading back home is resolution of the budget. LeadingAge North Carolina continues to work hard on the issues most important to you and we’ll continue pushing for our priorities as Senators and Representatives consider our issues.

New Changes to CMS Nursing Home Compare Released Yesterday
Changes in methodology with the CMS Nursing Home Compare numbers kicked in yesterday. In conjunction with LeadingAge New York, we’ve done a preliminary run of the impact by state and sponsorship type for the overall 5 star rating and each of the 3 components (staffing, health inspections, and quality). Overall, 15% of nursing homes nationally gained 1 or more stars and 36% lost one or more stars. The variation by state and provider type can be substantial. We’ve dovetailed pretty closely to national averages here in North Carolina, with 21% of nursing homes gaining one or more stars and 35% losing one or more stars. A complete look at state numbers can be found by clicking here.

As expected, the inspection rating was almost equal for the ups and the downs on a national level. On staffing, there were 3 times as many facilities losing a star as gained a star. On the quality measures, 47% of facilities lost 1 or more stars and only 7% gained 1 or more stars.

Make Sure to Attend the Town Hall Conversation at the Annual Conference
The LeadingAge North Carolina Town Hall Conversation is your opportunity to provide input to LeadingAge – both at a national and state level – about ways public policy is affecting you, the older adults you serve, and how policy could be changed for the better. This year’s Conversation will be held on May 6 from 2:30-4pm at our annual conference in Myrtle Beach. Results of the Conversation will be shared with LeadingAge’s Policy
Committee, Board of Directors and staff, and will be used to set public policy priorities to better represent your interests and the interests of older adults in Washington, DC.

Federal Updates
Congress is pushing forward with work on budget and appropriations measures for fiscal year 2020, which begins on October 1. One of the first considerations will be raising caps on discretionary spending that were imposed by the Budget Control Act of 2011. The budget caps would require draconian cuts in
funding for a wide range of federal domestic programs, including affordable housing and home- and community-based services for older people. The House Budget Committee has approved an increase in the spending caps for fiscal years 2020 and 2021.

Affordable Senior Housing
Preliminary work has begun on determining spending levels for housing programs for fiscal 2020. In conjunction with LeadingAge national, we are advocating for the following:

  • Expanded funding for new Section 202 homes to $600 million.
  • Full funding for rental assistance contracts renewal. • Full Service Coordinator funding, as well as $30 million to expand Service Coordinators to more communities.
  • Enactment of legislation to improve and expand the Low Income Housing Tax Credit program.
  • Protection of the National Housing Trust Fund, Capital Magnet Fund, and Private Activity Bonds.

Medicare Observation Days
Legislation has been introduced in both the House and the Senate, H.R. 1682 and S. 753 respectively, to resolve the observation days issue by requiring all time Medicare beneficiaries spend in a hospital to count toward the three-day stay requirement for coverage of any subsequent post-acute care. Both bills are bipartisan. In conjunction with LeadingAge
national, we strongly support the legislation and are urging legislators to cosponsor these bills.

Home and Community-Based Services
Money Follows the Person: Both the House and Senate have passed H.R. 1839, the “Medicaid Services Investment and Accountability Act,” to extend the Medicaid home- and community-based services spousal impoverishment protections through September 2019 and provide an additional $20 million for Money Follows the Person. We are hearing that the President plans to sign the bill into law.

Older Americans Act
The law that funds a wide range of home and community-based services, including congregate and home-delivered meals, family caregiver support, and transportation, is due for reauthorization this year. In conjunction with LeadingAge national, we are working with other stakeholders on reauthorization legislation, including an increase in funding to meet the needs of an aging population.

In conjunction with LeadingAge national, we are working for passage of S. 299, the “Geriatrics Workforce Improvement Act” introduced by Senators Susan Collins (R-ME) and Bob Casey
(D-PA). This bill would help to ensure a more adequate supply of health care and other professionals trained and educated to meet the special needs of people as they age.

Nurse Aide Training Lock-Out

Since the automatic loss of training authority is statutory, LeadingAge national has worked with Rep. Sean Duffy (R-WI) on the introduction of the “Nursing Home Workforce Quality Act,” H.R. 1265. The bill has bipartisan cosponsorship and in conjunction with LeadingAge national, we are working to get more House members to sign onto it.

Proposed Fiscal 2020 Medicare Rule
CMS posted the proposed rule late on Friday, April 19, along with a fact sheet. Among many other provisions, the proposed rule, “projects aggregate payments to SNFs will increase by $887 million, or 2.5 percent, for FY 2020 compared to FY 2019. This estimated increase is attributable to a 3.0 percent market basket increase factor with a 0.5 percentage point reduction for multifactor productivity adjustment.” CMS again reminded nursing homes that the Patient Driven Payment Model reimbursement system will take effect for fiscal 2020. LeadingAge national is analyzing the rule and will file comments on it; the comment deadline is June 18.

Bill Trackers
Both LeadingAge North Carolina and LeadingAge national maintain legislative “bill trackers.” Click here for LeadingAge North Carolina’s version; click here for LeadingAge national’s version.

Information About Memorials for Mike Walsh
The First Presbyterian Church in Burlington was packed to the rafters earlier this week for Mike Walsh’s memorial service. Mike, executive director at The Village at Brookwood, was one of the most beloved colleagues for many of us in North Carolina. His service was a celebration of his life, his passions, and his legendary humor. In lieu of flowers, memorials may be made to the “Michael D. Walsh Family Trust” in care of the Village at Brookwood, 1860 Brookwood Avenue, Burlington, NC 27215 for his children’s education. We hope that you will consider a contribution to Mike’s kid’s future educational needs.

LeadingAge North Carolina | 222 N. Person Street, Raleigh, NC 27601
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Advocacy in Action April 12, 2019

Posted By Jennifer Gill, Friday, April 12, 2019
Updated: Thursday, April 11, 2019

April 12, 2019

Legislation Requiring Emergency Generators Approved by House Committee
A bill introduced by Rep. Julia Howard requiring generators capable of providing “heat, air conditioning, lighting and other essential services” during power outages in skilled nursing facilities, combination facilities, and adult care homes was approved by the North Carolina House Committee on Aging. Cost estimates provided by the North Carolina Senior Living Association pegged the estimated price tag for outfitting the state’s adult care homes with emergency generators at $84 million. All LeadingAge North Carolina life plan communities/continuing care retirement communities have emergency generators. The bill now goes to the House Rules committee for further study. If passed by both chambers and signed by the Governor, the North Carolina Medical Care Commission would be tasked with writing rules to implement the legislation. LeadingAge NC has already had conversations with Medical Care Commission staff about the bill.

Nonopioid Opt Out Bill Introduced
A bill introduced by Reps. Mary Belk, MaryAnn Black, Josh Dobson, and Donna White would “recognize the desire and right of a patient to elect nonopioid prescriptions and treatments.” H318 (the Opioid Prescription and Treatment Opt Out Act) would require the Department of Health and Human Services, in consultation with the North Carolina Board of Medicine and the North Carolina Board of Pharmacy, to develop an official voluntary nonopioid advance directive form by January 1, 2020. The proposed legislation has been reviewed by the LeadingAge North Carolina Public Policy committee and their comments are in the process of being communicated to the bill’s sponsors.

Medicare-Certified Home Health Language Included in Senate Bill
Senators Jim Burgin, Ralph Hise, and Joyce Krawiec have introduced legislation that would exempt from certificate of need review the establishment of a home health agency by a continuing care retirement community. Senate Bill 646 would allow provision of home health services to one or more residents of a life plan community/continuing care retirement community who have entered into a contract to receive continuing care services with lodging. Similar exemptions for LPCs/CCRCs already exist in the State Medical Facilities Plan regarding adult care homes and skilled nursing facilities. It is our belief that if home health services had been as prevalent when those exemptions were placed in the State Medical Facilities Plan as they are now, an exception for home health would already be in the plan. To truly fulfill the duty of an LPC/CCRC, LeadingAge North Carolina and its member communities believe that the provision of Medicare-certified home health is a vitally important component within the post-acute continuum. LPCs/CCRCs have been historically successful in the operations of other care-related components within the campus (chiefly assisted living and skilled nursing for which exemptions already exist), even when faced with limited volumes. This petition would allow LPCs/CCRCs the option of applying for a Medicare-certified home health license and, ONLY if the State found their application compliant with all of its requirements, provide Medicare-certified home health services ONLY to the individuals with whom they have continuing care contracts, as defined by current North Carolina statute. And then, ONLY if the resident chose them. Watch for a special Advocacy in Action message next week.

Senior Housing Rally Scheduled for May 8 in Washington, DC
Senior housing advocates from around the country will gather in Washington, DC on May 8 for a rally on the steps of our nation’s capital to bring attention to the senior housing crisis and advocate for solutions. The rally, building on the success of the wildly successful one held in 2017, is sponsored once again by LeadingAge national. You can find information about the rally, access a detailed flyer, and even watch a nifty video from LeadingAge CEO Katie Smith Sloan. Sign up today and bring your voice to the conversation!

Blue Cross NC and Duke Health to Create New Health Insurance Company Targeting Seniors
If it’s approved by CMS, the new company named Experience Health will begin offering Medicare Advantage plans in the following counties on Jan. 1, 2020: Alamance, Durham, Franklin, Granville, Lee, Orange, Person, Vance and Wake. Blue Cross Blue Shield will provide billings, claims, and enrollment services while Duke Health will provide medical care and facilities.

NEW! LeadingAge North Carolina Bill Tracker
The LeadingAge North Carolina bill tracker is a quick and easy way to help members track current legislation in front of the General Assembly in Raleigh. The spreadsheet is simple to navigate and will be updated and sent to you on a regular basis.

LeadingAge North Carolina | 222 N. Person Street, Raleigh, NC 27601
919-571-8333 | |

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Advocacy in Action March 22, 2019

Posted By Jennifer Gill, Friday, March 22, 2019
Updated: Friday, March 22, 2019

March 22, 2019

Capitol Hill Visits Impact Elected Officials

This week LeadingAge North Carolina members covered Capitol Hill to visit with their elected officials and reinforce the urgent needs of our aging population. With support from LeadingAge national regarding key messages, members banded together to articulate clearly and forcefully to our representatives in Washington on behalf of older adults. Our thanks to everyone who took on this task, conquering nerves and supporting one another's voices. Together, we can and do make a difference!

Above, LeadingAge North Carolina members Suzanne Pugh (far left)  from Aldersgate in Charlotte and Heather March (2nd left) from Croasdaile Village in Durham along with Katie Smith Sloan (3rd right) of LeadingAge national, Tom Akins, and Leslie Roseboro meet with Nora Blalock and Sean Maxwell from Representative David Price's office during Capitol Hill visits at the LeadingAge national Leadership Summit in D.C.

Above, the delegation from North Carolina, including staff from United Church Homes and Services in Newton, Givens Estates and Givens Communities in Asheville, Aldersgate in Charlotte, Croasdaile Village in Durham, Galloway Ridge in Pittsboro, along with Steve Fleming (far right) of The Well-Spring Group in Greensboro, Tom Akins, and Leslie Roseboro visit with staff members Bill Bode and Andrew Nam from Senator Thom Tillis's office and Rachel Soclof of Senator Burr's office in D.C. as part of Hill visits during LeadingAge national's Leadership Summit.

Above, Kenneth Jenzen (2nd left) and Teresa Stephens (center) from Givens Estates and Givens Communities in Asheville along with Lee Syria (2nd right) and Aimee Reimann (far right) from United Church Homes and Services in Newton visit with staff member Doug Nation (far left) from Representative Patrick McHenry's office.

Sign Up for the Seniors Action Network NOW

The Seniors Action Network is a grassroots movement organized to give America’s seniors a greater voice in public policy. The network recruits, educates, and trains advocates to take leadership in the formation of public policy by direct outreach to decision makers. Members of the Seniors Action Network engage in advocacy on issues that impact seniors by communicating directly with their Members of Congress through telephone calls, emails, and letter-writing campaigns. For more information about the Network and to sign up, CLICK HERE.

Medicare Observation Days Legislation
Legislation has been introduced in both the U.S. House and the Senate, H.R. 1682 and S. 753 respectively, to resolve the observation days issue by requiring all time Medicare beneficiaries spend in a hospital to count toward the three-day stay requirement for coverage of any subsequent post-acute care. We strongly support the legislation and are urging legislators to cosponsor these bills.

Urge the U.S. House and Senate to Fund New Housing for Older Adults
As Congress deliberates funding levels for HUD programs for the next fiscal year, fiscal year 2020, legislators must hear from you about the need to expand and preserve housing funding for older adults with very low incomes. The significant need for more Section 202 homes is nationwide and only growing. Today, only 1 in every 3 older adults eligible for housing assistance receives it because the programs are too small to meet need. Expansion of the Section 202 program would mean that fewer older adults will be forced to choose between housing, healthcare, and food. CLICK HERE to add your voice to those supporting affordable senior housing.

Provider Training Opportunity: Provider Transition to Medicaid Managed Care 101
The NC Division of Health Benefits has published a Special Medicaid Bulletin, Provider Training Opportunity: Provider Transition to Medicaid Managed Care 101, dated March 2019. Providers are encouraged to review this important information. For details, please refer to the 2019 Medicaid Bulletin web page.

Governor Signs Law Delaying Voter ID Requirements Until 2020 Election
Late last week, Governor Roy Cooper signed into law a bill (S.214) delaying photo ID requirements for voting until the 2020 elections. The delay was necessary because it would have been challenging for local elections boards to implement the voter ID in time for special elections to fill vacancies in the 3rd and 9th congressional districts later this year. Many nonprofits provide services to people who are eligible to vote but do not currently have photo IDs - including some seniors and individuals with disabilities. As North Carolina's election laws continue to evolve, it is important for nonprofits to provide clear, accurate, and nonpartisan information about elections to the people they serve.

Geriatric Workforce Enhancement Program Reauthorization
We are working for passage of S. 299, the Geriatrics Workforce Improvement Act introduced by Senators Susan Collins (R-ME) and Bob Casey (D-PA). This bill would help to ensure a more adequate supply of health care and other professionals trained and educated to meet the special needs of people as they age. Current Geriatric Workforce Enhancement Programs in North Carolina include sites at Duke University, East Carolina University, and the University of North Carolina.

Spousal Impoverishment Protections for Medicaid HCBS Clients
This program expired at the end of the 115th Congress. The Medicaid Extenders Act included a three-month extension of this protection for spouses of Medicaid beneficiaries receiving home and community-based services. (Note: Nursing home residents covered by Medicaid and their spouses have their own protections and are unaffected by this policy.) Reps. Debbie Dingell (D-MI) and Brett Guthrie (R-KY) have introduced H.R. 1343 to make home health spousal impoverishment protection permanent.

Older Americans Act
The law that funds a wide range of home and community-based services, including congregate and home-delivered meals, family caregiver support, and transportation, is due for reauthorization this year. We are working with other stakeholders on reauthorization legislation, including an increase in funding to meet the needs of an aging population.

Nurse Aide Training Lock-out
Since the automatic loss of training authority is statutory, we worked with Rep. Sean Duffy (R-WI) in the 115th Congress on the introduction of the Nursing Home Workforce Quality Act. We educated dozens of Congressional offices about the devastating impact of the CNA training lockout, and many LeadingAge members participated in our grassroots campaign. Rep. Duffy has reintroduced the bill as H.R. 1265, with Reps. Collin Peterson (D-MN) and Greg Gianforte (R-MT) as co-sponsors.

Money Follows the Person
This demonstration program that helps states rebalance their Medicaid programs expired at the end of 2018. Congress passed the Medicaid Extenders Act of 2019, now law, to provide three months of funding for MFP, allowing states to use the money through the end of September 2019. Reps. Debbie Dingell (D-MI) and Fred Upton (R-MI) have now introduced H.R. 1342 to permanently authorize the Money Follows the Person program. In the Senate, Senator Rob Portman (R-OH) has introduced the corresponding measure, S. 548.

CDC Report Paints Grim Picture of Rapidly Escalating Fentanyl Overdoses That Have Hit Vulnerable Communities Hard
The death rate among African Americans from fentanyl-involved drug overdoses rose 141 percent each year, on average, from 2011 to 2016, and the death rate for Hispanics rose 118 percent in that period every year on average. Altogether, the records revealed that more than 36,000 Americans died with fentanyl in their systems during the study period. The majority of those deaths — 18,335 — occurred in 2016 alone. Meanwhile, the nation's top medical advisers say that medication for addiction is vastly underused.

LeadingAge National Bill Tracker
The LeadingAge national Regulatory Roundup 2.0, is a quick and easy tracker to help members find pertinent rules and federal regulations, with timelines for submitting comments and links to any comments LeadingAge may have submitted.

LeadingAge North Carolina | 222 N. Person Street, Raleigh, NC 27601
919-571-8333 | |

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Advocacy in Action March 8, 2019

Posted By Jennifer Gill, Friday, March 8, 2019
Updated: Thursday, March 7, 2019

March 8, 2019

CMS to Lift Nursing Home 5-Star Freeze in April and Make Other Changes to Nursing Home Compare
CMS just announced that the freeze on health inspection ratings of long term care facilities that was instituted in February 2018 will be lifted in April. This is among several changes CMS says it is making to provide greater support to consumers looking to compare the quality of nursing homes via Nursing Home Compare. Major changes include:

  • End of the freeze on health inspections in April and a return to using three rounds of surveys for that score;
  • Higher thresholds for staffing stars and a tighter standard for weekend RN coverage. Currently, care centers that report seven or more days in a quarter with no RN onsite are automatically assigned a one-star staffing rating. In April 2019, the threshold for the number of days without an RN onsite in a quarter that triggers an automatic downgrade to one-star will be reduced from seven days to four days.
    • New quality measures added of long-stay hospitalization standards and emergency room transfers, and higher scoring standards for existing measures.
    • Separate quality ratings for short-stay and long-stay residents and revising the rating thresholds to better identify the differences in quality among nursing homes.
    • More details will be forthcoming from LeadingAge national and LeadingAge North Carolina.

READ the CMS press release and the memo CMS sent to state survey agencies.

North Carolina House Committee on Aging Meets
LeadingAge North Carolina was among organizations in attendance at a meeting earlier this week of the North Carolina House Committee on Aging. Committee members heard from Joyce Massey-Smith (Director for the NC Division of Aging and Adult Services) and Mary Bethel, (executive director for the NC Coalition on Aging). Both Massey-Smith and Bethel provided perspective to legislators on key aging issues in the state, with a particular emphasis on the changing demographic facing policymakers moving forward.

LeadingAge North Carolina Heads for Capitol Hill on March 20
Twenty-four of your LeadingAge North Carolina colleagues from across the state will be attending the upcoming “Day on Capitol Hill,” held in conjunction with LeadingAge national’s annual Leadership Summit in Washington, DC. The full day of Congressional visits will be held on March 20 and feature time with nearly every North Carolina federal officeholder or their staff. We’ll be reporting on those visits in a special March 29 “Advocacy in Action” update.

CMS Nursing Home Employee Satisfaction Survey and Staff Competency Assessment Tools Available for Free
The CMS Civil Money Penalty Reinvestment Program is a three-year effort focused on improving dementia care, reducing adverse events and more. CLICK HERE for more information about the release of new tools on employee satisfaction and staff competency assessments.

The SBA Office of Advocacy Wants to Hear from You About Burdensome Regulations
The federal Small Business Administration Office of Advocacy is gathering information from small businesses about burdensome federal regulations. They invite you to share your experience with burdensome federal regulations HERE. The information you provide is used by SBA in their advocacy efforts and scrubbed of identifying information then passed to the agency/agencies that are creating the burden/s. It is also taken into account by SBA as they plan regional regulatory reform roundtables.

LeadingAge National Public Policy Priorities
Last month, LeadingAge national released its comprehensive set of policy priorities. Together, we’ll be pursuing these short and long-term legislative and administrative advocacy priorities. The national priorities fall into three major categories:

  • Lead Priorities are a primary focus of our daily advocacy work. They include the aging services workforce, nursing homes, affordable housing, managed care/integrated services and home and community-based services.
  • Engage Priorities represent important work on which we collaborate with other organizations. They include Long Term Services and Supports financing reform, Medicare/Medicaid, home health services, hospice services, veterans affairs, behavioral health, rural concerns and elder justice.
  • Monitor Priorities are issues we continue to watch carefully. They include Alzheimer’s disease and related dementias, technology and telehealth, medical marijuana and tax policy.

Prospective Payment System Calculator Tool Updated
LeadingAge has updated the Medicare Part-A Skilled Nursing Facility Prospective Payment System calculator and the Medicare Part B therapy rate calculator to help members assess and estimate the impact of final payment changes for FY 2019. Access to this tool requires login via My.LeadingAge.

Medicare Observation Days Legislation to be Reintroduced
The 115th Congress did not consider legislation LeadingAge supports to resolve the observation days issue by requiring that all the time Medicare beneficiaries spend in a hospital counts toward the three-day stay requirement for coverage of any subsequent post-acute care. LeadingAge national is pursuing its reintroduction and passage in the new Congress.

Regulatory Tracker Launched
LeadingAge national has launched its new Regulatory Roundup 2.0, a quick and easy tracker to help members find pertinent rules and federal regulations, with timelines for submitting comments and links to any comments LeadingAge may have submitted.

Guidance on Medical Marijuana and Weapons Policies from LeadingAge National
LeadingAge national has published guidance for members on medical marijuana and weapons policies in aging services organizations. This guidance is a starting point for members who are having discussions around these two issues.

LeadingAge North Carolina | 222 N. Person Street, Raleigh, NC 27601
919-571-8333 | |

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