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Advocacy in Action

Posted By Jennifer Gill, Friday, November 22, 2019
Updated: Thursday, November 21, 2019
November 22, 2019

Medicaid Managed Care Transformation Suspended
The North Carolina Department of Health and Human Services announced earlier this week that the transformation to a system of managed care for providing Medicaid services will not begin on February 1, 2020. Instead, current and future Medicaid beneficiaries will continue to rely on the existing fee-for-service system. Department officials did not have a new date for when the transition might occur. In announcing their decision, the Department pointed to the inability of the General Assembly and the Governor to reach a budget compromise. The General Assembly closed its session last week without an end to the impasse and with no funds dedicated to the transformation project. The Governor’s veto in late June of the General Assembly’s proposed budget was in large part predicated on the spending plan not including any funds for Medicaid expansion. Providers enrolled in Medicaid will continue to bill the state through its NCTracks system, the Department said.

Paycheck to Paycheck Homeownership Affordability Calculator
Paycheck to Paycheck is an interactive online tool from the National Housing Coalition that allows users to research and compare rental and homeownership affordability challenges of workers in 81 occupations in 259 metro areas nationwide.
The tool provides data to compare ‘Income Needed’ and ‘Median Salary’ in up to three metro areas at a time for aging services related occupations including:

  • Affordable Housing Occupancy Specialist
  • Laundry Worker
  • Computer Support Specialist
  • Maintenance Worker
  • Social Worker
  • Nurse
  • Food Prep Worker
  • Office Clerk
  • Groundskeeper
  • Home Health Aide
  • Housekeeper
  • Physical Therapist
    Nursing Aide

The website highlights affordability challenges workers face in five job categories in the construction industry: carpenters; electricians; heating, ventilation, and air conditioning (HVAC) mechanics; maintenance workers and plumbers. We know we have an affordability crisis when the men and women who build our homes can’t afford to live in most of them. The same is true for the aging services field, when members of the workforce can’t find or afford homes. You can apply the same methodology to create reports that focus on aging services occupations.

New Discharge Planning Rule Effective Next Week
CMS's new discharge planning rule goes into effect next week on November 29. This rule impacts hospitals and home health agencies, requiring a formal discharge planning process. As part of this requirement, hospitals and home health agencies are required to share nursing homes' quality measure and resource utilization data. CMS recommends the use of the SNF QRP data, available on the Nursing Home Compare website, along with any other "compare" sites and information that meets the patient's goals for discharge. What does this mean for our members? Hospitals and home health agencies will need to comply with the rule. Our members with skilled nursing facilities should also be aware of this rule, as it may impact referrals and census. LeadingAge has posted this information in the Nursing Homes group on the LeadingAge Member Community and recommended that nursing homes keep an eye on their quality measure data, utilizing the Five Star Analysis Reports to see how they might improve. As a reminder, the next Nursing Home Compare update is scheduled for December 4.

Three U.S. Senators Question Private Equity Firms Stakes in Nursing Homes
Senators Elizabeth Warren (D-MA), Sherrod Brown (D-OH) and Representative Mark Pocan (D-WI) sent letters to four private equity firms that invest in companies providing skilled nursing care, questioning their commitment to quality of care. Click here for a closer look at the issue.

AG Stein and Speaker Moore Bring Added Focus to Scam Callers
Looking to bring more attention to the scourge of unwanted telemarketing calls, North Carolina Attorney General Josh Stein posted a downloadable voice note that people can use as a voicemail message. The attorney general’s office has initiatives to combat telemarketing scams, featuring a hotline (1-877-5-NO-SCAM) that people can call if they have been the victim of a scam. Add to that legislation introduced by House Speaker Tim Moore and signed into law by Governor Roy Cooper (the “Truth in Caller ID Act,” which fines violators up to $5,000 for multiple transgressions), and it’s easy to see why North Carolinians are fed up with unwanted calls. Click here for Stein’s voicemail message.

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

Posted By Jennifer Gill, Friday, November 8, 2019
Updated: Friday, November 8, 2019
November 8, 2019

LeadingAge NC, NCHCFA, and Others Collaborate on Letter to Congressional Delegation
Earlier this week, LeadingAge North Carolina, the North Carolina Health Care Facilities Association, and others collaborated on a letter to the North Carolina Congressional delegation sharing our concerns about the CNA training lockout issue. Adam Sholar, CEO at NCHCFA, played a key role in this initiative. We continue to look for ways to leverage our voice with others in North Carolina to reach common goals.

Governor Roy Cooper Signs Into Law a Major Legislative Priority for LeadingAge North Carolina
Senate Bill 537 provides for a seat on the North Carolina Medical Care Commission for an individual “affiliated with a nonprofit continuing care retirement community.” The NC Medical Care Commission plays a key role in the financial health of our member communities and this action will help ensure that the Commission benefits from the wisdom of our membership’s collective knowledge.

As with any success, a number of folks shepherded this particular issue over the finish line:

  • Members of the Conference Committee that produced the final language approved by both chambers worked tirelessly to craft a bill that could garner support. Those conferees include Senators Ralph Hise, Joyce Krawiec, Harry Brown, and Andy Wells, as well as Representatives Josh Dobson, Donna McDowell White, and Donny Lambeth.
  • From the Department of Health and Human Services, Mark Payne and Matt Gross were especially helpful.
  • The LeadingAge North Carolina Public Policy Committee, chaired by Jonathan Erickson from United Methodist Retirement Homes, was instrumental in identifying this issue and pushing to keep it at the forefront.
  • None of our efforts would have been successful without the sustained hard work of our lobbyist, Lu-Ann Perryman…a very special thanks to her.

We’ll keep you informed as the opportunity becomes available to weigh in on potential nominees to the Commission. In the meantime, we hope you’ll celebrate with us!

Skilled Nursing Regulatory Update from LeadingAge Annual Meeting
LeadingAge national’s Division of Nursing Homes Director Evan Shulman last week presented a skilled nursing regulatory update at the LeadingAge Annual Meeting in San Diego. Presenting via a live remote feed, Mr. Shulman touched on a number of key topics before fielding questions from audience members. Click here for a comprehensive summary of Shulman’s presentation.

Final Bill Elusive as Senate Passes HUD Funding
The Senate passed its fiscal year 2020 HUD appropriations bill on October 31. The House passed its HUD FY20 appropriations bill in June. The two bills must be reconciled. Before the two can be reconciled, House and Senate Appropriations Committees must agree on spending limits for each of the 12 subcommittees, including the one that funds HUD. Without this subcommittee allocation agreement, the enactment of a final bill cannot occur.

The Senate’s bill is written under funding caps agreed to by the House, Senate and White House after the House’s HUD bill was passed. Because of the caps, the Senate has about $34 billion less in overall spending (across all the appropriations subcommittees) than the House bill does. The Senate’s HUD appropriations bill (which also includes funding for the Department of Transportation) is $5 billion below the House’s Transportation-HUD bill for FY20. For example, the Senate bill does not provide any funds for new Section 202 homes; the House bill provides $140 million. LeadingAge housing advocates are urging $600 million for new Section 202 homes in FY20.

Besides a lack of consensus on how to allocate funding among the 12 subcommittees, whether funding for a border wall should be included in an FY20 appropriations bill is a major area of disagreement. Funding for a border wall triggered the 2018 – 2019 longest-ever partial government shutdown.

Federal programs, like those funded by HUD, are now operating under a Continuing Resolution until November 21. Under the CR, programs are funded at FY19 levels for the duration of the CR. It’s very possible the CR will be extended until sometime in December, or even early in 2020. Another shutdown is also a possibility.

16th Annual LeadingAge Ziegler 200 Report Now Available
LeadingAge and Ziegler (a leading U.S. underwriter of financings for not-for-profit senior living organizations) announced the release of the 16th Annual LeadingAge Ziegler 200 (LZ 200) report. This report is a ranking and analysis of the nation’s 200 largest, most complex not-for-profit senior living organizations across the country as of December 31, 2018. It also outlines relevant business trends in the industry to showcase the variety of older adult services and offerings provided in the sector.

“Since the beginning of the LZ 200 report 16 years ago, we have helped drive change and innovation for older adults,” said Katie Smith Sloan, president and CEO of LeadingAge. “This year’s report demonstrates the significant role that LeadingAge members have in the aging services field and highlights the latest trends in the industry, like the continued increase in memory care offerings and the importance of resident engagement. Through this report, the entire sector can understand the latest technologies, services and growth opportunities that are driving the industry forward.”

The 2019 LZ 200 listing shows that senior living providers have grown primarily through community expansions and renovations, and affiliations. Nearly 30% of the total number of units for all senior living systems in the LZ 200 are represented by the 10 largest providers. The 2019 top 10 largest not-for-profit multi-site senior living organizations include:

  1. National Senior Campuses - Catonsville, MD
  2. The Evangelical Lutheran Good Samaritan Society - Sioux Falls, SD
  3. Acts Retirement Services, Inc. - West Point, PA
  4. Presbyterian Homes and Services - Roseville, MN
  5. Ascension Senior Living - St. Louis
  6. Trinity Health Senior Communities - Livonia, MI
  7. Covenant Living Communities & Services - Skokie, IL
  8. HumanGood - Pleasanton, CA
  9. Benedictine Health System - Duluth, MN
  10. Retirement Housing Foundation - Long Beach, CA

North Carolina was represented in the LeadingAge-Ziegler Top 200 by ten multi-site organizations, including:

  • Acts Retirement Services, Inc. (3)
  • Trinity Health Services Communities (6)
  • National Church Residences (41)
  • Lutheran Services Carolinas (60)
  • The Presbyterian Homes, Inc. (87)
  • United Church Homes and Services (91)
  • United Methodist Retirement Homes (94)
  • Givens (102)
  • Baptist Retirement Homes of North Carolina (153)
  • Friends Homes, Inc. (162)

The LZ 200 also showed that in the last 10 years, the average annual growth rate in total units was 2.8 %, with independent living and assisted living units growing each year but the number of nursing care beds decreasing. Other key areas of growth and innovation within the senior living industry include:

  • Similar to last year’s LZ 200 report memory care units are becoming an increasingly important component of the annual unit counts with 75% of the 2019 LZ 200’s listing offering specialized memory care units, compared to 60% in 2018.
  • Home-based services, such as home health, home care, adult-day care, continuing care at home (CCaH) programs and Program for All-Inclusive Care for the Elderly (PACE), continue to grow with approximately half of the 2019 LZ 200 offering some type of home and community-based service to nonresidents. However, the CCaH model is continuing to be eliminated from providers as only slightly more than 10 percent of this year’s LZ 200 offer it. This is 2% less than in 2018.
  • Adoption of new technologies slightly decreased as nearly 75% of providers use electronic point of care/point of service documentation systems and electronic health/medical records, compared to nearly 80% and nearly 76% in 2018, respectively. This year’s results on new technologies also showed that adoption of health and wellness technologies, such as medication monitoring or telehealth remote monitoring and care/case management and coordination is generally lower with less than 60% using these types of software. For the first time this year, the 2019 LZ 200 measured social connectedness/resident engagement, revealing that 49.5% of providers are using this technology.
  • Formal joint venture engagements marginally decreased this year with slightly more than 30% of 2019 LZ 200 organizations engaged in a formal joint venture, most commonly with another senior living provider, a health system or a home health/home care agency. However, engagement in a formal health care reform contract has steadily increased since the inception of the LZ report in 2014. This year, more than four out of 10 providers reported engaging in either Accountable Care Organization (ACO) or a bundled payment agreement.

The LZ 200 report is developed annually through a partnership between Ziegler and LeadingAge. It includes more than 200 providers of multi-site systems, more than 150 single-site campuses, and government-subsidized multi-site housing providers. To view the full report, please click here.

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

Posted By Jennifer Gill, Friday, October 25, 2019
Updated: Thursday, October 24, 2019
October 25, 2019

LeadingAge Fights Red Hand Nursing Home Icon
LeadingAge has mounted a campaign to halt the red hand icon CMS plans to attach to the Nursing Home Compare profiles of nursing homes cited for abuse. While abuse and poor quality care cannot be tolerated or excused, the icon will neither increase transparency nor help consumers pick the right nursing home for themselves or a family member. For more information on LeadingAge’s efforts, and how you can lend your voice, read more.

Learn About the IMAGINE Initiative
LeadingAge just released the "IMAGINE" Initiative – International Migration of Aging and Geriatric Workers in Response to the Needs of Elders. The "IMAGINE" paper outlines a series of bold proposals that, if enacted, would enable aging services providers to employ more foreign-born workers. The ideas took root in town halls hosted by state associations throughout the country, where LeadingAge heard—loud and clear—that workforce is by far the largest challenge faced by members. We know it’s going to take a lot of different solutions to solve the caregiver shortages we face today…and will face in the future. LeadingAge and affiliates will be sharing the paper with policy makers, colleagues, and partners in the coming months to raise awareness about the aging services workforce challenge and some possible solutions. Feel free to share the paper and use it as a conversation starter about the need for more workers in the aging services field. And CLICK HERE for a special message from LeadingAge CEO Katie Smith Sloan with more information about the initiative.

We Need Your Help: Take Action on New CNA Lockout Bill
Under federal law, nursing homes are inspected annually and fines are assessed for any deficiencies in compliance with federal regulations. If these fines exceed a certain level ($10,697 as of 2018), a nursing home automatically loses its authority to train certified nursing assistants for two years. H.R. 4468 is the second bill introduced to address this unfair penalty. It would end the mandatory 2-year lockout by authorizing that the training program be reinstated once the deficiencies for which the nursing home is cited are corrected.

Now is the time to use your voice and help us build momentum for this legislation. We need your U.S. Representative to become a cosponsor of this new legislation and show their support for nursing homes in your community.

How You Can Help:

CMS Memo to Strengthen State Survey Oversight
Late last week, CMS announced actions to strengthen State Agencies’ survey performance. The initiative stems from an evaluation back in 2018 and has led to efforts to improve how State Agencies performance is monitored and reviewed. We are analyzing the CMS memo and the steps CMS will take moving forward. The Memo can be found here.

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

Posted By Jennifer Gill, Friday, October 11, 2019
Updated: Thursday, October 10, 2019
October 11, 2019

We Need Your Help: Take Action on New CNA Lockout Bill
Under federal law, nursing homes are inspected annually and fines are assessed for any deficiencies in compliance with federal regulations. If these fines exceed a certain level ($10,697 as of 2018), a nursing home automatically loses its authority to train certified nursing assistants for two years. H.R. 4468 is the second bill introduced to address this unfair penalty. It would end the mandatory 2-year lockout by authorizing that the training program be reinstated once the deficiencies for which the nursing home is cited are corrected.

Now is the time to use your voice and help us build momentum for this legislation. We need your U.S. Representative to become a cosponsor of this new legislation and show their support for nursing homes in your community.

How You Can Help:

CMS Announces Major Changes to 5-Star Ratings for Abuse and Neglect Citations
Beginning October 23rd, nursing homes that have been cited for abuse that either caused harm or had the potential to cause harm will be indicated on Nursing Home Compare with a special icon. Additionally, star ratings for nursing homes with this icon will be capped at 2 stars for the health inspection rating, resulting in a maximum overall star rating no higher than 4 stars. CMS also announced that 2 quality measures will be removed from Nursing Home Compare. The short-stay and long-stay measures for residents who report moderate to severe pain will be removed from Nursing Home Compare and the 5-Star Quality Rating System. For more details on the Five Star changes read the Memo from CMS.

DOL Issues Final Rule on Overtime Threshold
The U.S. Department of Labor recently issued a final rule on the overtime threshold for exempt employees under the Fair Labor Standards Act. The Final Rule sets the minimum salary threshold for “white collar” exemptions, which will increase to $35,568 annually ($648 per week). The Final Rule goes into effect January 1, 2020. The exemption threshold for highly compensated employees is now set at $107,432, up from the previous threshold of $100,000. The Final Rule does not make any changes to the “duties test” under the FLSA for determining whether an employee is exempt. The DOL estimates that an additional 1.2 million workers will now qualify for overtime pay under the Final Rule. The salary thresholds in the Final Rule were consistent with LeadingAge’s comments on proposed rules in 2015, 2017, and earlier this year. For more information on the Final Rule click here.

North Carolina Department of Insurance Unveils New Website and Reference Guide

The North Carolina Department of Insurance has its new website up and running, with information about disclosure statements, a listing of all licensed CCRCs in the state, and helpful links to other stakeholders. In addition, the new website includes an updated CCRC Reference Guide, the department’s publication designed to assist prospective residents in their search for CCRCs in North Carolina.

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 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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