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January 19, 2018

Advocacy & Policy

Government Shutdown Looms

With government funding set to expire on Saturday, January 20, Congress needs to pass a stopgap spending measure and forward it to President Trump for his signature to avoid a shutdown. Efforts over the past two days to reach consensus on legislation keeping spending flowing until February 16 were thrown into turmoil yesterday as the President insisted on not including the Children’s Health Insurance Program in the bill. Republicans had hoped that inclusion of the CHIP provision in the bill would entice Democrats to support the stopgap legislation. Further complicating matters were immigration issues, most notably resolution of the Deferred Action for Childhood Arrivals program. As of press time, both the House and Senate were working on compromise legislation to avoid the impact of a government shutdown.

Analysis of Tax Reform Legislation

The National Center for Nonprofits developed a simple, easy-to-understand guide to the recently passed tax reform legislation. As previously reported, both the medical expense deduction and private activity bonds were preserved in the final version that was signed into law by President Trump.

Nursing Home Oversight and Requirements of Participation (ROPs)

While Phase II went into effect as of November 28, LeadingAge’s advocacy resulted in a delay in the imposition of civil monetary penalties for any deficiencies cited on the new requirements for the first 18 months. LeadingAge has posted tools and conducted webinars on the new requirements to assist members in preparing.

Nurse Aide Training Lock-Out

Our advocacy last year attracted some congressional interest in the CNA training lock-out issue. Since the automatic loss of training authority is statutory, LeadingAge national is drafting legislative language to make the remedy optional, rather than mandatory and soliciting a sponsor to introduce the measure.

Medicare Therapy Caps

Because Congress failed to extend the exceptions process before the end of calendar 2017, Medicare beneficiaries now are subject to the annual per-beneficiary caps on outpatient therapy. This year the caps are $2,010 for physical and speech combined and another $2,010 for occupational therapy. In November, the House Ways and Means Committee announced a bipartisan agreement that included making the therapy caps exceptions process permanent and extending the rural home health add-on for another five years. However, the committee indicated that these and other “extenders” would have to be budget-neutral and must therefore contain offsetting spending cuts. Reimbursement reductions for skilled nursing facilities and home health care providers are on the list. We are concerned about this possibility, since Medicare payments already are reduced by the 2% sequestration. Medicare extenders may be added to the 2018 continuing resolution Congress has to pass by tomorrow.

Medicare Observation Days Legislation

We are supporting H.R. 1421 and S. 568, the Improving Access to Medicare Coverage Act. The legislation would resolve the observation days issue by requiring all time Medicare beneficiaries spend in a hospital count toward the three-day stay requirement for coverage of any subsequent post-acute care. We urge you to contact your federal legislators to cosponsor these bills. Congressional action on this issue may come about as part of an end-of-year Medicare measure, as yet unseen.

Senior Housing Outlook for 2018

Last year, both the House and Senate Appropriations Committees approved HUD 2018 spending legislation that would fund Section 202 at $573 million, $70.6 million more than FY17. This amount would fully cover contract renewals and amendments. Also, both Appropriations Committees would have allowed HUD to expand its successful Rental Assistance Demonstration program to include Project Rental Assistance Contracts which we call "RAD for PRAC." RAD for PRAC would bring new housing preservation opportunities to aging PRAC communities and is a key priority for LeadingAge. The fiscal 2018 HUD spending measures approved by the Appropriations Committees last year were not enacted. Once the Administration and the congressional leadership reach agreement on total federal spending levels for this year, funding will be reallocated among federal programs. LeadingAge is urging Congress to include the funding levels previously approved for Section 202 and RAD for PRAC in whatever fiscal 2018 spending bill is passed to cover the remainder of this fiscal year.

Home and Community-based Services Legislation Features Three Initiatives

LeadingAge is advocating in favor of the following measures to improve Medicare coverage of home- and community-based services:

• S. 309/H.R. 4006, the Community Based Independence for Seniors Act. The legislation would establish a community-based special needs plan that would give low-income Medicare beneficiaries coverage for home- and community-based services. The House bill sets a tighter limit on the number of beneficiaries who may participate.

• S. 445, the Home Health Planning Improvement Act, introduced by Sens. Susan Collins (R-Maine) and Ben Cardin (D-Maryland). The bill would facilitate Medicare beneficiaries’ access to home health care by allowing physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives to order home health services. These health care professionals are playing increasingly important roles in the delivery of health care, particularly in rural and underserved areas.

• H.R. 3992, the Rural Home Health Extension and Regulatory Relief Act, which would extend the Medicare payment add-on for home health care providers and delay a Medicare payment change that would have serious consequences for home health care providers around the country.

2018 Congressional Calendar Now Available

The 2018 Congressional Calendar has been released. Click here for a handy one-page guide to when your elected federal officials will be meeting in 2018.

CMS Announces Initiative to Address Improper Facility-Initiated Discharges

CMS, in a Survey and Certification Letter dated Dec. 22, 2017 and posted on Dec. 26, 2017, announced an initiative designed to examine and mitigate facility-initiated discharges that violate federal regulations.

CMS noted in the Letter that “discharge/eviction” was the most frequent nursing facility complaint category logged by Long-Term Care Ombudsman programs nationally in FY2015. CMS stated that the reasons for non-compliant discharges can vary, but often are driven by payment concerns and behavioral/mental/emotional expressions or indications of resident distress.

To understand the full extent of the problem, CMS stated that it will be evaluating, at the CMS Regional Office (RO) level, all deficiencies precipitated by facility-initiated discharges. Specifically, it directed State survey agencies (SSAs) to transfer all cases “involving facility initiated discharge violations to the CMS RO for review where there is placement in a questionable or unsafe setting, where residents remain hospitalized, where there is a facility pattern, or other circumstances that the RO may identify of cases they would like transferred.”

Additionally, CMS is considering a variety of interventions to combat the problem, including surveyor and provider training, intake and triage training, CMP-funded projects that may help prevent facility initiated discharges that violate federal regulations, and enforcement.

The changes announced in the Letter took effect immediately.

Professional Development

Save the Date!

2018 LeadingAge North Carolina Spring Conference and Trade Show

The Omni Grove Park Inn
May 14-17, 2018
Asheville, NC

Co-workers want to receive email notifications about registration and other announcements? Be sure to tell them to visit our website and register in the top right corner of the page as community member staff, or business member staff if your company is a business member.

Awards Nominations Open

Celebrate our field! Who makes your community outstanding? What programs are worthy of attention? Recognize those special folks and programs that make a difference. Go online today to nominate that special person or program for a LeadingAge North Carolina 2018 award. Award nominations are due January 31, 2018.

Trade Show Registration Open

Business members please note that registration for the 2018 Trade Show is open. Booths are going quickly so be sure to reserve yours today and renew your business membership to connect with nonprofit retirement communities across the state.

2018 Event and Education Calendar Now Available

Please click here to view and print LeadingAge North Carolina's 2018 Event and Education Calendar for yourself and your staff. Be sure to mark your calendar for several programs. Be on the lookout for registration announcements by email, social media, and our website. We look forward to seeing you!


Register for Emergency Preparedness Programs Offered Across the State

The Center for Domestic Preparedness in Alabama has developed a one day (8 hour) course that is intended to help providers understand the CMS emergency preparedness rule and to assist them to working towards satisfactory completion. The course is free and instructors are provided by CDP.

Click here to view the syllabus overview and please note that the upcoming offerings will be offered across the state.

1. Jan. 22nd: JFHQ/SEOC, Raleigh
2. Jan. 23rd: Wake County Commons, Raleigh

Register Now for Infection Control Program Offered in March

S.P.I.C.E. offers this three day program every spring and fall. It is designed to provide participants with current and practical information for the recognition and management of common infection prevention issues in non-acute care facilities, with an emphasis on long term care. Basic statistics for surveillance and antibiotic stewardship are new additions to the course.

Infection Control in Long Term Care Facilities
March 26-28, 2018
William and Ida Friday Center, Chapel Hill, NC

Click Here to Register
Please see the new registration policy
Get a Course Quote by clicking here

Strategic Thinking

I Was a Skeptic of Mindfulness...Until I Tried to Make My Case

January 5, 2018, FiveThirtyEight

Mindfulness may sound like a new age concept that is definitely not for you. If so, consider taking a moment to read this author's take on the topic. Mindfulness simply refers to paying attention...and behaving thoughtfully.

9 Common-Sense Rules for Getting the Most Out of Meetings
December 5, 2017, Ideas.Ted.Com

Ever feel like your meeting just didn't go as planned? Check out this practical guide to making sure a meeting is as focused and productive as you need it to be.

VA Provides Fewer Unnecessary End of Life Interventions than Medicare, New Study Shows
January 9, 2018, Scope-Stanford Medicine

Most people prefer fewer medical appointments and interventions toward the end of life. Read this article for a brief explanation of the difference between VA and typical Medicare end-of-life interventions. The information might be helpful for residents who are veterans as well as others who love them.

3 Ways to Be a Strategist, Not a Tactician
January 13, 2018, Forbes

Be sure to read this article if you want guidance on bringing your work from execution of daily details to something more big-picture oriented. You'll be inspired to look to the future, expand your scope of influence, and drive larger scale change.

News and Notes

LeadingAge North Carolina Public Policy Committee to Meet January 25

LeadingAge North Carolina Public Policy Committee to Meet January 25
The LeadingAge North Carolina Public Policy Committee will meet January 25 in Raleigh to discuss a number of state and federal issues. Chaired by Jonathan Erickson (United Methodist Retirement Homes), the committee includes Zane Bennett (Plantation Village), Kyle Dilday (Retirement Living Associates), Pam Fox (Twin Lakes Community), Shane Gabis (The Cypress of Raleigh), Jefferson Kaighn (Acts Retirement-Life Communities), Lee Syria (United Church Homes and Services) and Lu-Ann Perryman (Carolina State Strategies). Watch your next Member Update for a report on the meeting.

Medical Care Commission Releases 2018 Meeting Dates

The North Carolina Medical Care Commission has released its 2018 meeting dates. They are February 9, May 9-10, August 9-10, November 1-2. Each meeting will take place in the Brown Building of the Dorothea Dix campus in Raleigh except for the May meeting which will take place at the Duke Health Pavilion in Durham. Click here to view the dates on their website.

Happy New Year!

Thank you for using Value First. Our goal is to continue helping LeadingAge members save money in all aspects of their operations. Value First is a full-service GPO (group purchasing organization) owned by LeadingAge national and twenty-five state associations, including LeadingAge North Carolina.

In addition to our Construction Services Program and free cost analysis in the food, medical, janitorial, and office supplies categories, we are also available to help you and your staff save money on equipment and services that you might not normally think of in connection with a GPO.

Do not hesitate to contact Vanessa Ceasar at 404-421-3956 if you need assistance with anything listed below—or other big-ticket items that are not on the list.

• Cabinetry
• Carpet
• Cellular employee discounts
• Coin-operated laundry equipment
• Commercial cleaning equipment
• Elevator maintenance
• Exercise equipment
• Furniture
• Hard surface & resilient flooring
• HVAC equipment
• Kitchen equipment
• Linens
• Medical waste removal
• Nurse call systems
• Passenger vans
• Patient transfer equipment
• Physical rehabilitation services
• Roof repair

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