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Tags Posts tagged with "home and community-based services"

home and community-based services

As ANCOR is analyzing the impact of the Centers for Medicare and Medicaid Services (CMS) mandate released this morning, it is clear that ICF employees are included; however, waiver services are not unless the provider employs 100 or more employees. We are trying to get a handle on how many providers this will impact. Please let Carol Ferenz know ASAP if this will impact your organization.

From the CMS Frequently Asked Questions document:

Q. Does this requirement apply to Medicaid home care services, such as Home and Community-Based Services (HCBS), since these providers receive Medicaid funding but are not regulated as certified facilities?

A. No, this regulation only applies to those Medicare and Medicaid-certified provider and supplier types that are subject to CMS health and safety regulations. CMS’s health and safety regulations do not cover providers of Home and Community-Based Services.

Message from ANCOR: 

The White House just released its framework for the Build Back Better Agenda this morning. The framework includes $150 billion for Medicaid Home and Community-Based Services. There is still no legislative text available for the budget reconciliation bill, which is how Congress will move forward this framework. Negotiations are still ongoing. We will continue to update you as we know more.

We are encouraged that reports indicate that HCBS funding will be included in the final bill. But we want to make sure we don’t let up on our advocacy in this final stretch!

Please join us TODAY as we participate in a Day of Action along with our coalition partners from disability, aging, and labor groups.

  • Please take action with our latest action alert and ask your members of Congress to support increased funding for HCBS. And please continue to share this widely with your networks!
  • Take a moment to engage on social media. You can tweet your members of Congress by using the directory linked here. Sample social media posts are below.

Here are some sample tweets you can use:

  • #Medicaid #HCBS is key to including ppl w/ #disabilities in the community, but the direct support workforce is in crisis. Read more from ANCOR about this devastating crisis and why #CareCantWait:bit.ly/3ASgUH9
  • Funding for home & community-based services is essential to the health and well-being of people w/ disabilities, but the #HCBS direct care workforce has been underfunded for too long. Congress must invest now because #CareCantwait bit.ly/3ASgUH9
  • Without funding for #Medicaid #HCBS, it’s only a matter of time before people w/ disabilities completely lose access to the options and resources needed to remain in their homes and in the community. Fund HCBS because #CareCantWait
  • 81% of American voters support increased funding for home & community-based services. Support funding for #Medicaid #HCBS now. #CareCantWait
  • “We have to look at how we are going to provide services for our most vulnerable adults and children in the coming decades, and we need to create a long-term, sustainable solution for that.” #HCBSCantWait bit.ly/3jDoS0b
  • Please support including HCBS funding in the Build Back Better Act to ensure people w/ disabilities & their families do not lose access to the options and resources needed to remain in their homes and in the community. #CareCantWait
  • Congress must include funding for HCBS in the budget reconciliation bill. People like Brandon depend on it. #HCBSCantWait RT twitter.com/POTUS/status/1451544259992203266

You are also encouraged to tweet your own stories. Below are additional hashtags to use:

  • #CareCantWait
  • #BuildBackBetter
  • #HCBSCantWait

We also wanted to make sure we shared with you ANCOR’s letter sent to Congressional leadership yesterday in a final push to support increased funding for HCBS.

Thanks for all of your hard work and please keep it going!

Here are the resources from the White House:

FACT SHEET

MICROSITE
The Build Back Better Framework: President Biden’s Plan to Rebuild the Middle Class

——————————
Elise Aguilar
Director of Advocacy
ANCOR
Alexandria, VA
(703) 535-7850
——————————

Donna Martin
Director for State Partnerships and Special Projects
ANCOR
1101 King Street, Suite 380
Alexandria, VA 22314
Office: 703.535.7850 x116
Direct Line: 571.781.0456

ODP Announcement 21-076 announces the release of the Office of Developmental Programs’ (ODP’s) Annual Waiting List report. The waiting list is comprised of individuals who are eligible to receive services and supports through ODP’s four home and community-based services (HCBS) waivers; however, due to insufficient waiver capacity, the state cannot currently meet their needs.

In this report, you’ll find information regarding ODP’s strategies and initiatives to address the problem. The report also demonstrates the progress that has been made since 2015 to reduce the number of individuals on the waiting list. The Annual Waiting List Report 2021 is located online at MyODP.

The Office of Developmental Programs (ODP) is re-releasing Announcement 20-072 with “HCBS At-A-Glance By Level of Community Spread” to better assist stakeholders in tracking and referencing specific guidance related to ODP functions in the context of the Level of Community Spread within a County. Updates appear in red.

The At-A-Glance Guide provides a quick reference on related operational guidance and will inform providers, Supports Coordination Organizations (SCOs), and Administrative Entities (AEs) planning across multiple counties. The At-A-Glance Guide has been updated to align with the Centers for Disease Control and Prevention (CDC) COVID Data Tracker as a primary source for monitoring the level of community transmission of COVID-19. The CDC COVID Data Tracker uses four (4) levels of community transmission: Low, Moderate, Substantial, and High.

The At-A-Glance Guide addresses the following functions:

  • Compliance with 55 Pa. Code Chapters 2380, 2390, 6100, 6400, and 6500;
  • Quality Assessment and Improvement (QA&I) process;
  • Independent Monitoring for Quality (IM4Q);
  • Supports Intensity Scale (SIS™) and PA Plus Assessments;
  • Administrative Entity (AE) Processes;
  • Licensing Inspections;
  • Investigations Completed by Certified Investigators; and
  • Supports Coordination Organizations (SCOs).

CONTACT: Please contact your ODP Regional Office for any questions about this announcement.

Information from ANCOR and Invite to an ANCOR Member Only Meeting Friday, July 2


Just the Highlights

  • The Better Care Better Jobs Act seeks to translate President Biden’s proposal for $400 billion in HCBS funding into actionable legislation.
  • The proposal offers many positive provisions, some of which have the potential to transform the Medicaid HCBS program, as well as a couple that may potentially raise implementation challenges.
  • Join us this Friday at 11 am EDT to learn more during a members-only briefing that will include remarks from Michael Gamel-McCormick, Disability Policy Director for the U.S. Senate Special Committee on Aging.

Dear ANCOR members,

I write to share exciting news about a bill ANCOR is supporting that was introduced in Congress late last week. The Better Care Better Jobs Act, or “Better Care” (S. 2210 / H.R. 4131), is being led in the Senate by Senators Bob Casey (D-PA), Ron Wyden (D-OR), Chuck Schumer (D-NY), Patty Murray (D-WA), Tammy Duckworth (D-IL), Sherrod Brown (D-OH) and Maggie Hassan (D-NH), and in the House by Representatives Debbie Dingell (D-MI), Frank Pallone (D-NJ), Jan Schakowsky (D-IL) and Doris Matsui (D-CA). The bill has already garnered support from more than 40 co-sponsors in the Senate.

Better Care seeks to translate President Biden’s proposal for $400 billion in HCBS funding into actionable legislation. Although the bill includes a few challenging provisions, on the whole, Better Care is nothing short of transformative, and ANCOR supports it for the investments it would make in the Medicaid Home and Community Based Services (HCBS) program, including both significantly expanded funding and structural transformations to strengthen the program. If passed, Better Care would allocate as much as $50 billion per year for the next 10 years in new HCBS spending, making it the single largest investment in the 50-year history of HCBS.

The proposed legislation includes a wide array of provisions, which you can learn more about by reading the full text of the legislation or the accompanying summary. However, there are several key highlights ANCOR is particularly excited about, some of which were included in the proposal expressly because of our advocacy. Among other provisions, Better Care would:

  • Increase the Federal Medical Assistance Percentage (FMAP) by 10 percent for the next 10 years. This FMAP enhancement would be in addition to the current 10-percent increase that went into effect for one year starting on April 1.
  • Allocate $100 billion for states at the onset of the funding increase described above to initiate an implementation planning process that includes stakeholder engagement.
  • Safeguard the delivery of services to current HCBS beneficiaries without jeopardizing the ability of potential beneficiaries to receive services by making new federal funding contingent on agreement by states not to (1) cut existing services or (2) make eligibility standards more stringent.
  • Require that states pay sufficient reimbursement rates to providers and mandate that reimbursement rates be reviewed at least once every two years. The biennial review process would mandate stakeholder engagement, to include providers, people with disabilities and their family members, direct support professionals and others.
  • Establish in statute “direct support professional” as a professional classification (i.e., distinct from personal care attendants, home health aides, etc.) and direct the U.S. Department of Labor to work with the Centers for Medicare and Medicaid Services to establish a Standard Occupational Classification for DSPs.
  • Offer, for the first time, FMAP funding to U.S. territories such as Puerto Rico and American Samoa, to supplement the territories’ existing Medicaid block grant funding.
  • Commit to the establishment of a set of standardized quality measures within two years of the bill’s passage.

Individually, these seven provisions have the potential to be gamechangers. Together, their potential is nothing short of transformative.

And—as with all legislation—Better Care is not perfect. Included are two particular provisions that have the potential to raise implementation challenges or be problematic: (1) a requirement that providers pass through a minimum proportional percentage of their increased reimbursement revenue to DSPs, and (2) an additional 2% FMAP incentive if states establish, either directly or through contracting with one or more nonprofit entities, a registry to connect people seeking services with qualified direct care workers. I flag both of these challenges for you not to suggest that ANCOR will or will not ultimately support these provisions, but rather to underscore that the extent to which we support these provisions will ultimately depend on how the details surrounding their implementation are codified into law.

The details of the Better Care proposal—including its many positive provisions as well the few provisions that demand more detail—mean that you will be essential in its pathway toward becoming law. Like most legislation these days, we don’t anticipate the legislation will secure the 60 votes needed to break a filibuster in the Senate, meaning the surest route for this bill to become law is its inclusion in the budget reconciliation process this fall. If you want to lend your support, there are things you can do now, soon and later to increase its chances of passing:

  • Now: Register for a members-only briefing to learn more about the bill and its path to becoming law. The briefing will take place this Friday, July 2 at 11 am EDT, and will feature ANCOR’s government relations professionals, as well as Michael Gamel-McCormick, Disability Policy Director for the U.S. Senate Special Committee on Aging. Register for free today.
  • Soon: On Friday, we will be issuing an action alert to aggregate support for Better Care and urge members of Congress to sign on in support of the legislation. Be on the lookout for an email from us or visit the ANCOR Amplifier to take action starting Friday.
  • Later: Assuming the bill is destined for the reconciliation process, it will be essential that lawmakers on Capitol Hill hear from constituents like you to preserve its many positive provisions in the version that is ultimately voted on. Stay tuned for more as the events of the summer unfold.

We say it a lot, but the changes ANCOR is championing on your behalf in Washington simply would not be possible without your passion, support and commitment. Thank you for all you’re doing—now, soon and later—to help us ensure this significant federal legislation becomes the law of the land.

Sincerely,

Barbara Merrill

CEO, ANCOR

Message from the Department of Human Services:

As you may know, the American Rescue Plan of 2021 (ARP) provides a temporary 10% increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for home and community-based services (HCBS). The funding must be used to enhance, expand, or strengthen HCBS beyond what is available under the Medicaid program as of April 1, 2021.

On Monday, June 14, the Department of Human Services (DHS) submitted a preliminary spending plan to the Centers for Medicare & Medicaid Services (CMS) that serves as a foundation for Pennsylvania’s planning efforts by outlining our principles and overarching priorities. The preliminary plan encompasses many of the stakeholder recommendations that have been made to date. The overarching priorities include:

  1. Increasing access to HCBS;
  2. Enhancing HCBS provider payment rates and benefits;
  3. Protecting the health and well-being of direct care workers and direct support professionals through the provision of supplies and equipment;
  4. Recruitment and retention efforts to support the workforce;
  5. Supporting caregivers;
  6. Assistive technology and other supports to improve functional capabilities of persons with disabilities;
  7. Supporting the transition of individuals to community-based living arrangements;
  8. Investing in activities to address Mental Health and Substance Use Disorder treatment and recovery needs of Medicaid beneficiaries; and
  9. Building HCBS capacity and rebalancing Long-term Services and Supports.

With these priorities in mind, we hope to hear more from stakeholders about Pennsylvania’s efforts as we continue to flesh out the details of our plan to strengthen, enhance, and expand HCBS. Comments must be submitted by close of business on July 6.

Please visit the public comment overview as well as Pennsylvania’s preliminary spending plan for further information. Your comments can be submitted via email. Additionally, a live virtual public comment session will take place on Wednesday, June 30 at 10 am for those who are unable or prefer not to submit written feedback. More information about how to RSVP for this session will be available soon.

This morning, the ANCOR Foundation’s Included. Supported. Empowered. campaign, along with their partners at United Cerebral Palsy, released the Case for Inclusion 2020.

The Case for Inclusion 2020 assesses all 50 states and the District of Columbia on 58 measures of how well state programs, primarily Medicaid, are supporting people with intellectual and developmental disabilities. This year’s report finds that although some states are seeing progress in their efforts to promote community inclusion, deeper investments in community-based supports are needed in order for people to live truly inclusive lives.

Among the key highlights of this year’s report, UCP and the ANCOR Foundation find that:

  • The total number of people with I/DD on waiting lists for Home and Community-Based Services (HCBS) increased by 49,000, from 424,000 in the last report to 473,000 in this year’s report. Ten states saw decreases in the number of people on their HCBS waiting lists, while 23 states saw their waiting lists grow.
  • Nationally, the turnover rate for direct support roles was 43.8%. In large part, this can be explained by low median hourly wages for DSPs, which stood at just $12.09 nationally.
  • The percentage of people with I/DD working in integrated employment — meaning they are leveraging supports to work alongside people without disabilities — creeped upward by just one percentage point, from 19% in the Case for Inclusion 2019 to 20% this year. Across the nation, there were 127,000 people with I/DD working in competitive employment, up from 124,000 in last year’s report.
  • There was an increase of two percentage points in the number of people with I/DD engaged in self-direction, from 11% in FY 2017 to 13% in FY 2018.

These high-level findings, along with comprehensive data for all 58 measures, can be found at the Case for Inclusion website.

Senators Portman (R-OH) and Gillibrand (D-NY) have introduced the Senate companion bill of the House’s Isaiah Baker and Margie Harris-Austin Act (HR 5443), called Ensuring Access to Direct Support Professionals Act (S 3220). This would extend reimbursement of Direct Support Professional (DSP) services while a person receiving Home and Community-Based Services (HCBS) is in the hospital. This addresses a longstanding challenge in the 1915(c) HCBS waiver program that prevents individuals with disabilities and seniors who go to the hospital from bringing with them the DSPs who know them best, to provide them with the support they rely on. The legislation brings 1915(c) in line with other HCBS authorities by allowing payment for DSPs to provide personal assistance and other services when the individual they support has a short-term stay in an acute care hospital.

ODP Announcement 19-149 releases data collected from Provider Self-Assessment Reports completed in 2018. The Center for Medicare and Medicaid Services (CMS) implemented a final rule regarding Home and Community-Based Service (HCBS) Settings in 2014. The final rule requires states to assess all residential and non-residential settings which receive funding or payment through an approved HCBS waiver. ODP developed a self-assessment for providers of these services to complete for each location.

In 2018, providers completed the self-assessment of over 6,000 Residential and Non-Residential service locations. The data was analyzed, and two reports were created:

For questions pertaining to these reports, please submit via email.