American Association of Homes and Services for the Aging

American Association of Homes and Services for the Aging (AAHSA): Advocacy for the Right Public Policy for the Right Reasons

Mid-Year Highlights of 2005 AAHSA Advocacy Accomplishments

Working for You on Federal Policy and Regulations…

On Medicaid Issues:

 Conducted persistent and targeted grassroots and direct lobbying efforts, resulting in a reduction of the proposed, five-year Medicaid cuts from $20 billion to $10 billion. AAHSA effectively collaborated with numerous provider/consumer organizations and generated over 2,000 messages to Congress from AAHSA members.  Canvassed AAHSA’s Legal Committee for recommendations on curbing asset transfers and provided a compilation of results to the Government Accountability Office and congressional committees with jurisdiction over the Medicaid program.  Conducted numerous, productive personal meetings between AAHSA CEO Larry Minnix and key congressional leaders.  Secured opportunities for AAHSA members to testify before congressional panels on asset transfers and other Medicaid issues; submitted our own written testimony as well.  Nominated an AAHSA member, who has since been appointed to the Medicaid Commission that will deliberate – over the next year - recommendations to Congress for modernizing the Medicaid program, including long-term care coverage.

On Medicare Reimbursement:

Payment system changes: CMS issued a proposed rule to revise the RUG system on May 13 with a 60-day comment period. In the course of our analysis of the proposed rule, we continued to find serious problems with it, and brought them to the attention of CMS.

 Developed and continually updated a rate calculator for members, posting it on our website, so that members can determine how they will fare under the proposed rule. Over 800 members used the calculator, reporting their results back to us.  Identified several mistakes in the rule and notified CMS. CMS subsequently implemented corrections, based on our input. As soon as the final correction was announced, we redid our calculation tool and circulated the updated information to our members.  Submitted comments on the proposed rule on July 12, 2005, recommending that CMS refrain from implementing the proposed refinements until a more appropriate RUG refinement system can be studied and developed. We also urged CMS to correct the errors found in their rate calculations and to extend the comment period to allow more informed analyses and public comments.  Analyzed the potential impact of the elimination of the payment add-on and found that the

likely increase in avoidable hospitalizations will cost the Medicare system more than it will save by ending the add-on; shared this vital information with CMS and Congress.  Sent a letter to every member of Congress from Larry Minnix on the need to preserve current Medicare payment levels.  Discussed Medicare payment issues with CMS head Dr. Mark McClellan and his staff via a personal meeting with Larry Minnix.

In addition, the prestigious National Academies of Science’s Institute of Medicine has appointed AAHSA VP for Health Strategies, Dr. Barbara Manard, to the committee charged to report to Congress on options for better linking Medicare payments to quality.

On Medicare Therapy Caps:

The current moratorium on the therapy caps mandated by the Balanced Budget Act of 1997 (BBA) will expire at the end of this year. Unless Congress acts this year, Medicare beneficiaries will have to pay out of pocket for the cost of any therapy they need that exceeds the caps that go into effect on January 1, 2006.

 Conducted direct and grassroots lobbying for H.R. 916 and S. 438 - legislation to repeal the therapy caps.

On Tax-Exempt Status:

Last year, the Senate Finance Committee began an exploration of tax compliance by nonprofit organizations. The Committee's staff produced a white paper, making comprehensive recommendations for improving compliance. This was followed, in January 2005, with a similar Joint Tax Committee report.

 Participated in a roundtable discussion with Finance Committee Chairman Charles Grassley (R-IA) on the white paper recommendations.  Based on the recommendations of our Legal Committee, filed detailed comments on the white paper with the Finance Committee, urging that protection of bona fide nonprofits and small, local charities be considered if changes in tax laws are proposed.  Worked with the Independent Sector, a coalition of nonprofits, in developing alternatives to some of the more repressive recommendations in the staff white paper.  Circulated Independent Sector recommendations to the AAHSA Legal Committee and forwarded their comments back to the Independent Sector for further discussion with the Senate Finance Committee.  Continued to monitor potential legislation based on the Committee’s findings.

On Survey and Certification Reform:

 Worked with Representative Dave Camp (R-MI) on drafting H.R. 3437, legislation to correct the most serious problems with the current survey and certification system.  Developed grassroots materials for members to urge House legislators to cosponsor, in addition to our own direct lobbying.  Identified potential co-sponsors for the bill, in order to ensure that it receives due consideration by the House.  Met with Thomas Hamilton, Director of the Survey and Certification Group at CMS, on survey and certification issues.

On Pay for Performance: This concept is gaining attention in Washington in the hope that federal and state governments will acknowledge the maximum quality of care they can expect for the limited expenditures made under publicly funded health care programs. A key issue is deciding on the quality indicators to be used to determine quality of care.  Worked with Representative Marci Kaptur (D-OH) on drafting H.R. 1166. In addition to preserving current Medicare reimbursement levels, this bill requires CMS to conduct a study of current and future financing of quality nursing facility care, including the following issues:

 Adequacy of Medicaid financing to pay for the quality of care required by state/federal law and regulations;  Medicare's cross-subsidization of care for Medicaid patients;  Total industry margins for skilled nursing facilities;  Impact of current trends, including litigation and staffing shortages on nursing facility costs;  Impact of demographic changes in relation to provision of long-term care services;  Options for addressing current problems with payment for nursing facility services; and  Options for financing quality long term care, including nursing home care, over the next five decades.

On Assisted Living:

 Participated in the establishment of the Center for Excellence in Assisted Living (CEAL), which will foster access to high quality assisted living by bringing together diverse stakeholders to:

 Bridge and advance research, practice and public policy;  Promote research on evidence-based quality practices in assisted living; and  Provide a national clearinghouse of information on assisted living.

 Collaborated in planning CEAL's August 2006 meeting on affordable assisted living.  Led CEAL upon the CEAL Board’s unanimous election of Doug Pace, AAHSA's Director of Assisted Living and Continuing Care, as CEAL's chair.

On Integration of Aging Services’ Programs:

 During our Future of Aging Services’ Conference, Senator Paul Sarbanes introduced S. 705, the Meeting the Housing and Service Needs of Seniors Act. The bill seeks to establish an Interagency Council on Aging to better coordinate federal programs under the jurisdiction of various federal agencies, evaluate how seniors' housing and service needs can be better met, and make recommendations to Congress on improvements in aging services’ programs. The bill has been approved by committee and is ready for consideration on the Senate floor.  Worked with Senator Sarbanes on drafting this legislation.  Encouraged our partners, in stakeholder networks, to join us in advocating for co-sponsorship of the Sarbanes legislation.  Secured opportunities for AAHSA members to testify in favor of the Sarbanes bill before the Senate Banking, Housing and Urban Affairs Committee.  Conducted a meeting/tour among CMS Administrator Mark McClellan, Larry Minnix and several AAHSA members at Riderwood Village in Maryland on July 8, 2005. Dr. McClellan viewed a model of well-integrated long-term care and participated in an in-depth discussion of AAHSA’s Five Big Ideas.

On Senior Housing:

The President's budget did not propose cuts in funding for senior housing; however, the budget document criticized the Section 202 program as “ineffective” because of the number of seniors still on waiting lists for affordable housing. The House and Senate have passed FY2006 appropriations bills that must be reconciled into a final version.  Conducted direct and grassroots lobbying efforts to maximize funding for senior housing programs in FY2006.  In mid-May, Larry Minnix, Tom Slemmer (National Church Residences), Dena Smith (Pacific Retirement Services), Alan Green (New Samaritan Housing Corporation) and Brian Pollard (Lancaster Pollard) met with HUD Secretary Alphonso Jackson about the HUD

Section 202 program and HUD operational issues. Secretary Jackson committed to working with us on these issues.  Submitted a statement, for the record, during a House Appropriations Subcommittee on Transportation, Treasury and HUD hearing.  Recommended, during a White House Conference on Aging solutions’ forum on May 17, 2005, that the Conference focus on affordable housing as a platform for the delivery of essential services.  Established an Affordable Housing Finance Cabinet, comprised of AAHSA members and representatives of the housing finance community, including Fannie Mae, Freddie Mac, state housing finance agencies, equity investors and investment bankers.  Spearheaded grassroots advocacy for H.R. 1461, the Federal Housing Finance Reform Act, to include an Affordable Housing Trust Fund.

On Home and Community-Based Services:

As with housing, the President's budget proposed level funding for Older Americans Act (OAA) programs and Social Services Block Grants (SSBG). Funding for these programs has not increased for several years, despite federal and state initiatives to rebalance the Medicaid program, providing frail elders more options for home- and community-based services (HCBS). The House and Senate each have passed FY2006 appropriations bills that must be reconciled into a final version.  Conducted direct and grassroots lobbying efforts to maximize funding for OAA, SSBG and senior transportation programs in FY2006.  Testified before the House Appropriations Subcommittee on Labor/HHS on the need for funding increases in these programs in the coming year. As passed by the House, the FY2006 Labor/HHS appropriations bill increased funding for nutrition programs, which Larry and Subcommittee Chair Ralph Regula had discussed, by $7.2 million; there were no cuts to other programs.  Secured $2 million in FY2005 appropriations for a Senior Transportation Technical Assistance Resource Center.  Developed a calculator tool for HCBS members to see how they will be affected by proposed changes in the Medicare payment system, posted at http://www.aahsa.org/advocacy/hcbs/payment_financing/default.asp.

AAHSA Tools you can use

 Website - At http://www.aahsa.org/advocacy/default.asp, we provide the latest information on federal regulations and legislation affecting nursing homes and other long-term care providers. Current features include: o Medicare reimbursement calculator tool: We have posted a calculator tool to help you determine how proposed reimbursement changes would affect your facility, at http://www.aahsa.org/advocacy/nursing_homes/payment_financing/snf_pps/estimatin g_revenue_2006.asp o Contact Congress: Your views make a difference, and you need to let your legislators know how proposed legislation will affect your facility and your residents. We provide up-to-date legislative information and sample letters that can be sent quickly and easily to legislators. o Medicare prescription drug benefit information resources for providers: This benefit goes into effect on January 1, and we have been working closely with CMS on policies specifically applicable to long-term care. Information is posted on our website at http://www.aahsa.org/advocacy/medicare_drug_benefit/default.asp.

 News briefs – We routinely provide two newsletters, emailed to members assuring access to up-to-the-minute news on legislative and regulatory activity in Washington, in a brief, easy- to-read format with links to additional information. o Weekly Perspectives: arrives in your e-mailbox Monday with the latest on developments affecting long-term care and aging services providers. o Nursing Home Regulatory Newsletter [ New ]: once a month, we compile all of the most recent news about CMS and other agencies’ regulatory activities affecting nursing homes and email the report to you.

 Consultation - Expert staff are readily available to answer detailed questions on reimbursement, survey and certification, and other issues facing nursing homes.

 Social accountability resources - Tools exist to help you show your community how you truly live the not-for-profit lifestyle. Find out more at http://www.aahsa.org/qualityfirst/resources/community_involvement/social_accountablity/def ault.asp

 Listserv participation - View and participate in AAHSA's active member exchange forums: Assisted Living, Attorneys, CCRCs, HCBS, Home Health, Housing Management, Housing Policy, Human Resources Director, Marketing and PR, Private Pay and more.

 Quality - Make a public commitment to quality by signing the Quality First Covenant; earn the public’s trust by building an infrastructure of strength in your key areas of care and service. See the Quality First website, completely dedicated to this process, where you can access assessment tools, fact sheets, public relations material, resources and more at http://www.aahsa.org/qualityfirst/default.asp.

Rev. 7-28-2005