12/29/2022

$1.7 trillion omnibus Bill passes House

Just before the Christmas holiday, the U.S. House of Representatives voted along party lines to pass the $1.7 trillion omnibus package, H.R. 2617 on Friday, December 23. The legislation has now passed both the Senate and the House and heads to President Biden’s desk for signature. Lawmakers also voted for a short term stopgap funding bill to prevent a lapse in government funding while the omnibus is enrolled.

The package included a number of notable wins for aging services, and LeadingAge has summarized the components in the following categories, with those in bold representing LeadingAge-backed proposals:  

Workforce Wins 

• The agreement includes $2,000,000 for the Administration on Community Living (ACL) to implement a direct care workforce demonstration project to identify and reduce barriers to entry for a diverse and high-quality direct care workforce. In addition, these funds will be used to explore new strategies for the recruitment, retention, and advancement opportunities needed to attract or retain direct care workers.
• The agreement provides $285,000,000 to support registered apprenticeships and urges the Department of Labor’s Employment and Training Administration (ETA), in collaboration with the Department of Health and Human Services, to support the expansion of the skilled care workforce,  provide home and community-based services to older adults and people with disabilities, increase education and training grant programs, and expand traditional and nontraditional apprenticeship programs.
• The agreement’s report language supports HRSA's efforts to develop the workforce needed to care for a rapidly aging U.S. population and encourages HRSA to address the skilled care workforce needs of seniors through existing workforce education and training programs.
• The Committee allocates an additional $2 million above the FY 2022 level for HRSA’s Geriatrics Workforce Enhancement Program that supports training to integrate geriatrics into primary care delivery and develops academic primary care-community based partnerships to address gaps in health care for older adults.
• Unfortunately absent are several of the foreign workforce immigration policies, which were highlighted in the November 28, LeadingAge letter urging Congress to support proposals that would help ensure aging services providers can meet the needs of older adults. LeadingAge will continue to advocate for these when the new Congress convenes in January. Members can access the LeadingAge article here with additional details.

Affordable Housing Wins

• The FY23 omnibus bill would add funding to build and operate nearly 1,120 Section 202 Supportive Housing for the Elderly homes, in addition to full renewal funding for Section 202 Project Rental Assistance Contracts and Section 8 Project-Based Rental Assistance contracts. While the bill would fully fund Service Coordinator grant renewals, it is unclear if there is sufficient funding in the bill for it to provide for new grant-funded Service Coordinators. The bill would also provide $6 million to help 202/PRACs convert under the Rental Assistance Demonstration and give HUD authority to make budget-based rent adjustments for post-Mark-to-Market PBRA contracts that are distressed or at risk of becoming distressed. LeadingAge had worked for more funds for these efforts than is in the omnibus but is pleased the bill provides full renewal funding and makes some important strides for housing expansion and preservation efforts. The bill also expands the types of households to be assisted by the Older Adult Home Modification program to all 62 and older households (besides those with HUD project-based assistance) and not just homeowners, another LeadingAge request.
• The bill includes $50 million for about 12,000 new Housing Choice Vouchers, which aging services providers can work to project-base in affordable senior housing and in assisted living. The bill also includes a new $85 million program to incentivize local governments to improve zoning practices for affordable housing and a new $75 million program for new Permanent Supportive Housing to expand housing options for people experiencing homelessness.
• Overall, the omnibus bill would provide $58.2 billion for HUD, an increase of $4.5 billion compared to fiscal year 2022.

 Home Health & Hospice Wins

• In the proposed Consolidated Appropriations Act, 2023, Congress instructs CMS to release data that LeadingAge requested in its rule comments. Having this data will allow for the comparison of behavior before and after the change to payment driven groupings model (PDGM) and enable providers to give CMS more accurate feedback on points of disagreement. What’s more, the legislation also requires CMS to meet with stakeholders to receive feedback on rate development for CY2024 and to also release the applicable data in advance of that public meeting. Even though this legislation will not impact the rates for CY2023, Congress listened to our advocacy and took action to address our concerns – and we are hopeful this will put us on the path to achieving a payment approach that works for our mission-driven, nonprofit members and guarantees that all older adults and their families can get needed care and services.
• The home health rural add-on was extended for episodes that occur in CY2023.
• The ability for hospices to do the face to face recertification via telehealth was extended for 2 years until 2024 (as part of the broader telehealth extension)
• The agreement includes $1,000,000 to fund an evidence review and technical expert panel on the feasibility of developing consensus based quality standards for high quality bereavement and grief care. Hospice is the only provider group specifically named that must be consulted in the process. This was a LeadingAge authored provision. LeadingAge also advocated for the inclusion of report language on the scope of the need for grief and bereavement services – this language was also included.
• The agreement allows for marriage and family therapists and mental health counselors to serve on the hospice IDT in the social work role (it does not require one of these professionals, it just allows them to fill this role).

 Nursing Homes

•  The package includes $150 million for Veterans Administration Grants for Construction of State Extended Care Facilities, an increase of $100 million above the fiscal year 2022 enacted level. This increase will allow the Veterans Administration to provide more grants to assist states in constructing state home facilities, for furnishing domiciliary or nursing home care to veterans, and to expand, remodel, or alter existing buildings.
• The bill includes a $2 million increase for the long-term care ombudsman program, which was funded at $18.8 million in fiscal year 2022.  It also provides $15,000,000 for the nationwide Adult Protective Services formula grant program.

Telehealth Wins

• Medicare telehealth flexibilities will be extended for two years. The provisions have already been extended for 151 days after the end of the public health emergency.

Medicare & Medicaid

• Medicare telehealth waivers were kept in place for 2 years, through 2024. This includes allowing the home to be the originating site, removal of geographic restrictions, expanded eligible practitioners, allowing the use of audio only telehealth services, and allowing the hospice face to face recertification to be done via telehealth. The legislation also requires a study on telehealth and program integrity.
• The Medicaid “unwinding” was delinked from the public health emergency. The continuous coverage provisions put in place by the Families First Coronavirus Response Act will end March 31, 2023. The increased FMAP will be phased out over the course of 2023. Q1, it remains at 6.2%. Q2, it will be 5%. Q3, it will be 2.5%. Q4, it will be 1.5%. There are a number of guardrails around transparency and reporting tied to states continuing to get the increased FMAP over the course of the year. We will provide more details on this provision in the coming days.
• The proposed physician fee cuts were reduced from CMS’s proposal. The cuts will be 2% for CY2023 and 3.5% for CY2024 – the rule called for a 4.5% cut for CY2023. This impacts providers that bill Medicare part b – so among our members, palliative care practices, nursing home medical directors, primary care practices generally, referral sources to home health and adult day, and part b services across the continuum like PT, OT, etc.
• The hospital at home program waiver was kept in place for 2 years.

COVID-19

• Parts of a Pandemic Preparedness bill made it into the package, including making the CDC director into a Senate-confirmed position.
• The agreement includes $10,000,000 for health systems research on how best to deliver patient-centered, coordinated care to those living with Long COVID, including the development and implementation of new models of care to help treat the complexity of symptoms those with Long COVID experience.
• Other COVID-related provisions are spread throughout the bill.