2016 Home and Community Based Services Issue Brief

 HOME AND COMMUNITY BASED SERVICES ISSUE BRIEF 

Over 12 million Americans of all ages with functional impairments today rely on personal assistance and other long-term services and supports (LTSS) to perform daily activities, to maintain their quality of living and, live as independently as possible. Consumer preferences for home and community based services, as well as federal and state goals to meet these preferences and control costs have produced significant shifts in policy. Despite this shift in policy, there remain multiple barriers to address the growing population of older adults and persons with disabilities that will need these services. 

• Adult Day Services, Transportation, Meal Programs 
  • ISSUE: Presently the federal government does not pay for long-term services and support unless an individual is on Medicaid. Low-income, chronically ill Medicare beneficiaries need community-based services to provide the support and dignity they deserve and are a commonsense alternative to costly institutionalization. The shortage of non-emergency transportation to medical appointments, as well as the limited options for long-term services and supports in rural areas results in increases in nursing home utilization. 
    
    
  • SOLUTION: Community Based Independence for Seniors Act (H.R. 4212). The legislation would establish a Medicare Advantage Community-Based Institutional Special Needs Plan demonstration program that would provide eligible Medicare beneficiaries: Adult day care services, Homemaker services, Home delivered meals, Transportation services, Respite care and Non-Medicare-covered safety and other equipment.
      

• Veterans Affairs 
  • ISSUE: Medicare and Medicaid providers are not considered federal contractors, but the VA does treat providers of LTSS as federal contractors. The extensive reporting requirements have been a barrier for providers to obtain contracts to serve Veterans. Veterans especially have limited access to adult day services, hospice, and home health in rural areas because the nearest Veterans Medical Center may be 40 plus miles from their home.
    
    
  • SOLUTION: Veterans Access to LTC and Health Services Act (S. 2000). If passed, the legislation would allow the VA to enter into Provider agreements that are less costly to implement. 
    

• Home Health  
  • ISSUE: Non-physicians increasingly provide necessary medical services to Medicare beneficiaries, especially in rural and underserved areas. Nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants sometimes are more familiar with particular cases than the attending physician, and at times are more readily available than physicians to expedite the processing of paperwork, ensuring that home health care to the beneficiary will not be interrupted.
  • SOLUTION: Home Health Planning Improvement Act HR 1342 and S 578. The legislation would allow advanced practice registered nurses (APRN), nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants to order home health services under Medicare. Changing Medicare regulations to allow these trained health care workers to sign home health plans of care and certify Medicare patients for home health will help deliver vital care to older adults without unnecessary delays. 
   
• Hospice:  
  • ISSUE: The United States Senate Committee on Finance Bipartisan Chronic Care Working Group is considering requiring Medicare Advantage plans to offer the hospice benefit provided under traditional Medicare. The Medicare Hospice Benefit is currently undergoing significant changes, and their impact on the delivery of hospice care remains uncertain.  Hospices therefore may hesitate to enter into contracts with MA plans, particularly if the contracts do not, at a minimum, cover costs.
  • SOLUTION: The Congress should urge CMS to implement a process for stakeholder input that includes convening a Technical Expert panel to discuss this issue. 
    

• Older Americans Act (OAA) Funding 
  • ISSUE: Federal funding has been stagnant for years and is now subject to budget caps imposed through 2021. The sequester cuts in FY 2013 - FY 2015 forced Area Agencies on Aging to suspend programs, limit service hours, reduce staff  for meal programs, non-emergency transportation, in-home services and adult day services and otherwise struggle to cut costs from an already efficient but underfunded system.
    
    
  • SOLUTIONS: We also encourage Congress to increase funding for Title III B Home and community-based supportive services, Title III E National Family Caregiver Program, Title III C Homebound meals, Title III C Congregate meals, Lifespan respite care program, Aging and Disability Resource Centers (ADRC), and Elder Rights Support Activities.