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Bipartisan Group of Senators Reintroduces Observation Stay Legislation<p>​​Sens. Sherrod Brown (D-Ohio), Susan Collins (R-Maine), Sheldon Whitehouse (D-R.I.), and Shelley Moore Capito (R-West Va.) have reintroduced their bipartisan legislation to update a current loophole in Medicare policy that would help protect seniors from high medical costs for the skilled nursing care they require after hospitalization.</p><p>The Improving Access to Medicare Coverage Act would allow for the time patients spend in the hospital under “observation status” to count toward the requisite three-day hospital stay for coverage of skilled nursing care. Rep. Joe Courtney (D-Conn.) is the lead sponsor of bipartisan companion legislation in the House of Representatives. The other House sponsors are Suzan DelBene (D-Wash.), Ron Estes (R-Kansas), and Glenn Thompson (R-Pa.).</p><p>Under the current Medicare policy, a beneficiary must have an “inpatient” hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care under “observation status” do not qualify for this benefit, even if their hospital stay lasts longer than three days, according to the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), a supporter of the Improving Access to Medicare Coverage Act.</p><p>“Seniors should be able to focus on their recovery instead of billing technicalities and sky-high medical bills, or, worse yet, trying to recover without the medical care they need because they can’t afford it,” said Brown. “This legislation would improve access to the medical care seniors need and saves money on hospital readmission costs. It’s a simple fix and the least we can do to protect our seniors from outrageous medical costs that they have no control over.”</p><p>Collins said when seniors require hospitalization, their focus should be on their health and recovery, not on how they were admitted.<br>“The financial consequences of this distinction between an observation stay and inpatient admittance can be severe for seniors,” she said. “Our bipartisan bill would help insulate older Americans from undue out-of-pocket costs and ensure that they get the care that they need.”</p><p>Whitehouse added that seniors trying to recover shouldn’t have to worry about accessing the skilled nursing care they need. This bipartisan legislation would fix a quirk in the billing rules that forces patients into stressful and pointless long stays in the hospital, he said.</p><p>“West Virginia’s seniors shouldn’t have to pay more for their health care because of a technical loophole in our current Medicare law,” Capito said. “The Improving Access to Medicare Coverage Act is a commonsense bill to right this wrong and protect seniors while they’re recovering in the hospital and at their most vulnerable. This bipartisan effort would take a crucial step forward in improving access to care for our seniors.”</p><p>&#160;AHCA/NCAL said the nursing care profession backs the legislative effort in the Senate. “Our nation’s skilled nursing facilities are privileged to help America’s seniors receive the therapy and care they need after a hospital stay, but Medicare’s three-day hospital stay requirement is arbitrary and unfair,” said AHCA/NCAL President and Chief Executive Officer Mark Parkinson.</p><p>“Too many seniors are left to foot the bill for their post-acute care, all because their hospital stay was coded as under observation. They deserve the chance to recover without worrying about how they’re going to pay for it. We greatly appreciate Sens. Brown, Capito, Collins, and Whitehouse for leading this charge once again, and we urge Congress to swiftly pass this legislation,” he said. </p><p>Specifically, the bill would&#58;</p><p>•&#160;Amend Medicare law to count a beneficiary’s time spent in the hospital on “observation status” toward the three-day hospital stay requirement for skilled nursing care; and</p><p>•&#160;Establish a 90-day appeal period following passage for those that have a qualifying hospital stay and have been denied skilled nursing care after Jan. 1, 2021.</p><p>The Improving Access to Medicare Coverage Act has been <a href="https&#58;//www.brown.senate.gov/download/reintroduce-bipartisan-legislation-to-protect-seniors-high-costs-medical">endorsed by more than 30 organizations, </a>including&#58; AARP, Alliance for Retired Americans, American Case Management Association, American Health Care Association, AMDA – The Society for Post-Acute and Long-Term Care Medicine, Center for Medicare Advocacy, LeadingAge, National Academy of Elder Law Attorneys, National Association of State Long-Term Care Ombudsman Programs, National Center for Assisted Living, National Committee to Preserve Social Security &amp; Medicare, National Consumer Voice for Quality Long-Term Care, and the Society of Hospital Medicine.&#160;</p>2021-06-15T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/capitol_moon_night.jpg" style="BORDER&#58;0px solid;" />PolicyPatrick ConnoleThe law would count time spent in the hospital on “observation status” toward the three-day stay requirement for skilled nursing care under Medicare.
HHS Extends Deadlines for Provider Relief Fund Recipients<p>In a move welcomed by the long term care profession, the Department of Health and Human Services (HHS) on June 11 <a href="https&#58;//www.hhs.gov/sites/default/files/provider-post-payment-notice-of-reporting-requirements-june-2021.pdf?cm_ven=ExactTarget&amp;cm_cat=COVID-19+Update+%23182+Clif&amp;cm_pla=All+Subscribers&amp;cm_ite=released&amp;cm_lm=pconnole%40ahca.org&amp;cm_ainfo=&amp;&amp;&amp;&amp;&amp;">released </a>updated reporting requirements for recipients of Provider Relief Fund (PRF) payments.</p><p>According to a summary by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), with this announcement, HHS expands the amount of time providers will have to report information, aims to reduce burdens on smaller providers, and extends key deadlines for expending PRF payments for recipients who received payments after June 30, 2020. </p><p>Some key updates include&#58;</p><p>•&#160;The period of availability of funds is based on the date the payment is received (rather than requiring all payments be used by June 30, 2021, regardless of when they were received).</p><p>•&#160;Recipients are required to report for each Payment Received Period in which they received one or more payments exceeding, in the aggregate, $10,000 (rather than $10,000 cumulatively across all PRF payments).</p><p>•&#160;Recipients will have a 90-day period to complete reporting (rather than a 30-day reporting period).</p><p>•&#160;The PRF Reporting Portal will open for providers to start submitting information on July 1, 2021.<br>Mark Parkinson, president and chief executive officer of AHCA/NCAL, said, “The extensions by HHS regarding the use and reporting of aid received through the Provider Relief Fund is welcome news to the long term care profession.”</p><p>He added that “we greatly appreciate the administration recognizing that our battle with COVID-19 is not over yet, and that our ongoing efforts require ongoing resources. We now strongly encourage the agency to distribute the remaining funds and to dedicate a significant portion to long term care, which has been the epicenter of the pandemic and now faces imminent closures without additional aid.”</p><p></p>2021-06-11T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0520_News1.jpg" style="BORDER&#58;0px solid;" />Policy;COVID-19Patrick ConnoleThe updated reporting requirements aim to reduce burdens on smaller providers.
AHCA, NCAL Seek Extension to Deadline on Provider Relief Fund Reporting<p>The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) continues to seek an extension to the June 30 deadline for providers to report on how COVID-19 Provider Relief Fund (PRF) monies were spent and/or return unused funds.</p><p>The PRF, established by the CARES Act, has been an instrumental resource for health care providers amid the pandemic, the association said. Long term care facilities have received approximately $14 billion of the $178 billion in the PRF since the pandemic began, which has helped providers with the costs associated with combating the virus. </p><p>Personal protective equipment (PPE), testing, hiring additional workers, and providing hero pay are just a few things the aid has helped pay for, AHCA/NCAL said. For many providers, the funding was the difference between keeping their doors open or closing them for good, the association added. </p><p>In April, the organization sent a <a href="https&#58;//www.ahcancal.org/News-and-Communications/Fact-Sheets/Letters/HHS-Letter-PRF.pdf">letter </a>to Health and Human Services (HHS) Secretary Xavier Becerra, requesting that the reporting deadline be extended to Dec. 30, 2022. In the letter, AHCA/NCAL said the extension is needed because&#58; </p><p>•&#160;Skilled nursing facilities (SNFs) and assisted living communities (ALCs) will experience ongoing higher operating costs while occupancy remains at record lows. The industry is expected to lose $94 billion over a two-year period (2020-2021) due to the skyrocketing costs to fight the pandemic. In 2020, nursing homes spent roughly $30 billion on PPE and additional staffing alone. Many SNF and ALC providers faced financial struggles even before the pandemic, but the situation is becoming more dire, with the industry anticipating record closures.</p><p>•&#160;Declining occupancy has compounded financial challenges. SNF occupancy declined by 16.5 percent between January 2020 and January 2021. Occupancy rates for ALCs dropped to a record-low 77.7 percent in the fourth quarter of 2020. AHCA/NCAL said its research estimates that more than 1,600 SNFs could close in 2021. A recent AHCA/NCAL member survey said 56 percent of ALCs would not be able to maintain operations at current levels an additional 12 months without additional revenue or financial relief.</p><p>And, the group said it is not alone in requesting an extension. Reps. Cindy Axne (D-Iowa) and Mariannette Miller-Meeks (R-Iowa) also sent a <a href="https&#58;//axne.house.gov/sites/axne.house.gov/files/Axne%20and%20Miller-Meeks%20PRF%20Deadline%20Letter%20to%20HHS.pdf">letter </a>to Becerra—co-signed by nearly 80 Republican and Democrat members—asking that the June 30 deadline be extended, and that remaining PRF funding be distributed as soon as possible. The American Hospital Association <a href="https&#58;//www.aha.org/lettercomment/2021-05-10-letter-americas-hospitals-and-health-systems-urging-hhs-extend-deadline">requested </a>that the deadline be extended until the end of the public health emergency as well. </p><p>Restaurants, which also experienced significant hardships over the course of the pandemic, have until 2023 to use COVID-relief funding. AHCA/NCAL said it hopes that HHS takes the same approach with the PRF for health care providers.&#160;&#160; </p><p>“Federal lawmakers rallied around long term care facilities and gave them some of the critical assistance they needed, but they still need support,” AHCA/NCAL said. “COVID-related expenditures will remain constant for the foreseeable future. Extending the reporting deadline will help long term care providers maintain operations and continue to protect our most vulnerable citizens and frontline health care heroes.”<br></p>2021-06-03T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0520_news4.jpg" style="BORDER&#58;0px solid;" />Policy;COVID-19Patrick ConnoleDeclining occupancy has compounded financial challenges, and more than 1,600 SNFs could close in 2021.
COVID-19 Challenges Bring Opportunity for Systemic Changes<p>​The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said the COVID-19 pandemic has brought to light systemic challenges impacting the long term care profession, but at the same time offers an opportunity for making major adjustments to the way in which care is provided to the nation’s elderly and those with disabilities. <br></p><p>“With new COVID cases reaching record lows thanks in large part to the vaccines, the industry is optimistic that we have turned a corner,” AHCA/NCAL said. “As we look toward the future, long term care leaders and lawmakers must work together to apply the lessons learned and ensure that all seniors have access to quality long term care options.”<br></p><p>First off is the fact that America’s elderly population is growing, the association said.<br></p><p>“Substantive reform is needed within the industry as we prepare for the increased demand in long term care services.” <br></p><p>AHCA/NCAL, in partnership with LeadingAge, said it has proposed the&#160;Care For Our Seniors Act—a reform package that will support better pandemic management and strengthen overall care in nursing homes. The package consists of four policy areas&#58;<br></p><ul><li>Clinical improvements to enhance quality of care;</li><li>Workforce improvements to strengthen and support frontline caregivers;</li><li>Oversight reforms to make systems more resident-driven; and</li><li>Structural modernizations focused on resident dignity and safety.</li></ul><p>The nursing home industry has called attention to these long-standing issues for years—issues that have only been exacerbated by the pandemic, AHCA/NCAL said.</p><p>For example, workforce shortages plagued nursing homes long before COVID-19, but the pandemic worsened these shortages and left available workers stretched thin. The unprecedented challenges and traumatic experience of the past year have taken a heavy toll on caregivers, leading to considerable burnout among staff. <br></p><p>AHCA/NCAL said industry leaders are concerned that the profession will see a mass exodus of workers. In fact, <em>The Washington Post</em> reports&#58; “According to a Washington Post-Kaiser Family Foundation poll, roughly 3 in 10 health care workers have weighed leaving their profession. More than half are burned out. And about 6 in 10 say stress from the pandemic has harmed their mental health.”<br></p><p>Meanwhile, a study published in the<em> Journal of the American Medical Directors Association</em> found that 31 percent of COVID deaths in nursing homes in Ontario, Canada, would have been prevented if all residents had had single-occupancy rooms. The modernization proposal in the Care for Our Seniors Act calls for a shift to more private rooms, which will allow for greater privacy and dignity for residents, as well as promote enhanced infection prevention and control, AHCA/NCAL said.<br></p><p>Implementing these reforms requires a commitment from federal and state lawmakers to properly fund nursing homes—particularly ensuring that Medicaid reimbursement rates cover the actual cost of care. With the majority of nursing homes already operating on razor-thin margins, the cost of making improvements will not be possible without financial assistance, the association said.<br></p><p>“Long term care was forgotten at the beginning of the pandemic, but they cannot be forgotten now. Lawmakers have an opportunity to put America’s seniors and frontline caregivers first,” AHCA/NCAL said.<br></p>2021-06-01T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/capitol_blue_skies.jpg" style="BORDER&#58;0px solid;" />COVID-19;PolicyPatrick Connole​AHCA/NCAL, in partnership with LeadingAge, said it has proposed the Care For Our Seniors Act—a reform package that will support better pandemic management and strengthen overall care in nursing homes.