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NASUAD Public policy discussion and prioritization DRAFT UNFINALIZED VERSION. Bea Rector Director, Washington State Home and Community Services Division Damon Terzaghi Senior Director, NASUAD. Background.
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NASUAD Public policy discussion and prioritizationDRAFT UNFINALIZED VERSION Bea RectorDirector, Washington State Home and Community Services Division Damon TerzaghiSenior Director, NASUAD
Background • Every few years NASUAD works to update its public policy platform in order to include the most current and relevant information and legislative/regulatory recommendations • Now that the new Congress and State Administrations have been seated, we believe it is an appropriate time to update the platform • These recommendations will likely remain in effect as the official platform for the next two years • This is your chance to weigh in: • Be loud and be proud! • And be proud to be loud…
Process Overview • NASUAD Staff review prior recommendations with NASUAD’s Public Policy Committees: • Two committees: • Aging and Disability (focus on discretionary programs); • Medicaid and LTSS (focus on entitlements including Medicaid/Medicare/duals); • Committee membership is open to any interested state (Sign up today!) • Committees make recommendations for modification to platform • Board of Directors reviews resulting draft platform, provides additional recommendations, and moves to recommend approval • Membership provides feedback, additional comments, and moves for final approval to the platform • NASUAD takes these recommendations and builds formal narrative booklet We Are Here
Recommendations • Reauthorize the Older Americans Act • Note: NASUAD issued specific OAA Reauthorization platform in August 2018 based on membership recommendations • Increase Flexibility for States • Combine Title III-C1 & C2 into one program • Establish a demonstration program that allows states to evaluate providing OAA supports in a targeted, person-centered way • Support Programs that Assist Individuals to Age in Place: • Community Services Block Grant • Social Services Block Grant • Low Income Home Energy Assistance Program • HUD Housing Programs, particularly with a focus on affordable, accessible housing • Specific interest in III-B sustainability
Recommendations • Promote Elder Justice and Adult Protective Services: • Support the ACL APS Recommendations by establishing authorizing Federal Legislation and funding for APS • Enhance support for Ombudsman program • Support Research and Evaluation in the OAA and Aging Services • Establish/strengthen research arm under ACL to address both Aging and Disability • Either expand NIDILRR to encompass aging and disability; or • Establish corresponding aging-focused research entity in ACL • Support the NWD/ADRC initiative: • Continue to advocate for ongoing, increased appropriations for NWD • Allow III-B funding used to support NWD to serve individuals under 60
Recommendations • Align current policy allowing Tribal AAAs to set their own age eligibility threshold for Title VI services with Title III eligibility • Address workforce issues: • Increase allowable options to support caregivers under Medicaid HCBS • Provide grants and other funding sources to help develop innovative recruitment/retention models, including expanded telemedicine • Improve HCBS settings implementation • Allow new constructions subject to heightened scrutiny to enroll as Medicaid providers based upon approved plans that demonstrate compliance to address challenges with capacity • Provide timely responses and approvals to states that submit heightened scrutiny packages
Recommendations • Clarify person-centered planning requirements • Ensure that CMS applies consistent requirements nationally • Clarify that only essential hands-on providers are required to sign the plan and be included in plan distribution to reduce burden/red tape and protect privacy • Provide clarification on conflict of interest requirements, including a statement that entities are not conflicted from Medicaid case management if they deliver OAA services • Continue to allow Medicaid 1115 waivers to include HCBS/LTSS innovations • Provide employment supports for older workers and individuals with disabilities: • Programmatic improvements to Medicaid Buy-in programs • Expanded support via interagency workgroups • Increase availability of supports to older workers • Move SCSEP and ODEP to ACL • Increase Tribal VR appropriations to account for inflation
Recommendations • Improve electronic visit verification policy and issue clarifications regarding important issues, such as: • Shared living • Self-direction • APD approval • MECT processes • Error rates • Ensure that the EVV FMAP penalty only applies to specific services that are noncompliant
Recommendations • Medicare: • Expand policy allowing for short-term LTSS to be provided via Medicare Advantage plans to FFS • Provide states with flexibility to assure access to necessary DME • Expand Medicare billing standards related to professional certification to expand provider pool and align with state Medicaid programs (one such example could be licensed mental health professionals) • Include a Medicare dental benefit • Establish a demonstration project in CMMI that allows interested states to manage the Medicare funding for dual eligible individuals
Additional Discussion • Things we missed? • Concerns with proposed recommendations in the platform? • Modifications/edits to proposals discussed?
For additional information: Damon Terzaghi dterzaghi@nasuad.org (202) 674-8582 www.nasuad.org