General News

U.S. House of Representatives Passes 6-Month Continuing Resolution – On Sept. 13, the U.S. House of Representatives passed H.J. Res. 117, the Continuing Appropriations Resolution (CR) that funds the federal government through March 27, 2013.

The bi-partisan vote was 329-91. The CR is based on the top number for discretionary spending in the Budget Control Act of 2011 (the act that avoided default and created the next big challenge, sequestration) with 2012 appropriations levels as the base.  

Hence, agencies actually receive a small increase -- 0.6% -- over FY 2012. The CR prohibits agencies from initiating new projects; only on-going operations are permitted. Funding for entitlements and mandatory programs (Medicare and Medicaid) “shall be continued at a rate to maintain program levels under current law” (read, probably no changes in funding).

The U.S. Senate agreed to vote on the CR on Wednesday, Sept. 19. We anticipate that the Senate will support the CR as passed. Both Houses of Congress are expected to adjourn at the end of next week until after the election.

Thank you to Marsha Greenfield, Vice-President, Legislative Affairs, LeadingAge, for the information in this article. 

Learn How the Election will Impact LeadingAge Policy Priorities – As you know, we’re facing a huge election—the results of which will have a major impact on state and federal policy and aging services providers across the country. Join us at the LeadingAge Annual Meeting in Denver, October 21-24, to have an open discussion about current policy issues that will affect your organization. With Medicare/Medicaid changes looming and spending cuts on the horizon, you can’t afford to miss this. We will be addressing those and other key issues like:

• Innovative models of affordable housing with services.
• Regulatory issues affecting long-term services and supports.
• Expanding into home- and community-based services.
   

Congressional leaders will be there. LeadingAge and LeadingAge Florida staff will be there. And you need to be there too. Browse the Policy & Legal Issues track as well as the full education program featuring more than 200 sessions—and Register Today!

Expectations for a Continuing Resolution; What May Happen with Sequestration – With the regular session of this Congress sputtering to a close by the end of this week, there are a couple of things we wanted you to be aware of:

Fiscal 2013 stopgap spending bill:

The House passed this measure, H.J. Res. 117, last Thursday (September 13) and the Senate should take it up this coming Wednesday. We expect it to pass. By the end of this week, we expect Congress to adjourn until after the election. The continuing resolution keeps federal agencies in operation through March 27, 2013. 

• Funding is provided at fiscal 2012 levels plus a 0.06% increase for programs subject to appropriations. Those programs include Section 202 housing and Older Americans Act home and community-based services funding.
• Unfortunately, the continuing resolution does not provide the new Section 202 construction funding for which we have advocated all year and which was approved by the House in June. Negotiations among House and Senate leaders and between the two parties required a “clean” CR with little funding for new initiatives.
• Medicare reimbursement is not subject to appropriations. CMS has indicated that nursing homes will get a payment update averaging 1.8% beginning on October 1. The actual payment update will vary according to case mix and geographic location. 
• Medicaid funding to the states is not subject to appropriations and will go to the states under the existing formula.
• Administrative funding for Medicare and Medicaid is subject to appropriations. Under the terms of the CR, administrative funding for activities like nursing home surveys will be at the 2012 level plus a 0.06% increase.

Obama Administration report on sequestration

On Friday, September 14, the White House finally issued the report on the potential impact of automatic spending cuts ordered by the Budget Control Act of 2011, as mandated by the Sequestration Transparency Act which Congress passed in August.

• The automatic spending cuts (sequestration) will hit both defense and domestic programs.
• Medicaid is one of a handful of programs that will not be affected.
• Medicare reimbursement to health care providers will be cut by 2%. These cuts will amount to an $11 billion cut in Medicare spending.
• The report estimates the cut in Section 202 housing funding at 8.2%, amounting to $31 million (p. 111).
• Section 811 housing for people with disabilities would get an 8.2% cut, amounting to $14 million (p. 111).
• And the Older Americans Act programs would be cut – 8.2%, $121 million.
• The report notes that Older Americans Act programs under the Administration on Aging are subject to sequestration but does not provide a figure on the amount of the cuts.

If Congress allows the automatic spending cuts to go into effect, the funding cuts will be applied to the amounts the programs received under the continuing resolution. So, the 0.06% increase in funding for Section 202 and Section 811 housing and the Medicare payment update will disappear as of January 1 and spending for the remainder of the year will be lower. Congress will take no action before the election to head off sequestration. Any hope of averting the automatic cuts lies in the post-election lame duck session.

There are three potential scenarios:

1. In the lame duck session, Congress could adopt a budget plan for fiscal 2013 that would provide for the amount of deficit reduction called for in the Budget Control Act;
2. Congress could vote in the lame duck session to delay sequestration (which many folks think is the most likely possibility); or 
3. Congress could let the spending cuts take effect and let the new Congress figure out how to modify or cancel. Some analysts have pointed out that funds already in the pipeline for federal agency activities and projects could prevent the automatic spending cuts from being felt immediately on January 2.

LeadingAge and LeadingAge Florida are urging Congress to prevent sequestration by adopting a fair and balanced budget plan for fiscal 2013 in the lame duck session.

For more information about the Statewide Medicaid Managed Care program, please click here.

Thank you to Barbara Gay, Director of Governmental Affairs, LeadingAge for the content in this article.

AHCA Issues Guidance on Medicaid Managed Care Specialty Plans – On September 19, AHCA issued guidance on Medicaid Managed Care Specialty Plans. It clearly stated that pursuant to section 409.966 (3)(b), F.S., the Agency for Health Care Administration may not select plans in the same region for the same managed care program that have a business relationship with each other. Pursuant to section 409.962(3), participation by specialty plans shall be subject to the procurement requirements of this section.

Q/A followed the statement for clarification purposes—

Q: Can a managed care plan that operates as a Specialty Plan under the Statewide Medicaid Managed Care program also operate a Managed Medical Assistance plan within the same region?
A: No, managed care plans that are awarded a bid and contract with the Agency under the Statewide Medicaid Managed Care program as a Medical Assistance plan in a particular region may not contract with the Agency as a Specialty plan in the same region. This restriction does not apply to Long Term Care Managed Care plans.
Q: If a managed care plan is awarded a bid and contracts with the Agency as a Specialty plan under the Statewide Medicaid Managed Care program would the plan be allowed to subcontract to provide particular services with another managed care plan in the same region?
A: Yes, a managed care plan contracted with the Agency as a Specialty plan under the Statewide Medicaid Managed Care program may subcontract to provide particular services with another managed care plan in the same region, provided the relationship cannot be deemed a joint venture.
Q: Can a managed care plan bid on and be awarded contracts for two different types of Specialty plans in the same region?
A: No.

For more information about the Statewide Medicaid Managed Care program.

Influenza Season is Around the Corner – Now is the perfect time to remind your residents that seasonal influenza vaccination is the best defense against the flu. Medicare provides coverage for one flu vaccine and its administration per influenza season for seniors and other Medicare beneficiaries with no co-pay or deductible. And, don’t forget to immunize yourself and your staff. Know what to do about the flu.

Remember – Influenza vaccine plus its administration is a covered Part B benefit. Influenza vaccine is NOT a Part D covered drug. CMS will provide information and a link to the 2012-2013 Influenza Vaccine prices when they are available.

For more information on coverage and billing of the flu vaccine and its administration, as well as related educational resources for health care professionals and their staff, please visit the CMS Medicare Learning Network Preventive Services Educational Products and CMS Immunizations web pages. And, while some providers may offer the flu vaccine, others can help their patients locate a vaccine provider within their local community. HealthMap Vaccine Finder is a free, online service where users can search for locations offering flu vaccines.

Innovations in Advocacy Make the Most of Not-for Profit Strengths – The third leg of the LeadingAge promise—Advocate—recognizes our responsibility to tell our story of quality and innovation in aging services, and to act to make sure government does right by the older people we serve. Here are some creative ways that providers and seniors are being mobilized for effective advocacy.

The Education of an Advocate
In 2010, Doug Dodson, president of Lee Healthcare Resources, which supports Cypress Cove, a CCRC in Ft. Myers, FL, had never had much involvement with advocacy until visiting Tallahassee with other members of LeadingAge Florida.

“Doug had never even been to the capital and never made rounds,” says Janegale Boyd, president/CEO of LeadingAge Florida. “He was fascinated that he could walk in and talk to a legislator with an appointment. He was amazed at what a good relationship we had with legislators in his area. … He came away from it a changed person. He found out the legislators really do put their shoes on one at a time like we do.”

Two years later, Dodson is an experienced and effective advocate, so much so that he recently won the association’s “Advocate of the Year Award” for “exceptional advocacy efforts on behalf of the field of housing/retirement communities or long-term care for seniors.”

LeadingAge Florida, as it prepares members for advocacy, routinely asks them about who they know, or who they have access to, either among legislators or others with influence. Dodson not only had influential members on his board, but during a visit to Washington, DC, to meet with U.S. Rep. John Mica (R-Winter Park) the delegation learned Dodson has a relative on Mica’s staff.

“One of the legislators from [Dodson’s] county is State Rep. Gary Aubuchon, chair of the Rules & Calendar Committee. Aubuchon was the reason we were able to get our bills heard. We passed CCRC, nursing home and affordable housing bills,” says Boyd.

One example of Dodson’s energy was his advocacy for the continuing care at home bill.

“Doug and his relationships made the difference with [that] bill,” says Tom Randle, LeadingAge Florida’s vice president of public policy and government affairs. Randle says Dodson’s energy and connections were crucial to getting a hearing for the bill, especially because the legislature’s 60-day session was already at the halfway point when he got involved.

Dodson tries to deflect credit for his work to others, but admits he’s learned a lot.

“I’ve been doing [advocacy] for three years now,” he says. “The first year I was scared to death, then I saw this is how laws get influenced. If you don’t roll up your sleeves and speak your mind you’ll get run over. You have to create economically and politically sustainable systems to help seniors.”

Mobilizing Seniors for Sustained Advocacy

LeadingAge Iowa
Because direct advocacy from seniors is so effective, Iowa aging-services providers now have a means to organize their residents and clients for maximum advocacy effectiveness.

LeadingAge Iowa is launching the “Senior Alliance,” a statewide resident association, “as a forum to educate residents/consumers [about] policy issues, regulations and funding sources for senior health care services.”

Bill Nutty, LeadingAge Iowa’s government relations and member services director, says the idea is to reach out to active seniors in Iowa retirement communities, those who would participate in letter writing and other advocacy activities.

“The second part,” says Nutty, “is to encourage candidates to attend meet-and-greets at member communities, and talk to residents.”

Senior Alliance members will be asked to respond to LeadingAge Iowa’s legislative Action Alerts. E-mailed alerts—sent when legislative issues call for input—will direct Alliance members to an online advocacy site, where prepared e-mails can be sent. Seniors wanting to go a step beyond that can speak to legislators by phone, and Senior Alliance will also set up face-to-face meetings when possible.

Nutty says that one key to the new alliance is to form relationships with existing groups, such as the Older Iowans Legislature, a statewide grassroots group of seniors, or the Iowa Person-Directed Care Coalition, an organization of aging-services stakeholders drawn from provider organizations, government and consumer organizations. He also notes that existing resident associations may be fertile ground for recruiting seniors to join the Alliance.

LeadingAge Iowa has created materials outlining the program: A flyer and poster designed to recruit seniors, packets to guide administrators in setting up senior alliance groups and to facilitate “meet-and-greets,” and more.

Data Brings Economic Impact Home
When making a case for the value of long-term care providers, you can talk about their innovations in the care of the elderly, or their role as anchors in their communities, or you can talk about the plain hard numbers of economic impact.

LeadingAge New York decided to do all three things in one package. In late 2011 the association published Impact, a booklet that summarizes the economic impact of aging-services providers all over New York State, while highlighting a number of innovations and providers that are good citizens.

LeadingAge New York
“Recently the governor created a group of economic development councils, 10 of them for different regions of the state,” says Ami Schnauber, director of government relations for LeadingAge New York. “We thought, what better time to tell the story of long-term care providers, because they are economic drivers. We did a study, based on the same 10 regions as the councils.” Impact breaks down the economic effects of the state’s long-term care system, which it calls “an economic powerhouse” worth $30 billion to the state’s economy. The booklet has become a part of the association’s advocacy work, with copies sent to elected officials, regulators, media and other stakeholders.

For each region, LeadingAge New York members are highlighted for their economic importance to the region, their innovations in care, and how they fit into their communities. Schnauber notes that innovation is what defines not-for-profits from for-profit providers, hence the emphasis on new thinking in aging services.

“Some members are enormous—one is a top-two employer in its region and another is a top-ten,” says Schnauber. “Even in the case of small members in small communities, their economic impact is huge.”

Promotion of the report has focused on local coverage in each region. Customized press releases use the facts about local members as the hook for media coverage.

One key to the development of the report was encouraging members to use an economic development tool—an Excel spreadsheet—based on the Regional Input-Output Modeling System (RIMS II) provided by the U.S. Dept. of Commerce’s Bureau of Economic Analysis. Simply by inputting total revenue, expenses and employment data, a member can generate information on how many jobs the organization generates and what financial impact it has on a community. Data from members helped the association create the statewide report. (Schnauber says the handbook on the Bureau of Economic Analysis website is very helpful in understanding how to use the regional multipliers.)

“In politics it’s all about jobs, jobs, jobs,” says Schnauber. “One piece of our tool allows you to put in a percentage cut to Medicaid. If we know Medicaid is taking a hit of X%, we can see, with this tool, what kind of loss this would create and how many lost jobs could result.”

“One thing we try to impress on these economic development councils is that it’s not just about the bricks and mortar,” says Schnauber. “There is a fabric of community that’s available, and that’s a key component that our members play a role in. The goal is to have vibrant long-term care network [that] is an incentive to have people locate their business there.”

Hands-On Work Creates Face-to-Face Advocacy
LSN
State Rep. Darlene Senger (R-Naperville), center, visits with Sr. Jeanne Haley, administrator of St. Patrick’s Residence, Naperville, IL, and Kirk Riva of Life Services Network of Illinois.
The aphorism that “all politics is local” is true because it implies “hands-on” politics, the face-to-face connection between politicians and their constituents.

Life Services Network of Illinois (LSN) makes a priority of creating those direct connections. Its Partners in Quality program, now in its fifth year, aggressively facilitates visits of elected officials to LSN members throughout the state.

“We think one of the big strengths of our members is [their] involvement in advocacy and their responsive actions with legislation in the arena,” says Kirk Riva, LSN’s vice president for public policy. “So many times in Springfield, legislators are looking for a solution in search of a problem. It’s horror stories in the media that often drive legislation. What’s a better way to tell our stories than to have legislators visit our [members] and show them a better understanding of the innovative programs and services improving quality of life for their constituents?”

LSN staff contact elected officials, coordinate with members to set up dates for visits, and brief members and residents on the issues at hand. With very few exceptions, an LSN employee is present to ensure that each visit goes smoothly. More than 200 visits have been arranged under Partners in Quality, the goal being 50 to 60 per year. Well over half of LSN’s members have hosted visits so far.

“There is a media component as well,” says LSN President Christopher Laxton. “We give a little award to the legislator and let local media know so there are always photo ops. The award is in recognition of their commitment to advancing quality in aging services. We also have a sample press release we give to the legislator for their use, and they do use them quite a bit.”

In 2009, Chicago newspapers were running articles about problems at some nursing homes that Laxton says were damaging to the public image of providers, even though the homes in question were not LSN members. Riva says the legislative session the following year saw a lot of bills aimed at providers. “I think things would have gone much worse if a lot of the members of the [state] assembly hadn’t known first-hand about our members,” Riva says.

“The focus is on state lawmakers,” says Laxton, “but we have had some of the federal delegation as well. We bring all the members who’ve hosted these visits together at a legislative lunch in December, and will include two or three of the friendly state legislators there too.”

“The amazing thing to me,” says Riva, “is that over the five years we’ve been doing it, only one or two legislators have said they are not interested. I thought it would be hard to get people to come, but it’s been the complete opposite.”

Busloads Mean Business
While the focus in Illinois is on bringing legislators to seniors, in California, senior housing residents are the ones hitting the road. Aging Services of California (ASC) has been busing groups of affordable senior housing residents to Sacramento to meet and directly influence lawmakers.

The trips began three years ago, when some senior housing providers in Oakland took residents to the state capital. The resulting conversations between seniors and legislators, which ASC vice president of policy Eric Dowdy says were “really sincere, even better than [with] the members themselves,” convinced the association to continue the practice.

“We’ve had 40-80 people per visit,” Dowdy says. “We do an advocacy day, structured with a breakfast where we talk about issues, coaching them on how to talk to legislators, then send them on their way.” This year, he adds, “we’re doing a separate event—a special housing advocacy day. It will be the same week the state budget will be signed.”

Each delegation typically includes a staff person from the member, often needed as an interpreter for residents who don’t speak English. ASC will typically send along a staff member to lead the discussion.

Making the Editorial Case
While most of the advocacy work done in our field involves building and leveraging relationships with elected officials and government agencies, building relationships with media can be just as important.

Aging Services of Minnesota President/CEO Gayle Kvenvold takes her advocacy on the road by visiting the editorial boards of daily newspapers all over the state.

“We’ve been doing these tours to coincide with critical points in the legislative process in Minnesota,” Kvenvold says. “Legislators read the editorials in their local newspapers, and they pay attention.”

Minnesota’s legislative sessions begin in January, so wintertime trips around the state are common, though trips are also scheduled to coincide with critical decision points as bills work their way through the legislature.

“We typically will visit all the dailies,” Kvenvold says, “and in critical legislative districts, where the representative chairs an important committee or has particular influence. We always have a local member with us so they can relate the issue to their community and their residents. The member can also talk about the innovations in their community. It’s a great way to supplement our grassroots activity.” Here is one example of an editorial that addressed an important issue and gave favorable publicity to the association.

Kvenvold offers some lessons learned from her long contact with editorial boards:

• All politics really is local. “Make the message about [the newspaper’s] community. No one tells that story better than a local provider.”
• Data matters. Always bring along solid information about the number of jobs aging-services supports in that community and the economic activity it engenders.
• Always shine a light on really good work being done in that community by aging-services providers.
• Get to the point. “We always know going in what our two or three most important talking points are. It’s unpredictable how these meetings will go and they could end quickly.”
• Build relationships. “We’re on a first-name basis with some editorial board members. They don’t always write an editorial [on our issues] but no visit is wasted. Sometimes, months later, they’ll use a fact that we brought to light, or a point that we made, in an editorial.”

“Voice Our Vote” Matches Seniors and Lawmakers

LeadingAge Ohio
LeadingAge Ohio staff and members pose with Ohio State Sens. Capri Cafaro and Joe Schiavoni at our East Region Voice Our Vote event at Shepherd of the Valley Boardman. 

Looking for a regular forum where providers, senior residents and association staff can stay on top of political developments and improve the effectiveness of their advocacy, LeadingAge Ohio has launched a series of events, Voice Our Vote, at member sites around the state. The gatherings include seniors, aging-services providers, and elected officials.

LeadingAge Ohio has traditionally hosted quarterly regional forums for members, offering one continuing education credit and featuring member vendors as presenters, says Katie Colgan, LeadingAge Ohio director of public policy & member relations. Voice Our Vote was launched when the association decided to alter the format of one of these meetings—in lieu of a “lobby day” at the state capital—and, in her words, “engage our members and tap into the energy of residents.”

A Voice Our Vote meeting usually includes a presentation from LeadingAge Ohio staff member about why advocacy is important, along with an explanation and discussion of the immediate issue at hand. State legislators are invited for a presentation and casual conversation with seniors. “Our goal,” says Colgan, “is to get people out and interested in advocacy and get legislators in front of them.”

The six Voice Our Vote meetings held so far have been hosted by member provider organizations. Those members are also encouraged to coordinate with their colleagues in other organizations, and to reach out to elected officials to encourage their attendance. Attendance has typically been around 50 people, and there has been local media coverage of a couple of the events.

Thank you to Gene Mitchell, editor of LeadingAge magazine, for the content of this article.

Host Legislators at your Community – Now that the 2012 election season is in full swing, legislators will be spending time in their districts. This is the perfect time for communities to host them for a Town Hall Meeting. It is important for legislators to see your communities, observe the quality care your residents receive, and hear your stories. These grassroots and relationship-building activities are critical elements of effective advocacy work.

For more guidance on bringing legislators to your communities, please read LeadingAge’s Congress to Home Program Guide.

If you are interested in hosting a legislator at your community, please contact Tom Randle, Vice President of Public Policy and Government Affairs, at (850) 702-0307. If you already have plans to host a session, please let us know how our advocacy team can assist you.

LeadingAge Florida's Florida Night Get Together, Oct. 22, Denver – You are invited to the Florida Night Get Together held in conjunction with LeadingAge's Annual Meeting Oct. 21-24 in Denver, Colo. The dinner will be Monday, Oct. 22 at 6:00 p.m., MT, at the 1515 Restaurant, located at 1515 Market Street, Denver. The cost is $30.00 per person. This is an opportunity to network with your LeadingAge Florida friends! With hundreds of people registered for this year's LeadingAge Annual Meeting, you don't want to miss those you want to connect with, so register now for the Florida Night Gathering.

For more information and to register, please click here. 

Senior Housing Report for CCRC, Nursing Home, AL, and ILU Members Now Available – LeadingAge Florida has collaborated with CliftonLarsonAllen (CLA) to bring you a special Florida-specific analysis of operations and compensation information for senior housing members (CCRC, nursing home, AL, ILU). We know you look for specific information from Florida and it can be difficult to find. Now it is available! The reports have been compiled from data collected from Florida communities and include component costs, staffing ratios, full-time equivalents (FTEs) and other key indicators. Now you can have the data, including medians and averages of all respondents.

The first-year pricing for Senior Housing Report for CCRC/NH/AL is $250 for Single Community; Multi-site Corporations pay $250 for the first site, $175 for the second site, and $150 for the third and additional sites. Discounted pricing is available for survey participants; contact LeadingAge Florida for more details. To purchase the report, please click here. Please contact Sue Ann Bunevich at (407) 802-1226 or Jon Hansen at (704) 998-5249 with questions or comments on the reports.