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Monitoring the Winds of Change

Capitol Building
Public Policy Advocacy Update

The start of a new legislative session, particularly when there is a change in the majority leadership, brings a host of new challenges and opportunities. As committee chairs and staff switch from minority to majority status and vice versa, keeping track of who is where and doing what is no easy task. Fortunately, as an active member of the Leadership Council of Aging Organizations, we are able to collaborate with 70+ other national organizations to share updated information.

Rep. Linda Sanchez (D-CA) again will introduce her Medicare Option proposal for ADS. I have had several discussions with Rep. Sanchez’s staff regarding some of the language in the bill that dissuades possible Republican support. However, they have decided to introduce the bill as it was in the past session in order to provide room for negotiation. I have advised them that I will take an amended version to the Senate to seek bipartisan sponsorship to provide a starting point for negotiation.

The expressed view of the new Senate Appropriations staff is helpful in pursuit of Medicare option—that programs targeted to cost avoidance will be more favorably reviewed than others that seek new or expanded services and appropriations. Therefore, the approach that we developed in 2014 to Modernize Medicare with ADS for Cost Avoidance is on target.

Rep. Barbara Lee (D-CA) has reintroduced her Adult Day Center Enhancement Act (H.R.264) to provide a phased-in $28 million model responding to the needs of younger individuals living with neurological diseases or conditions such as multiple sclerosis, Parkinson’s disease, traumatic brain injury, or other similar diseases or conditions. Because there is a new cost, we will need to find an offset.

Concerns about implementation of the CMS HCBS Medicaid Waiver rule published in 2014 have not been significantly alleviated with publication of the sub-regulatory guidance for nonresidential centers. In addition, the National Association of State Directors of Developmental Disabilities Services is continuing to argue strenuously that CMS should flatly prohibit the provision of any HCBS services on the grounds of any institution. We may need to explore the possibility of asking the Administration to place a hold on implementation of the regulation for nonresidential centers serving primarily elderly and/or Alzheimer’s consumers as the most expedient method of protecting our ADS centers.

The compromise version of the Older Americans Act (OAA) reauthorization that did not come to a vote in 2014 has been reintroduced in the Senate and may be fast-tracked within the next few weeks. Reportedly, the compromise contains a remedy to the outdated “hold harmless” formula that has stalled reauthorization for the past few years. Use this link to obtain a copy of the bill summary.

Finally, vigilance is the watchword for this year. Early signals from the new Republican leadership in the Senate and that from the returning leadership in the House are that both groups are content to allow sequestration to resume. If that happens, it means $45 billion will be trimmed from the nondefense side of the budget. Both the OAA and Medicaid are targets and through the LCAO, we are preparing to seek more reasonable compromise.

—By Roy Afflerbach, The Afflerbach Group, LLC, NADSA Public Policy Advisor