In The News

Democrats’ Efforts on BBB Reconciliation Package Continue to Stall

From Partnership for Medicaid Home-Based Care

Sen. Joe Manchin (D-WV) has further narrowed the universe of policies he wants to include in a modified Build Back Better Act (H.R. 5376) to focus on tax changes (namely, increasing the corporate rate to 25 percent and establishing the capital gains tax rate at 28 percent); deficit reduction; and policies to reduce prescription drug prices.  He has indicated that any other changes must go through regular order, effectively giving policies like HCBS investments little chance (at the moment) to advance in reconciliation.  Some policymakers are concerned that Sen. Kyrsten Sinema (D-AZ) is not aligned with Sen. Manchin’s desired tax changes, which could jeopardize even a small reconciliation bill.  Further, with Sen. Manchin attempting to negotiate a bipartisan climate package with Sen. Lisa Murkowski (R-AK) and other policymakers turning their attention to the conference committee for the Bipartisan Innovation Act, active discussions on reconciliation are unlikely in the coming weeks.


CMS’ Requirements for NPs Ordering Home Health Services Raises Concern

NAHC has major concerns it will be addressing with CMS

On April 27, 2022, the Centers for Medicare & Medicaid Services (CMS) issued Change Request 12615 to clarify requirements for allowed practitioners under the home health benefit.

In the “Background” section of the transmittal, CMS states that nurse practitioners and clinical nurse specialists acting as “allowed practitioners” under the Medicare home health benefit must work in collaboration with a physician, as well as in accordance with state practice laws, and that nurse practitioners must document their scope of practice and the relationships they have with physicians with whom they are collaborating in the medical record.

CMS reiterates, in the transmittal, the regulations at §410.74, §410.75, and §410.76  in the manual section at 30.2.1.

30.2.1 – Definition of an Allowed Practitioner

Allowed practitioners in addition to physicians, can certify and recertify beneficiaries for eligibility, order home health services, and establish and review the care plan. Allowed practitioners are defined at § 484.2 as a physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) as defined at this part. NPs, CNSs, and PAs are required to practice in accordance with state law in the state in which the individual performs such services. Physician assistant means an individual as defined at § 410.74(a) and (c). Clinical nurse specialist means an individual as defined at § 410.76(a) and (b), and who is working in collaboration with the physician as defined at § 410.76(c)(3). Nurse practitioner means an individual as defined at §410.75(a) and (b), and who is working in collaboration with the physician as defined at §410.75(c)(3).

Individual states have varying requirements for conditions of practice, which determine whether a practitioner may work independently without a written collaborative agreement or supervision from a physician, or whether general or direct supervision and collaboration is required.

In the absence of State law governing collaboration, collaboration is to be evidenced by NPs documenting their scope of practice in the medical record, and indicating the relationships that they have with physicians to deal with issues outside their scope of practice.

CMS’ policy is both confusing and concerning regarding what CMS might be requiring of NPs in terms of collaboration in states where NPs have full practice authority (FPA). The National Association for Home Care & Hospice (NAHC) requested that CMS provide guidance on what the Medicare Administrative Contractors will be requiring for medical review. CMS responded as follows:

“…the contractors will only be looking for a statement in the medical record documenting the NPs scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice, when the NP is NOT required to have a collaborative agreement. In other words, in states that do not govern collaboration.”

 CMS further clarified that it considers states with full practice authority NPs to be states that do not have laws that govern collaborative agreements.

NAHC disagrees with CMS interpretation of the requirements for NPs with FPA. The regulation requires collaboration for NPs to be in accord with state laws. Additionally, section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which includes the provision for NPPs to certify and order home health services, only requires that NPPs practice in accord with state laws and is silent regarding collaborative agreements with physicians.

NAHC is working with the American Association for Nurse Practitioners to bring our concerns to CMS in order to reach an acceptable resolution.


NAHC Supports New Bill To Empower Seniors to Stay in their Homes

Go to NAHC’s Advocacy Center to support this legislation!

Our homes are so important to us. It’s not just where we sleep and eat most of our meals, it’s our place to be independent. And, since the pandemic, it’s increasingly an office, a gym, a child care center, and, of course, if you need health care, your home is a great place to receive it.

That is why NAHC is thrilled to announce that on Friday, May 6, U.S Representatives Charlie Crist (D-St. Petersburg) and Thomas Suozzi (D-NY) introduced the Home Modification for Accessibility Act (H.R. 7676), legislation that provides tax incentives for home modifications so seniors and those with disabilities can more easily and safely continue living in their own homes.

The Home Modification for Accessibility Act empowers Americans to make decisions about where and how they live by offsetting the costs associated with making home modifications through a penalty free early retirement withdrawal and lifetime tax deduction of up to $30,000. This will reduce injuries and subsequent medical costs associated with falls, as well as drive development and investment in the market and create new job opportunities for skilled laborers and contractors.

“This bill is a step in the right direction towards enabling more seniors to age in place while ensuring they are positioned for many more years of comfortably living in their own homes,” said NAHC President William A. Dombi. “This legislation has the full support of the National Association for Home Care & Hospice.”

Not only is living at home the preferred option for 90 percent of aging Americans, it is also vastly more affordable for people and the country. Having to live in a nursing home where room costs can average anywhere from $6,000 to $8,000 a month.

“Given the option, the vast majority of seniors and people with disabilities want to stay in their own home for as long as possible. It’s more comfortable, less costly, and improves quality of life,” said Rep. Crist. “Unfortunately, many homes lack accessibility upgrades to make this a reality for seniors on fixed incomes and people with disabilities. That’s why I introduced the Home Modification for Accessibility Act – to provide tax incentives so that more Floridians have the option to live and age safely in their own home. It’s the right thing to do!”

“We have a storm coming, with the number of disabled elders expected to double in the coming years. Fewer family caregivers are available for these aging Americans and the market for long-term care insurance is not currently sufficient to address these demographic challenges,” said Rep. Suozzi. “We must do all we can to ensure New Yorkers have the option to live and age safely in the comfort of their own home.”

“This bill will help correct a fundamental injustice in American life. While we’re living longer and healthcare is increasingly conducted at home, the country’s housing stock is not meeting our daily and safety needs,” said Louis Tenenbaum, founder and president, HomesRenewed Coalition. “Incentives outlined in this bill will encourage people to demand building and renovation designs that support aging in place with joy, dignity and independence,” added Tenenbaum. “Over time, these features will become the norm, benefiting individuals, families, the healthcare system and our economy.”

Please join NAHC in supporting this legislation, which will enable aging and disabled Americans to continue to live in their own homes.


COVID-19 Updates (05/16/2022)

  • Coronavirus cases and hospitalizations are rising in a majority of American states, in what appears to be the first widespread increase since the peak of the Omicron surge in January.
  • The coronavirus, SARS-CoV-2, has had billions of chances to reconfigure itself as it has spread across the planet, and it continues to evolve, generating new variants and subvariants at a clip that has kept scientists on their toes. Two-and-a-half years after it first spilled into humans, the virus has repeatedly changed its structure and chemistry in ways that confound efforts to bring it fully under control.
  • Due to an updated analysis of the rare cases of thrombosis with thrombocytopenia syndrome (TTS), which typically occur 1 to 2 weeks after vaccination, use of the J&J vaccine should be restricted to those for whom mRNA vaccines are "not accessible or clinically appropriate," or who would not get vaccinated if not for the J&J vaccine, the agency said.

More COVID-19 Fallout: Social Isolation Associated with Poor Health and Emotional Distress

Commonwealth Fund

As a result of social distancing and other interventions, the COVID-19 pandemic has cut many people off from their emotional and social support systems. For older adults, this may have exacerbated feelings of isolation; the percentage of those who reported feeling isolated jumped from 27 percent in 2018 to 56 percent after the start of the pandemic. This is particularly concerning for older adults with high health care needs — that is, people with multiple chronic conditions or functional limitations who require assistance with daily activities. Feelings of isolation not only create emotional distress but also have the potential to further exacerbate their already complicated health problems and even contribute to early mortality. Social distancing was an effective approach to slowing COVID-19 transmission — especially among a population at increased risk of infection — but any resulting feelings of isolation may have contributed to new health and social risks for this medically vulnerable group.

To explore how isolation affects high-need older adults and examine their experiences during the pandemic, we analyzed data from the Commonwealth Fund 2021 International Health Policy Survey of Older Adults. We found, consistent with previous research, that high-need adults are significantly more likely to report social isolation; more than one of 10 (12%) high-need older adults reported often feeling isolated from others, compared to 5 percent of older adults without high needs.

In line with previous research, isolation appears to be associated with poorer health. High-need older adults who reported feeling isolated were more likely than those not feeling isolated to report they were in fair or poor health (rather than good or excellent health); these adults were also more likely to report going to the emergency room for care that could have been provided by their regular clinician.

Among high-need adults who feel isolated, nearly two-thirds reported having a mental health diagnosis or feeling emotionally distressed in the past year; this is a significantly higher rate than high-need adults who do not feel isolated. Experts report that the relationship between mental well-being and feelings of isolation are bidirectional, with isolation worsening an individual’s mental health conditions, and mental health conditions exacerbating feelings of isolation. It is possible the COVID-19 pandemic had a multifaceted impact on the mental well-being of older adults.

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