PARCR Members,

Copied below is a Member Alert by LeadingAge PA in response to Governor Wolf”s announcement on Tuesday, February 4, 2020 of his proposed budget for state fiscal year 2020-21. The Alert, at this point, appears to be an Alert of information because the Alert ends with “Please watch for calls to action in the near future.”

Also below are statements from Adam Marles, CEO and President of LeadingAge PA, along with information about LeadingAge PA. Mr. Marles expresses disappointment over this new budget proposal.

Please feel free to contact me if you have questions or wish to make comments.

Gail Stelger

Vulnerable Seniors Ignored by Governor Wolf for the Sixth Year

Yesterday, Governor Wolf shared his executive budget for state fiscal year 2020-21. This announcement was like Groundhog Day all over again, as shared by LeadingAge PA’s President and CEO Adam Marles. While the governor formed a Council on Reform to ensure vulnerable populations have access to needed services, he chose to not increase funding for Medical Assistance senior services yet again. LeadingAge PA’s initial review of the Governor’s Executive Budget identified the following points of interest to LeadingAge PA members:

• No Medical Assistance rate increases for nursing homes, LIFE providers, adult day programs or home health care.
• An increase in the minimum wage to $12 per hour.
• $5 million in state funds to grow the LIFE program by an additional 430 participants.
• $1.4 million to expand access to the Ventilator Dependent Resident Grant Program.
• $8.1 million to provide services to reduce the waiting list for the OPTIONS program of home based services provided through the Department of Aging. General information on the budget includes:
• Overall spending is proposed at just over $36 billion in state general funds, which is a 4.22% increase over the available funds for 2019-20.
• The governor did recognize vulnerable populations other than seniors with funding for other priorities such as $19 million for persons with intellectual disabilities.
• The proposed budget discusses a blueprint for overcoming several obstacles to joining the workforce such as transportation, childcare, updating licensure requirements, and gaps in training.
• The governor’s address included generous funding for public schools, including $1 billion dollars to fix toxic school buildings.
• The address mentioned keeping Pennsylvania safe and adds $10 million for gun violence prevention.
• In the coming weeks, the governor promises to put forth a health care reform plan that will address the high cost of prescription drugs, protect consumers, and empower more families to make decisions about their futures without being held captive by their health insurance.

As additional information becomes available, we will be sharing it with members.

Please know that LeadingAge PA has already begun advocacy for a 2% rate increase for nursing homes and the LIFE program. We are also urging the General Assembly to include $17 million of new funding to begin a nursing home quality incentive program. Your advocacy will be necessary if we are to be successful. Please watch for calls to action in the near future.

LeadingAge PA Calls 2020-21 PA Budget Proposal 'Disappointment'

MECHANICSBURG, Pa. (Feb. 4, 2020) - LeadingAge PA, an association representing more than 350 nonprofit providers of services for seniors, today issued the following statement from President and CEO Adam Marles on the 2020-21 budget proposal from Gov. Tom Wolf:

"Pennsylvania has essentially flat-funded Medical Assistance for more than five years and must stop ignoring nursing home residents who rely on Medicaid. That's why today's announcement that the latest budget proposal will continue to flat fund nursing home care felt like Groundhog Day all over again. Last year alone, there was a $632-million loss that hurt nursing homes' ability to maintain high quality care, and retain and attract staff. We urge the Pennsylvania General Assembly to insert a 2% rate increase into the budget and provide an additional $17-million investment in Community HealthChoices to fund a quality incentive initiative. This would reward nursing facilities that staff well, utilize public funds to provide better salaries and benefits to direct care workers, and demonstrate quality. Pennsylvania should reward its best nursing homes, and provide the funding necessary to properly care for its oldest citizens."

LeadingAge PA reported on its proposal for the for 2020-2021 budget. Below is the report detailing the Quality Incentive Program and a 2% rate increase for both nursing homes and LIFE programs. Please note the last paragraph about grassroots advocacy.

In addition there is information on the Older Adult Protective Services Act, the Independent Senior Living Facility Privacy Act (HB2291), and The Centers for Medicare and Medicaid Services Fiscal Accountability Regulation.

LeadingAge PA Advocacy Update

State Budget Advocacy for 2020/2021

Almost as soon as the ink was dry on the 2019/2020 budget, LeadingAge PA began to work on our proposal for the 2020/2021 budget. We spent a number of months developing a Quality Incentive Program that would reward nursing homes for better staffing, better utilization of state Medical Assistance funds and better quality measures. This initiative was presented to the Wolf Administration as a proposed program to be included in the governor's Executive Budget that was announced on February 4, 2020. Unfortunately, for the sixth straight year, the Executive Budget did not include any rate increase for nursing homes.

In the meantime, until the budget is finalized by the legislature and the governor, we are working diligently on strategies to obtain not only $17 million in new state funding for our proposed Quality Incentive Program, but also a 2% rate increase for both nursing homes and LIFE programs. A rate increase for LIFE programs would be a modest return to the rates they were reimbursed prior to 2009 when they were reduced by 5%.

However, if we are to be successful, the General Assembly needs to hear your voice, too. In the upcoming months, please watch for Member Alerts with information on grassroots advocacy efforts.

Older Adult Protective Services Act

Since November 2019, we have been hard at work advocating for changes to the Older Adult Protective Services Act (OAPSA). The changes we are proposing would balance protections for seniors, ensure workers are not subject to numerous new criminal history background checks and prevent providers from being burdened with costly administrative processes.

Revisions to OAPSA are needed since multiple appellate court decisions have rendered parts of the existing law unconstitutional. Currently, there are two bills in the General Assembly aimed at fixing the law.

In the Senate, Senator Robert Mensch (R-Lehigh) has introduced SB819, while in the House, Representative Tim Hennessey (R-Montgomery) has introduced HB1930. Both bills contain provisions for prohibited offenses and time frames under which an applicant cannot be hired.

SB819 has passed the Senate and now sits in the House Aging and Older Adult Services Committee. LeadingAge PA opposes this bill and has asked the House to not take it up. HB1930 is more favorable, in its current form. However, in November and December 2019, the bill was scheduled for a vote out of the House Aging and Older Adult Services Committee with amendments that would have been disadvantageous for our members. Working in coalition with other long-term care and service provider associations, we were able to stop this bill from being voted on both times. We continue to work with the House Aging Committee, the Governor's Office, and the Department of Aging on language that we can agree upon.

Independent Senior Living Facility Privacy Act

The need for this legislation arose from an incident when representatives from the Department of Human Services canvased independent living apartments and questioned residents about their care needs. LeadingAge PA is actively working with Representative Eric Nelson (R-Westmoreland) to revise the language of House Bill 2291 from the last legislative session. The new language is intended to offer some protections for both independent living providers and residents. Once the co-sponsor memo is available, we will ask LeadingAge PA members to contact your members of the State House and request they sign on as co-sponsors of this legislation.

The Centers for Medicare and Medicaid Services Medicaid Fiscal Accountability Regulation

In November 2019, the Centers for Medicare and Medicaid Services (CMS) released a proposed regulation, the Medicaid Fiscal Accountability Regulation (MFAR) that could structurally alter Pennsylvania's already underfunded Medicaid program. Not only does this regulation have the potential to affect our nursing home members, it could also have devastating effects for our Continuing Care Retirement Community / Life Plan members. If this regulation was to be implemented as it is currently proposed, the process for approval of provider taxes, such as the Nursing Facility Assessment Program, would be significantly more subjective and unpredictable, the consequences of which CMS admits are unknown.

Not only has LeadingAge PA recognized the lack of clarity in the current proposed regulation, the unknown consequences to the Medicaid program, and the potential disruptions to the already tenuous system supporting the commonwealth's most vulnerable citizens, but we have already begun taking action on behalf of our members! We have submitted comments to CMS, written letters to the Pennsylvania Congressional Delegation, and drafted talking points for you, our members, to use when contacting CMS and our elected officials in Washington, D.C. Additionally, we are providing education on the CMS proposal to not only our members, but also our state officials who have received comment letters from many CCRC residents.