meredith ponder federal policy and advocacy manager nanasp october 15, 2015
TRANSCRIPT
Washington Update
Meredith PonderFederal Policy and Advocacy ManagerNANASPOctober 15, 2015
What IS Going On In Washington!?
Something in the water? Speaker woes Debt ceiling – next 30 days Trade deal? Spending deal? Medicare premiums It’s a HUGE mess.
Funding
Congress passed the CR, keeping status quo in funding until December 11
What follows? A possible bipartisan 2 year budget
agreement?
Return of Sequestration?
Overriding issue with this agreement—future of sequestration
Budget Control Act imposed it in 2013
Across the board cuts Then second round waived it in the
so-called Ryan-Murray 2 year budget deal
Led to increases in 2014 for OAA Nutrition Programs: $47 million
Is it Necessary?
President’s budget assumes no sequestration and investing in certain programs
Congressional budgets would bring it back
At the heart of the post-December 11 agreement
Sequestration less needed than before. Deficit at lowest level since 2007
OAA Appropriations Chart
Program FY14 Final FY15 Final FY16 Pres FY16 Senate FY16 House
Home and Community Based Supportive Services
$347.7 million $347.7 million $386.2 million $347.7 million $347.7 million
Congregate $439 million $439 million $458.1 million $439 million $441.5 million
Home-Delivered $216 million $216 million $236.4 million $216 million $219.5 million
NSIP $160 million $160 million $160 million $160 million $160 million
Nutrition Grant $20 million 0 0
Totals, IIIC $815 million $815 million $874.5 million $815 million $821 million
Title VI Native Americans Nutrition and Supportive Services
$26.2 million $26.2 million $29.1 million $24.8 million $31.1 million
Title VII Elder Abuse
$20.7 million $20.7 million $20.7 million $20.7 million $20.7 million
Chronic Disease Self Management
$8.0 million $8.0 million $8.0 million $7.6 million $8 million
Elder Justice Initiative
- $4 million $25 million $4 million $4 million
Older Americans Act
Also awaiting final action September 30 marked the 5th
anniversary of when law technically expired
Bipartisan renewal passed by the Senate—3 year modest extension of the Act
House needs to step up Time has come President Obama at WHCOA lent his
support
Medicare Increases?
One important accomplishment of this Congress: repeal the SGR, or the way physicians are reimbursed under Medicare
End uncertainty felt by physicians and older adults each year
Fixed for good Looming are big hikes in Part B for about
30% of beneficiaries—up by 52%! Advocacy work already underway to
prevent
ACA at 5 and for the Future ACA as responder to aging boom ACA has created more preventive
services Closing donut hole completely by
2020: prevention through adherence Improvements to Medicare Advantage
plans—stronger and less expensive Holding Part B premiums down Medicaid expansion
ACA and Seniors
Provisions for older adults also include the Medicare goal to extend life through delivery system reforms Value-based purchasing Care transitions Care coordination Bundled care models
ACA LTSS Provisions
Balancing Incentives Program: As of last month, $3 billion spent in 21 states to increase access to HCBS by increasing matching funding for Medicaid
ACA expanded Money Follows the Person program demonstration to help states rebalance their Medicaid long term services and supports systems
Also expanded the Aging and Disability Resource Centers program
White House Conference on Aging
July 13, 6th in history 2 of the 4 priority topics were
Healthy Aging and Long-Term Services and Supports Both are relevant to nutrition
Other topics: Retirement Security Elder Justice
Healthy Aging/LTSS
For these categories, NANASP: Co-hosted a webinar with AND Submitted responses to the HA/LTSS policy
papers Hosted a listening session at our conference Submitted a petition on recognition of
malnutrition with 150 signatures/comments We feel that nutrition was not adequately
discussed in the HA paper in particular, and the problem of senior malnutrition was left out entirely
Managed Care/Long Term Care More like long time wait Lot of smoke (ideas of think tanks etc) Not much fire (new legislation, higher
political profile for issue) Growth in Medicaid one major element…
but no Medicaid expansion in many other states
Greater shift in spending to HCBS A 2016 campaign issue? Should be. Guess how many candidates talk about
LTSS?
Malnutrition
Newest focus is on malnutrition which simply is poor nutrition
It can be related to: An excessive or imbalanced diet Clinical conditions that impair the body’s
absorption or use of foods A diet that lacks essential nutrients
Starting a new coalition: Defeat Malnutrition Today, http://defeatmalnutrition.today
We want you to join!
In the Pipeline?
Chronic Care Management: Senate Finance Committee working group on this issue, led by Sens. Isakson and Warner. NANASP/Academy of Nutrition and Dietetics submitted a paper
Medical Nutrition Therapy: H.R. 1686 (Rep. DeGette) – would extend Medicare MNT coverage to those with pre-diabetes and at risk of developing type 2 diabetes
Elder Abuse
One reality we can’t ignore in our field: elder abuse/elder justice
Like LTC, a denial issue Realities are there
1 in 10 older adults will be a victim 6 million total cases are reported every year 1 in 2 people with dementia will be a victim Average victim is an older woman living alone; nearly
half of all women 75+ live alone People with disabilities, minorities more likely to be
victimized $2.9 billion in 2009 was lost to financial exploitation
Going Forward in Elder Justice Fund the Elder Justice Act Implement the rest of the Elder Justice Act Pass the Older Americans Act Protect Social Services Block Grant from
cuts Reauthorize the Elder Justice Act Ensure new Victims of Crime Act funds go
to underserved victims such as elder abuse crime victims (WHCOA outcome)
Ensure other WHCOA recommendations on elder justice are achieved
Social Services Block Grant
A program with multiple constituents including older adults
Estimates are that $30 million in elderly nutrition is provided through SSBG, $25 million HDM and $5 million congregate
A program always on chopping block Some talk of defunding
What follows from the WHCOA
Unclear; depends on release of final report and its ability to provide roadmap
Items announced at the Conference will be followed up on, both in terms of those which Administration can do and from some of the partnerships
Our Focus
Has to be on triple threat to older adults: Hunger Food insecurity Malnutrition
Keys to the Future
Stay true to mission Demonstrate and document value Be innovative and adaptable Build, sustain, and strengthen partnerships Be proactive on diversity and family caregivers Invest in education Learn the ropes of managed care Be advocates Be leaders in age-friendly community work
Future: Stay True to Mission
Mission of OAA/aging network as relevant today as in 1965: Maintain the independence and dignity
of older adults in community through consumer-driven home and community based services
Target services to those in greatest economic or social need
Leverage other support for services
Future: Demonstrate/Document Value
Services always about outcomes Intervention of HCBS preferred and saves
money It is all about data—right data collected and
disseminated to show value to government and private funders
Data collection is a huge problem among the aging network—lack of funding for collection, lack of collection of the right data
Show the evidence-based nature of services
Future: Be Innovative and Adaptable
OAA services have evolved to meet changing needs
Need to continue to be innovative in Program design Service delivery, including location of
services Staff selection
Can help with non-public sources of support
Future: Build Partnerships Need to be leaders in building partnerships
within the community with businesses, hospitals, care facilities, and government
Federal funding makes up smaller portions of most programs’ revenue now and will continue to shrink
Need to strengthen these partnerships to cultivate payoff both financially and professionally
Study best practices in other areas
Future: Proactive on Diversity Changing face of older population.
Growing overall but especially among minorities
Will double in size by 2030 Targeting goals need to be stronger Have to bolster our Title VI OAA grants for
services for native Americans More LGBT older adults need culturally
competent services as well See diverse clientele not as a demographic
challenge but a market opportunity
Future: Family Caregivers Future of aging network tied to working on
behalf of family caregivers Only federal program for family caregivers—
NFCSP has been run through network since early 2000’s
Need is growing. Education and training critical
Federal funds will grow as will private support Extra focus on grandparents raising
grandchildren Place where aging network has foothold
Future: Invest in Education NASUAD survey has found that a lot of
retirement is happening in the aging field right now
To remain current and to train newcomers, the aging network needs investments in education and training; right now, that money is being spent on services because times are tight
Money should be budgeted specifically for education and training
As more focus goes to HCBS, so must there be people trained to provide services
Future: Managed Care
More than 70% of Medicaid enrollees are enrolled in managed care nationwide
Shift to home and community based services hallmark of new Medicaid
Aging network key as having history in service delivery and being trusted in community
Future: Better Advocacy
Needs to be a larger part of aging network
Educate and inform vs. lobbying You all have stories to tell Work all levels of government Be constant Work together, not alone Don’t be late to the game
Future: Age-Friendly Communities
Aging network natural leader in evolving age-friendly community movement
Always been about community and coordinating services
Advocate for the older adults you serve not just inside but outside doors. Advocate for improved transportation, housing, parks and recreation and cultural competency in programs and services
Be intergenerational in focus Public and private money will flow—seen as
sound investment Be leaders in this effort!
2016 Elections and Closing
2015 is a year of anniversaries, but after celebrating, then what?
2016 is the big election year The senior vote is bigger, more diverse…
but changing in preference? HUGE need for better advocacy for
older adults, grassroots, not tied to interests, pure in nature
Challenges we must confront.
Questions?
For more information or a copy of the presentation, please [email protected].