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 emailmponder@nanasp.org.