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Virginia Health Care Association | Virginia Center for Assisted Living

DC Outlook for Assisted Living in 2018

DC Outlook for Assisted Living in 2018

The National Center for Assisted Living (NCAL) is gearing up for another very busy year in Washington, D.C. Conventional wisdom holds that Congress is less active passing major legislation in election years, but leadership may continue to push for certain legislative achievements to demonstrate to the American people why their party should continue to control both houses of Congress. The agenda this month is already packed, including a must-pass federal budget by January 19.  

Currently, there are no federal proposals to regulate assisted living, but we remain prepared for any sudden shifts. NCAL will continue to educate on and defend the importance of keeping regulation of assisted living at the state level. 

The following update was prepared by Lilly Hummel, NCAL Senior Director of Policy and Program Integrity.

Medicaid
A possible avenue to federally regulating assisted living is through Medicaid. This is critical for all assisted living providers, regardless of their payer mix, because states can revise their licensure requirements for assisted living to reflect Medicaid requirements. NCAL is closely tracking reports raising concern about Medicaid program integrity in all settings, including assisted living. This year the Government Accountability Office will publish a report on Medicaid in assisted living, and the Office of Inspector General reports continue to raise alarms about lack of oversight of Medicaid personal care services. 

In addition, Speaker Ryan has stated his intent to continue efforts to reform Medicaid by potentially converting the funding to per capita caps and/or block grants. Such reforms drastically reduce Medicaid resources over time, thereby threatening access to home and community-based services, like assisted living. However, the Republicans’ chances of comprehensive Medicaid reform have dwindled after the recent Alabama special election, which reduced the Republican advantage to just 51-49 in the Senate. NCAL will continue to closely monitor and defend Medicaid for assisted living.

Administrative Action
This coming year we will likely see an uptick in regulatory action now that more of President Trump’s political appointees are confirmed, though leadership vacancies continue to be high in some Departments. Despite some changes in direction (e.g., reversing course on Medicare mandatory bundling programs) from the Centers for Medicare and Medicaid Services (CMS), implementation of the Home and Community-Based Settings Final Rule will continue despite the delay for states to comply by 2022. This coming year, expect to see CMS activity around waivers and demonstrations for home and community-based services, and the ongoing expansion of Medicaid managed care among the states. 

We may also see relevant proposals from the Department of Labor (DOL) and the Occupational Safety and Health Administration (OSHA). For example, DOL has signaled its intent to issue a new proposed rule this fall related to overtime, after the Obama Administration’s overtime rule was declared unlawful by a federal judge in 2017. NCAL will also closely monitor any immigration proposals that would fill critical job openings in our assisted living communities. 

In short, we expect to see a variety of legislative and regulatory activity as the Trump Administration settles into its second year. NCAL will continue to defend the importance of assisted living as a critical setting for our residents.

Thank you for everything you do and for the honor to represent you.