We have an obligation to speak up for those we and our sister organizations serve. As difficult choices are made regarding the future if the healthcare and human services system AJAS operates not only on behalf of the enlightened self interest of its members but in the interest of those without resources or the ability to raise their voices in advocacy. We recognize that the Federal Budget and the laws and policies established by our government must be moral documents that represent our best values as a nation. AJAS will speak as one to help to frame the debate and to stand for those who cannot stand alone.

Public Policy & Legislative Group Legislative Action Plan Agenda for 2017/2018

AJAS PPLG Legislative Action Plan Agenda for 2017/2018

1. Affordable Care Act Changes (TBA)- opposing Medicaid caps/block grants to the states
2. Recommend the establishment of a Medicaid Redesign Team- MRT (involvement of AJAS and other providers in developing recommendations to manage the risk… and setting up continuum of care coordination)- refer to position paper submitted to Senator Rob Portman and to Senator Robert Casey.
3. Deleting Medicare Hospital observation stay- allowing seniors who are in the hospital for 3 days or more to qualify for short term post hospital rehab inpatient stay under Medicare.
4. Extending the moratorium on Medicare rehab therapy caps, which will avoid limiting seniors from obtaining needed outpatient rehab therapy services
5. Implementing new CMS Regulations- emergency preparedness plan, CMS phase 1/2 regulatory changes; and the new SNF Quality reporting program (positives/negatives?)
6. Senior Housing- Supporting increased funding for HUD 202 Housing ( in current appropriations bills; Supporting projects that link low income housing with access to services such as Medicaid, or with personal care services through service coordinators.
7. Home Health- Supporting legislation that allows non-physicians to certify home health need. Also, new CMS conditions of participation with significant changes effective 1/18.

Position Statement:

1. We oppose converting Medicaid to a Per Capita Cap and strongly believe that such a system change would be detrimental to older adults in our long-term care facilities and our community, who rely on such critical care and services. A Per Capita Cap model would limit how much federal money States receive to administer their Medicaid programs and end the current guarantee that federal payments will keep pace with fluctuating health and long-term care needs. Over time, these substantial costs and liabilities would be shifted to States who will be unable to meet these needs.

2. The Congressional Budget Office recently released their budgetary outlook on the American Health Care Act finding that converting Medicaid to a Per Capita Cap system would cut the federal share of Medicaid by 25% — or $880 billion — by 2026. Such a significant cut would greatly undermine Ohio’s ability to care for our older adults who will be in great need of long- term services and supports. These challenges will be more exacerbated in Ohio given our rapidly aging population particularly as the Baby Boomer generation grows increasingly older as documented in the Scripps Gerontology Center report in 2012.
3. As you are aware given your expertise in this area, Medicaid is a lifeline for low­ income older adults in Ohio and nationwide; it is a key source of health and Long-term care coverage. Based on a March 2017 study from the AARP Public Policy Institute regarding Ohio:

a. Older Ohioans- in FY 2013, more than 2.6 million Ohioans (23 percent of the state’s total population) received health coverage and LTSS through Medicaid.

b. About 7.7% (203,000) of Ohio’s Medicaid beneficiaries were low-income older adults and 15.8% (417,000) were children and adults under age 65 with disabilities. There are over 81,000 Medicaid residents in Ohio Nursing Homes (2012).

4. Under a per capita cap system, if Ohio is forced to limit or reduce enrollment in Medicaid, these low-income and frail older adults will lose the critical services they need. Our senior living communities will lose the financial support they require to care for our state’s older adults and most frail, and there will be a chilling effect throughout our state’s economy.

We are committed to serving as a resource should a Medicaid Redesign Team composed of Long Term Care providers and experts be convened to develop care systems which will help to save the government money, while ensuring the provision of quality care for our nation’s elders.

Specifics to be addressed include:

a. Providers establishing a true care coordination model to ensure continuity and cost-effective care and services between health care providers, long-term care providers and hospitals. We will all help manage the risk.
b. Design disease state protocols with acute care hospitals to reduce rehospitalizations.
c. To develop recommendations to reduce duplicative regulatory systems and save Medicaid dollars.
d. To revise payment models to decrease fraud in billing, applying such penalties to reduce the Medicaid budget. We would provide actual case examples of health care fraud, prosecution, and measures to prevent such fraud and save dollars.
e. Develop preventive health programs for older adults, similar to the proposed Better Health Rewards Program. Such innovative programs would focus on wellness, health promotion and case management of elderly in the community; ultimately saving Medicaid dollars.

When caring for and representing our nation’s greatest generation and preparing for future Americans in need of our care, we want to ensure that our approach to Medicaid is as pragmatic as possible in order to ensure its sustainability. We pledge our focused and resolute support in order to find the most prudent solutions these complex issues.


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