The Lead April 23, 2021 - LeadingAge Illinois

Assisted Living:
Assisted Living Update

Nursing and Rehabilitation:
Postvaccination SARS-CoV-2 Infections Among Nursing Facility Residents and Staff Members

Independent Affordable/Subsidized Housing:
HUD Withdraws Proposed Rule, Strengthens Equal Access Protections
Practitioners Cover Fair Housing, LGBT+ Housing Updates on LeadingAge Call

Home and Community Based Services:
PACE Legislation in the Illinois House

Technology:
Keynotes at 2021 Collaborative Care HIT Virtual Summit
Increasing Resident Engagement

Top Stories:

From the Desk of Karen Messer, President and CEO
LeadingAge National has had several conversations with key U.S. Senate and House leadership staff and they recently developed an article that provides an outlook for upcoming Congressional action on “What’s on Congress’s Agenda.” They highlight:

CMS/HHS nominations
President Biden’s Joint Session
The American Jobs Plan – infrastructure process
President’s FY22 Budget Request; and
Timing of immigration reform legislation.

You can access the article here.

With gratitude,

Karen

IDPH Weekly Meeting Recap
LeadingAge Illinois and the other associations held our weekly meeting with the Illinois Department of Public Health (IDPH) on Thursday. Here is a recap of what we discussed:

Vaccinations:
Families and friends of long term care staff and residents can now receive vaccinations through the long term care pharmacies. Click here for a listing of the pharmacies.

Annual Questionnaire:
IDPH has questions related to provider challenges due to COVID in 2020. LeadingAge Illinois asked for clarification on why this question is being asked and concerns with the questions. They will look at the questions internally and report back next week.

Tiered Mitigation:
IDPH said providers should continue to follow the CMS county positivity data. There is no indication from the Department a region will be going into tiered mitigation.

CMP Funds:
IDPH reported there is $17 million in CMP funds, but not all of the funds are available. CMS guidance will determine distribution, which is competitive. IDPH was asked to get confirmation on the $17 million figure. We will be following up to get a solid determination on the funds.

If you have questions or concerns you would like us to bring to the table next meeting, contact Ruta Prasauskas.

LeadingAge National Virtual Lobby Day Recap
On Wednesday, several LeadingAge Illinois members took part in the LeadingAge National Virtual Lobby Day. We had 12 virtual meetings with U.S. congressional offices informing members of Congress and their staff of the need for additional relief for aging services providers.

Special thanks to the following members for making the congressional meetings a success.

Elissa Besterwitch, Balsam Terrace / Spruce Manor
Christopher Blair, Covenant Living Communities and Services
Carla Brown, Ascension Living
Ralph Gaines, Embrace Living Communities
Elizabeth McLaren, Covenant Living Communities and Services
Paul Ogier, Lutheran Senior Services
Scott Studebaker, Providence Life Services
Jennifer Truppa, Embrace Living Communities
Sallie Williams, Heritage Ministries

Members pushed the message for congressional help needed on:

Continued Provider Relief:
Congress needs to add $6 billion in COVID-19 provider relief funds that can be requested by hardest hit aging services providers in need of continued assistance.

We appreciate the relief that has been provided by previous relief packages but expenses for personal protective equipment, ongoing testing, and lost revenue from inconsistent census are amongst the reasons that to recover, aging services providers still need the opportunity to access more provider relief funds. Given the disproportionate impact on long-term care and aging services providers, we ask that nursing homes, assisted living, home and community-based services providers, home health, and hospice services be explicitly named as eligible for Provider Relief Funds.

PPE:
Ensure that the cost of required testing and personal protective equipment, which keep staff and residents, patients, and clients safe, are fully covered.

Resources for Recovery:
Ensure the recovery of aging services providers by supporting the recommendations in the LeadingAge Blueprint For A Better Aging Infrastructure

Support Creation of a Public Insurance Program for LTSS:
We support the creation of a public insurance program for long-term care to reduce the burden on middle-class families and on the Medicaid program. One example is the WISH program being developed by Rep. Suozzi from NY, which would provide long-term care insurance through the Social Security program.

Pictured Above (left to right): As a part of LeadingAge National Virtual Lobby Day, members met with the following Offices of U.S. Congress: (top) Rep. Darin LaHood, Rep. Robin Kelly, Rep. Krishnamoorthi, Rep. Bobby Rush, (middle) Rep. Danny Davis, Rep. Jan Schakowsky, Rep. Marie Newman, Rep. Sean Casten, (bottom) Rep. Rodney Davis, Sen. Tammy Duckworth, Se. Richard Durbin, and Rep. Lauren Underwood.

LeadingAge Illinois Advocacy Center
With the deadlines for substantive introduced bills to get out of committees now surpassed, we are currently reviewing amendments that are being added to bills daily. The deadline for third reading for substantive bills in each chamber is today. There is always the potential deadlines can be extended. Bill filing deadlines were extended early in the session.

Here is a look at some recent legislative activity:

SB2432 (Grocery Tax) is on third reading in the Senate. This bill, which is an association priority, allows assisted living and life care communities to pay sales tax on food at the 1% rate. The bill made it out of the Senate Revenue Committee last week with an 8-0 vote.

HB559 (BIPA)
This is the most promising of the Biometric Information Privacy Act (BIPA) bills that were introduced this session. LeadingAge Illinois has been involved in the preparing of an amendment to this bill that would help ease the burden this Act places on members. The amendment will not be filed until (if) the bill passes the House and makes it to the Senate. Stakeholders involved in this legislation want the bill that passed out of committee to make it out of the House as is and then amend it with the new language. The strategy is to get the bill passed in the House first.

HB1965 (Informed Consent)
LeadingAge Illinois supports this legislation and went on record for support in Thursday’s House Human Services Committee hearing. The bill passed out of committee by a vote of 14-0. The bill states that the maximum possible period for informed consent shall be until a change in the prescription occurs as to the change in the type of psychotropic medication or an increase or decrease in dosage, dosage range, or titration schedule of the prescribed medication that was not included in the original informed consent When informed consent is not required for a change in dosage, the facility shall note in the resident’s file that the resident was informed of the dosage change prior to the administration of the medication or that verbal, written, or electronic notice has been communicated to the resident’s surrogate decision maker that a change in dosage has occurred.

HB3498 (Telehealth)
As a member of the Protect Telehealth Coalition, this bill is an association priority. LeadingAge Illinois again went on record for support of this bill on Thursday in the House Healthcare Availability and Access Committee hearing. A number of members also filed slips of support for the bill. It mandates telehealth coverage and payment parity with in-person care. It passed out of the committee by a 12-0 vote and heads to the House floor with 55 co-sponsors that include the House Speaker.

SB221 (Home Services)
We are currently neutral on this legislation while still seeking additional member input. The bill adds the following to the definition of home services:

Bathing without client self-direction, including areas of the body other than those areas with special skin care needs
Applying topical prescription lotions to rashes, skin tears, stage 1 or 2 decubiti, and first and second degree burns
Applying compression stockings
Assisting with normal feeding, including pre-measured, thickened liquids
Applying shampoo in hair care treatment requiring a prescription
Permitting nail filing of clients with conditions that might involve peripheral circulatory conditions
Assisting with personal, mechanical, or electronic transfers of clients when the client can assist with transfer
Assisting with ambulation of clients using adaptive equipment for ambulation
Assisting with changing oxygen tanks
Adjusting oxygen flow
Turning oxygen tanks on and off
Repositioning clients every 2 hours or as instructed by the plan of care

SB272/HB2021 (Water Quality)
This language has been in three different bills this session. We are opposing it due to the fees/costs involved and penalties for noncompliance with the Illinois Department of Public Health (IDPH) water quality management program. This is one of two IDPH legislative initiatives this session.

SB1096 (COVID Testing Coverage):
This trailer bill to legislation that mandated insurance coverage of COVID testing for nursing home workers will now include assisted living and supportive living. This is an association priority and we have had several discussions with legislators and stakeholders on this legislation.

If you have any questions about the legislation above or any other public policy matter, contact Jason Speaks.

Weekly TANs and Medicaid Pendings Update
Our consultant, Matt Werner, has provided his weekly update on Transaction Audit Numbers (TANs). Click here to access the TANs report and here for an update on Medicaid pendings.

COVID Test Positivity by County
LeadingAge Illinois Consultant, Matt Werner of Werner Consulting, has provided his most recent update on COVID Test Positivity by County. Click here for the most recent report.

HFS Notice on Provider Responsibility for Completing Applications
The Illinois Department of Healthcare and Family Services (HFS) issued a provider notice this week to remind long term care and supportive living providers that all forms and applications submitted on behalf of a resident need to be correct and complete. As enrolled Medicaid providers, long term care facilities must submit Medicaid applications, the 3654 form (Additional Financial Information for Long Term Care Applicants) and all MEDI TAN submissions with accurate information. Click here for the notice.

IDPH Adopts Emergency Rules on Fingerprint Check Timelines
The Illinois Department of Public Health (IDPH) recently adopted emergency rules in the Health Care Worker Background Check Code, effective April 10 for a maximum of 150 days. The rules extend the time frame for health care employees, students, or applicants to have their fingerprints collected by a livescan vendor from 10 working days to 30 working days after signing an authorization and disclosure form allowing IDPH to perform a criminal background check.

Assisted Living:

Assisted Living Update
There are currently 526 licensed establishments in Illinois (26,764 units). There are currently 14 pending licensure. The Illinois Department of Public Health (IDPH) alerted LeadingAge Illinois that they are still considering an increase in license fees due to the number of communities and need for additional division staff. The Division of Assisted Living has 14 staff at this point.

One of the new staff to the division, who has been at the Department for several years, is Kendra Fabish, a public service administrator. Kendra joined Lynda Kovarik, division chief of assisted living, at the LeadingAge Illinois Assisted Living Virtual Boot Camp 1.0 this week.

“What a crazy year (2020) and I am thankful to my staff for their hard work and the passion we have for this Assisted Living program,” said Lynda to attendees. “Kudos to all establishments for taking care of this special population especially this past challenging year and working with the Department when questions arise.”

Pictured Above: (left to right) Lynda Kovarik, division chief of assisted living and Kendra Fabish, public service administrator at the Illinois Department of Public Health (IDPH).

Nursing and Rehabilitation:

Postvaccination SARS-CoV-2 Infections Among Nursing Facility Residents and Staff Members
The CDC released an MMWR on post-vaccination SARS-CoV-2 infections among skilled nursing facility residents and staff members in Chicago from December 2020 – March 2021. Residents and staff members of skilled nursing facilities (SNFs) are recommended to receive COVID-19 vaccine as a priority group. Twenty-two possible breakthrough SARS-CoV-2 infections occurred among fully vaccinated persons ≥14 days after their second dose of COVID-19 vaccine. Two thirds of persons were asymptomatic. A minority of persons with breakthrough infection experienced mild to moderate COVID-19–like symptoms; two COVID-19–related hospitalizations and one death occurred. No facility-associated secondary transmission was identified. SNFs should prioritize vaccination and follow recommended COVID-19 infection prevention and control practices, including following work restrictions, isolation, quarantine, testing of residents and staff members, and use of personal protective equipment.

Independent Affordable/Subsidized Housing:

HUD Withdraws Proposed Rule, Strengthens Equal Access Protections
On April 22, HUD Secretary Marcia Fudge announced that HUD is withdrawing the previous administration’s proposed rule that would have allowed shelter programs and operator to deny transgender individuals accommodations. Along with the proposed rule withdrawal announcement, HUD is releasing technical assistance resources to support HUD’s Office of Community Planning and Development grantees in implementing the Equal Access Rule, which ensures that people have equal access to HUD CPD programs, shelter, and services, regardless of sexual orientation or gender identity.

Practitioners Cover Fair Housing, LGBT+ Housing Updates on LeadingAge Call
In honor of April’s Fair Housing Month, LeadingAge Maryland and Ohio’s monthly “Housing Happenings” call featured housing practitioners on HUD Fair Housing issues and LGBT-affirming affordable housing models. The call covered Violence Against Women Act (VAWA) requirements for housing providers, service and assistance animal guidance, cultural competency trainings for housing staff, and an upcoming event on LGBT+ housing models.

Home and Community Based Services:

PACE Legislation in the Illinois House
HB3628, the Program of All-Inclusive Care for the Elderly (PACE) Act is on second reading in the Illinois House. It passed out of the House Appropriations-Human Services Committee by a vote of 18-6 on March 26. Here is a look at what this legislation does:

Program implementation:
No later the March 1, 2022, the Department of Healthcare and Family Services (HFS) must submit a State Plan amendment to the federal Centers for Medicare and Medicaid Services (CMS) to establish the Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services under the Illinois State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the Department of Healthcare and Family Services, and PACE organizations.

Beginning June 1, 2022, or upon federal approval, the Department must develop the PACE program in consultation with:

Nursing homes
Case managers
Area Agencies on Aging, and
Others interested in the well-being of frail elderly Illinois residents.

No later than June 30, 2022, the Department must have prepared a comprehensive plan that describes on a county-by-county basis how PACE services will be delivered within the designated region.

By August 1, 2022, the Department shall issue a request for proposals seeking qualified, experienced, and financially sound organizations to enter into risk-based contracts. The Department may enter into contracts with public or private organizations for implementation of the PACE program, and also may enter into separate contracts with PACE organizations, to fully implement the single state agency responsibilities assumed by the Department in those contracts, the Illinois Public Aid Code, and any other State requirement found necessary by the Department to provide comprehensive community-based, risk-based, and capitated long-term care services to Illinois’ frail elderly.

The Department may enter into separate contracts with up to 15 PACE organizations. This subsection shall become inoperative upon federal approval of a capitation rate methodology as provided in Section 16 (Rates of Payment).

No later than October 1, 2023, HFS shall begin accepting applications from eligible persons interested in receiving services from the PACE program. The Department shall begin reviewing and approving applications by November 1, 2023.

The requirements of the PACE model that shall not be waived or modified include all of the following:

The focus on frail elderly qualifying individuals who require the level of care provided in a nursing facility.
The delivery of comprehensive, integrated acute and long-term care services.
The interdisciplinary team approach to care management and service delivery.
Capitated, integrated financing that allows the provider to pool payments received from public and private programs and individuals.
The assumption by the provider of full financial risk.
The provision of a PACE benefit package for all participants, regardless of source of payment, that shall include all of the following:
- All Medicare-covered items and services.
- All Medicaid-covered items and services, as specified in the Illinois Title XIX State Plan.
- Other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status.

Provisions governing the treatment of income and resources of a married couple, for the purposes of determining the eligibility of a nursing-facility certifiable or institutionalized spouse, shall be established so as to qualify for federal financial participation.

The Department shall establish capitation rates paid to each PACE organization at no less than 95% of the fee-for-service equivalent cost, including the Department’s cost of administration, that the Department estimates would be payable for all services covered under the PACE organization contract if all those services were to be furnished to recipients of medical assistance under the fee-for-service medical assistance program provided under Article V of the Illinois Public Aid Code.

This subsection shall be implemented only to the extent that federal financial participation is available.

This subsection shall become inoperative upon federal approval of a capitation rate methodology as provided in Section 16.

Notwithstanding subsection (g), and only to the extent federal financial participation is available, the Department of Healthcare and Family Services, in consultation with PACE organizations, shall seek increased federal regulatory flexibility from the federal Centers for Medicare and Medicaid Services to modernize the PACE program, which may include, but is not limited to, addressing all of the following:

Composition of PACE interdisciplinary teams.
Use of community-based physicians.
Marketing practices.
Development of a streamlined PACE waiver process.

This subsection shall be operative upon federal approval of a capitation rate methodology as provided under Section 16.

Sec. 16. Rates of payment:
The General Assembly shall make appropriations to the Department to fund services under this Act. The Department shall develop and pay capitation rates to organizations contracted to implement the PACE program as described in Section 15 using actuarial methods.

The Department may develop capitation rates using a standardized rate methodology across managed care plan models for comparable populations. The specific rate methodology applied to PACE organizations shall address features of PACE that distinguishes it from other managed care plan models. The rate methodology shall be consistent with actuarial rate development principles and shall provide for all reasonable, appropriate, and attainable costs for each PACE organization within a region.

The Department may develop statewide rates and apply geographic adjustments, using available data sources deemed appropriate by the Department. Consistent with actuarial methods, the primary source of data used to develop rates for each PACE organization shall be its cost and utilization data for the Medical Assistance Program or other data sources as deemed necessary by the Department. Rates developed under this Section shall reflect the level of care associated with the specific populations served under the contract.

The rate methodology developed in accordance with this Section shall contain a mechanism to account for the costs of high-cost drugs and treatments. Rates developed shall be actuarially certified prior to implementation.

The Department shall consult with those organizations contracted to implement the PACE program in developing a rate methodology according to this Section.

Consistent with the requirements of federal law, the Department shall calculate an upper payment limit for payments to PACE organizations. In calculating the upper payment limit, the Department shall correct the applicable data as necessary and shall consider the risk of nursing home placement for the comparable population when estimating the level of care and risk of PACE participants.

The Department shall pay organizations contracted to implement the PACE program at a rate within the certified actuarially sound rate range developed with respect to that entity, to the extent consistent with federal requirements and subject to subsection (h), as necessary to mitigate the impact to the entity of the methodology developed in accordance with this Section.

During the first 2 years in which a new PACE organization or existing PACE organization enters a previously unserved area, the Department shall pay at a rate within the certified actuarially sound rate range developed with respect to that entity, to the extent consistent with federal requirements and subject to subsection (h), to reflect the lower enrollment and higher operating costs associated with a new PACE organization relative to a PACE organization with higher enrollment and more experience providing managed care interventions to its beneficiaries.

This Section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available. This Section shall apply for rates implemented no earlier than July 1, 2022.

Amends the Illinois Public Aid Code:

Subject to approval by the federal Centers for Medicare and Medicaid Services (CMS), PACE program services shall become a covered benefit of the medical assistance program, subject to utilization controls and eligibility criteria that require that the beneficiary be certifiable for nursing facility services based on criteria established by the Department under the medical assistance program.
Covered services under the PACE benefit of the medical assistance program include those set forth in 42 CFR 460.92:
- All Medicare-covered services.
- All Medicaid-covered services, as specified in the State’s approved Medicaid plan.
- Other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status.

If you have any questions on this piece of legislation, contact Jason Speaks.

Technology:

Keynotes at 2021 Collaborative Care HIT Virtual Summit
This June 8-10, 2021, industry experts will share pandemic lessons learned and implications for technology and collaborative care, the next generation of alternative payment models, and much more. Speakers will share their perspectives on topics related to this year’s theme, “The Role of Health IT in Collaboration During Crises.” Check out the lineup of keynote speakers and register now.

Increasing Resident Engagement
LeadingAge CAST has updated its Social Connectedness and Engagement Technology Selection Tool that showcases hands-on resources that help providers understand, plan for, select, implement, and adopt the appropriate social connectedness technology. Additions to the tool include five new case studies that evaluate how technology can reduce resident loneliness and social isolation. Read more.