The Lead December 22, 2020

Top Stories:
Overview of Year-end Congressional Package
Vaccine Update
LeadingAge Illinois Provider Members: The 2021 Call for Cabinet Applications is Now Open!

Member Spotlight: CJE SeniorLife

Internship Opportunity! New LeadingAge National Summer Enrichment Program

Top Stories:

Overview of Year-end Congressional Package
LeadingAge has prepared a high level overview on the combination omnibus-coronavirus relief package. The approximately 5,500 page bill, The Consolidated Appropriations Act, 2021 (Omnibus and Coronavirus Relief Bill) directly or indirectly impacts most every part of the aging services continuum. This package provides another, long-awaited round of coronavirus relief, funds the government through September 30, 2021, and includes a number of other priorities for aging services providers. There will be several more articles on the package forthcoming.

There are two key items not included in the final agreement related to coronavirus relief that ultimately proved too controversial to obtain consensus. There is no general funding for state, local and tribal governments, although there are funds that governments can use for specific purposes. Also, Congress was not able to come to agreement on liability protections for businesses, including health care providers. Once this package passes, the 116th Congress will have concluded its business. LeadingAge is formulating their advocacy agenda for 2021, which will include continued advocacy for additional financial relief, and policy priorities including telehealth, housing, and other issues not fully addressed in this bill. This bill is only a down payment on extensive relief that is still needed by our members.

Paycheck Protection Program:
The bill provides about $300 billion for the Paycheck Protection Program. The period for applying for loans would extend to March 31, 2021. Loans would be limited to $2 million for most borrowers, down from $10 million from the CARES Act. Organizations who received a PPP loan during the first iteration would be able to apply for a second draw loan if certain conditions are met. Business expenses allowable under the PPP loans would be expanded to include items like PPE, operational expenses and other costs, and a 60% payroll rule would continue. And the bill would put into statute a provision allowing business expenses paid for with PPP dollars to be treated the same as other business expenses for tax purposes. The bill contains loan forgiveness simplification for borrowers with loans below $2 million and outlines the audit process for loans above $2 million and it opens the loans to 501(c)(6) organizations. Please look for a more detailed article on the changes to the PPP program in the coming days.

Vaccines, Testing, and CARES Act Extension:
The bill contains money to support vaccine distribution and administration, understanding that it is critically important that all levels of government be supported in their efforts to distribute and administer vaccines and therapeutics. A total of $8.75 billion is allocated to the Centers for Disease Control and Prevention for vaccine distribution and administration. $4.5 billion is for states, local, territorial, and tribal public health departments and 300 million is for a targeted effort to distribute and administer vaccines in high risk and underserved populations. $19.7 billion dollars was allocated for the manufacturing and procurement of vaccines and therapeutics and the ancillary supplies necessary for vaccine and therapeutic administration.

In line with LeadingAge and the VNAA’s asks for Congress, there is more money in the package that can be used for testing and other aspects of an effective COVID-19 response. $22.4 billion dollars is allocated for testing, contact tracing, surveillance, containment and mitigation. This money will be distributed to States, localities, territories, and tribal organizations but is flexible in the range of permitted activities. Some examples that LeadingAge and the VNAA members might want to suggest to their states are testing, support for workforce, and other mitigation activities. The bill also allows states a one year extension, until December 31, 2021, to expend their CARES Act funds.

Provider Relief:
The Provider Relief Fund (PRF) section of the Consolidated Appropriations Act, 2021 includes a small amount of additional PRF funding plus some key policy changes to the program. It would appropriate an additional $3 billion to the PRF and allow certain providers to calculate their lost revenues using a budgeted to actual revenue comparison instead of the actual year-over-year comparison currently required by HHS. It also allows parent organizations to reallocate all PRF among their subsidiaries, including targeted distributions like those that went to nursing homes. Finally, it directs HHS to use 85% of new and remaining PRF dollars to cover providers reported financial losses and changes in operating expenses through first quarter of 2021. A more detailed breakdown of the changes to the Provider Relief Fund can be found here.

Affordable Housing Provisions:
The COVID-19 relief package includes important housing-related provisions requested by LeadingAge. The package includes $25 billion in Coronavirus Relief Fund Payments for Rental Assistance and extends the nation eviction moratorium for nonpayment of rent, set to expire on December 31, 2020, until January 31, 2021. The bill also includes a minimum 4% Low Income Housing Tax Credit floor for buildings placed in service after January 20, 2020. A separate article on HUD appropriations can be found here.

Paid Sick and Family Leave:
The Families First Coronavirus Response Act (FFCRA) established a temporary paid sick leave and paid family leave program that was set to expire on December 31, 2020. Alongside these programs, FFCRA established refundable payroll tax credits for paid sick and family leave. These tax credits are extended through the end of March 2021. It appears the tax credits are modified so that they apply as if the corresponding employer mandates were extended through the end of March 2021 which leads us to believe that the program is expanded through March, but we will provide an update as we analyze further.

Medicare Payment Changes:
The bill contains two key payment increases for Medicare providers. The sequester moratorium, which went into effect in May, will be extended for another three months until March 31, 2021. Additionally, in recognition of the hardships of COVID-19 and the substantial cuts that some providers saw as a result of the Medicare Physician Fee Schedule, there will be a one-time, one-year 3.75% payment bump to the entire Medicare Physician Fee Schedule.

Health Extenders:
Congress included in this bill a number of ongoing Medicare and Medicaid provisions that needed to be extended such as the Money Follows the Person (MFP) program and the spousal impoverishment protections. The MFP program is extended until 2023 with $450 million dollars per year in funding and a number of improvements including a shortened institutional residency requirement. The spousal impoverishment protections are also extended to 2023. The “extenders” portion of the bill also contained a number of other priorities related to the Medicare and Medicaid programs. One key example is include allowing occupational therapists to conduct the initial assessment and complete the comprehensive assessment for home health agencies with respect to certain rehabilitation services. More information about the extenders will be forthcoming along with a specific article on the changes in the bill for hospice providers.

Other areas of importance:

  • Child care: The bill appropriates $10 billion for a new Child Care Stabilization Fund grant program at the Department of Health and Human Services to provide grants for child care providers that will assist families of essential workers (such as health care sector employees) and other workers determined to be essential during the response to COVID-19 by public officials. The grants would be available to child care providers that are currently open or temporarily closed due to COVID-19 and can be used for a variety of purposes.
  • Nutrition: The bill extends waivers providing flexibility in Older Americans Act nutrition services to provide needed flexibility to state units on aging to ensure that older adults’ nutritional needs can continue to be met safely during the pandemic. The Administration for Community Living was allocated $952 million for senior nutrition programs, an increase of $15 million above the 2020 enacted level.
  • Federal Communications Commission (FCC) COVID-19 Telehealth Program: The legislation allocates an additional $250 million to the FCC for its COVID-19 Telehealth Program authorized under the CARES Act. It also puts in place new transparency obligations for the program surrounding the FCC’s review of applications, and directs the Commission to ensure, to the extent feasible, that all states benefit from the program. We will continue to work on an extension for all the telehealth waivers that have supported our members during the public health emergency.
  • Elder Justice: $100 million dollars is allocated to the Administration for Community Living (ACL) address abuse, neglect, and exploitation of the elderly, including adult protective service and long-term care ombudsman activities. This aligns with work LeadingAge has been doing on the reauthorization of the Elder Justice Act and we looked forward to continue work on this in the new Congress.
  • Reduction in medical expense deduction floor: Between 2013 and 2017, individuals under 65 years old could claim an itemized deduction for unreimbursed medical expenses to the extent that such expenses exceeded 10% of annual gross income (AGI), while for individuals 65 or older, the threshold was 7.5% of AGI. Prior to this period, the 7.5% threshold generally applied regardless of age. The bill will make permanent the lower threshold of 7.5% for all taxpayers.

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Vaccine Update
Today’s vaccine update includes:

  • Pharmacy Partnership for Long-Term Care Program
  • Who’s Next In Line for the Vaccine
  • CDC Long-Term Care Facility COVID-19 Vaccination Toolkit
  • COVID-19 Vaccination Record Card

Webinar with Walgreens:
LeadingAge and experts from Walgreens will discuss the Pharmacy Partnership for Long-Term Care Program for COVID-19 Vaccinations on Tuesday, December 29 at 2:30 p.m. CST. They will provide the most up to date information on how Walgreens is managing the vaccination process for assigned members and will answer questions from LeadingAge members. They will also provide the latest set of resources for providers to help educate staff and residents as well as elements of distribution of the COVID-19 Vaccine. The webinar is similar to this afternoon’s webinar held at 12 p.m. that featured LeadingAge and experts from CVS/Omnicare. You can register for the December 29 webinar here

Next in Line for the Vaccine:
On December 20, the Advisory Committee on Immunization Practices recommended prioritizing people over 75 and essential frontline workers in phase 1b. For phase 1c, they recommended prioritizing people between 65-74, people between 16-64 with high risk medical conditions, and essential workers not yet vaccinated. This is guidance only as the final decisions rest with the states. Read more in this article.

CDC Long-Term Care Facility COVID-19 Vaccination Toolkit:
The CDC is working to release a COVID-19 vaccine toolkit specific to long-term care. They have pledged that they will release pieces of the toolkit as they are ready, rather than waiting for the entire toolkit to be complete. The first piece of the toolkit has arrived in the form of FAQs. You can access these FAQs here.

COVID-19 Vaccination Record Card:
The Illinois Department of Public Health (IDPH) recently sent out via SIREN Alert, the COVID-19 Vaccination Record Card.  The card includes medical information about the vaccines an individual has received.

Other Resources/Information:

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LeadingAge Illinois Provider Members: The 2021 Call for Cabinet Applications is Now Open!
Cabinets represent each LeadingAge Illinois member type and help set program and public policy goals. Cabinet members provide leadership, support and guidance to meet these goals – achieving results in their specialty areas. As part of a cabinet, you will have the opportunity to lead, influence the future of aging services in Illinois, network with colleagues in similar roles and as a Cabinet member, your participation provides pathways for future guidance/leadership opportunities.

If you’re a LeadingAge Illinois provider member interested in applying for a Cabinet position, please click on and save the 2021 Cabinet Application and also the accompanying Cabinet Roles and Responsibilities Overview document.

Please submit your completed application and accompanying resume or CV to Maribel Rice. For any questions, please contact LeadingAge Illinois at 630.325.6170.

The Cabinet application submission deadline has been extended to January 22, 2021.

To learn more about LeadingAge Illinois leadership opportunities, please click here!

We hope that you will consider applying!

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Member Spotlight: CJE SeniorLife
CJE SeniorLife provides a wide array of services including long term care, memory care, assisted living, independent housing, home delivered meals, transportation, adult day, counseling services as well as many community and assistance programs. The organization serves about 20,000 older adults and their family members, and employs more than 600 employees.

One of those employees serves on the LeadingAge Illinois Technology and Innovation Task Force. Christian Hill, Manager of Business Systems and Data Analytics, has been a part of the Task Force since its inception. He has worked in the aging services industry for over seven years.  “People who make a career in technology tend to be able to apply their skills in any industry,” said Christian.  “The rewarding part of being in the aging services industry is that the application of those same skills has a real impact on the quality of life of the people we serve.”

Technology and innovation have played a large role in helping CJE serve older adults.  Most recently, they have had to rely on video call technology to reduce the growing feeling of isolation that have been caused by the pandemic. “Due to the lockdowns, residents are not able to have visitors and have had to rely on products such as zoom to see their families,” explained Christian. “Before the pandemic, we have been able to expand services to our clients by using technology to increase efficiencies in our business processes. The burden of having enough administrative staff to expand services is one that we always look to technology to overcome.”

The role technology and innovation plays in the industry was ever present during the pandemic, playing a vital role.  At CJE, the majority of the administrative staff went to remote work early in the year and continue to be offsite to this day. CJE also transitioned as many of their manual business processes into digital processes as they could in a relatively short amount of time leveraging existing technology, but also through new platforms. Some of their services also transitioned when they were not able to meet clients in person.

Christian and other members of the Technology and Innovation Task Force met this month to discuss the experiences of their organizations during the pandemic and share ideas.  The Task Force plans to reconvene in early 2021 to discuss more ideas and best practices that will assist association members.

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Internship Opportunity! New LeadingAge National Summer Enrichment Program
LeadingAge National’s new Summer Enrichment Program is a 10-week immersive internship hosted by a member organization in 2021. We are recruiting a diverse pool undergraduate and graduate students for a unique opportunity to obtain real world experience in aging services. The Summer Enrichment program was developed to provide leadership opportunities for students in aging services that ensures our field is representative of the diversity that makes up our society. The intern will be provided mentors, meaningful work, and access to a professional network that will assist them in reducing barriers to leadership roles within the field of aging.

Interested students nearing the end of their undergraduate studies (a minimum of 2 years completed toward Bachelor’s degree is required) or who are in graduate school are encouraged to apply.

Click here to learn more or sign-up for the January 5, 2021 (11 a.m. CST) information session.

LeadingAge’s Summer Enrichment Program is designed to grow, strengthen, and diversify the pipeline of aging services leaders. LeadingAge is seeking provider organizations to host a paid student internship beginning in the summer of 2021. Internship opportunities go live this week, so apply today by completing the host site application. Questions? Contact Christy Kramer.

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