In a new quarterly member communication, NCAL Executive Director Scott Tittle recaps the latest AHCA/NCAL activities as they relate to serving our assisted living membership, while also providing some context on recent happenings in D.C. According to Tittle, “We hope you will find it to be a helpful way to stay on top of key issues facing our sector. You may have seen some of this information in other recent reports, but I hope to break it all down a little further for you here, so you understand why we’re focused on these items on your behalf.”  Tittle’s update covers:

• GAO Report on Medicaid in Assisted Living
• Continuing to Support HCBS Advocacy
• The Next Phase of the Quality Initiative for Assisted Living
• Member Engagement Opportunities
• Coming Up in the Next Quarter

GAO Report on Medicaid in Assisted Living

The beginning of 2018 proved to be one of our busiest in quite some time. As this is a critical mid-term election cycle, we anticipated a demanding start to the year knowing members of Congress would want to be home by summer to run for reelection. While most of the D.C. drama (passing a budget, confirming a new secretary of Health and Human Services, etc.) didn’t directly impact assisted living, we still saw increasing interest in our profession due to ongoing stories in the media, as well as a government report issued early this year.

In February, the Government Accountability Office released a report, entitled “Medicaid Assisted Living Services: Improved Oversight of Beneficiary Health and Welfare Is Needed.” We had been anticipating this report for some time. In 2015, four senators from both sides of the aisles who were also members of the Special Committee on Aging requested the report. AHCA/NCAL was in contact with several of those senate offices after the report was requested, and met with all of them again shortly after the report was finally released.

Generally, the report calls for better state reporting of certain data, including “critical incidents”, with more guidance and enforcement needed from CMS on exactly what information states must report. It does not call for federal regulation of assisted living or conclude that assisted living is providing poor care.  Still, any federal report on our profession certainly makes us sit up a bit.

For the most part, we agree with the GAO’s findings, which may come as a surprise to some. We believe in the basic principle of Medicaid-that it’s a state-run program that must follow broad federal guidelines to receive federal support. As such, states should fulfill their reporting duties to the federal government, and in doing so, we may be able to learn a lot more about HCBS programs across the country.

We stand ready to work with Congress and the Administration, but don’t believe any new policies are necessary-there are laws already on the books that need to be seen through.

Continuing to Support HCBS Advocacy

As the HCBS Settings Rule (finalized in 2014) continues to be implemented, NCAL remains focused on helping state affiliates and providers protect assisted living as an available home and community-based setting. Despite a three-year delay of the deadline for compliance (now 2022), CMS and states are still forging ahead on finalizing statewide transition plans. In certain states, these plans could very well hinder certain assisted living communities from participating in Medicaid waiver programs, especially if they have characteristics deemed potentially “institutional” in nature under the rule.

There are specific characteristics that consistently seem to cause red flags in certain states. In response, NCAL developed some policy briefs on these issues to assist state affiliates in their advocacy and education efforts. These policy briefs on co-location, choice and privacy, licensure, and memory care can all be downloaded from our Medicaid page on the NCAL website. We will continue to push CMS for further guidance to states on these issues as well.

The Next Phase of the Quality Initiative for Assisted Living

We believe that to win, the profession needs to be right on policy and on quality. For the last six years, we’ve been leading on the quality front with a nationwide effort to improve the care we provide without a government mandate. The Quality Initiative for Assisted Living encourages providers to meet specific, measurable targets to further demonstrate our commitment to high quality care.

In March at our Quality Summit, we released the next iteration of the Quality Initiative for Assisted Living. For the next year three years, we’re staying focused on the same four core areas-staff stability, customer satisfaction, hospital readmissions, and the off-label use of antipsychotics-with new target goals. These areas are significant to improving person-centered care while helping assisted living providers stay competitive in their local marketplaces. You can attend a free webinar on Tuesday, April 10 to learn more.

But the key to realizing the Quality Initiative as a profession will be sharing more assisted living data to see how we’re doing. Therefore, it is critical that all NCAL member communities take advantage of their membership and sign up for our free data platform, LTC Trend Tracker. Not only can you see how your communities are faring with the Quality Initiative goals, but you can also see how you measure up compared to your peers.

All of our quality and data solutions programs work in tandem: focus on the goals of the Quality Initiative, track your progress in LTC Trend Tracker, and then use that comparative data to apply for the Quality Awards Program. It’s the perfect way to start your quality journey, if you haven’t already.

Member Engagement Opportunities

One of NCAL’s strengths is our diverse membership. We represent a variety of providers: large and small, for profit and not for profit, etc. The ability for you all to network and share ideas is part of the reason you join. Beyond the Quality Summit and Independent Owners Conference (which are open to all members), we were pleased to recently host several events catered to distinct groups of assisted living professionals:

• NCAL’s In-House Counsel Roundtable (Feb 28) held in conjunction with the AHLA Long Term Care and the Law Conference in New Orleans. Offered each year to in-house general counsel of assisted living companies, we had a great discussion this year on emergency preparedness strategies and best practices. 
• The Assisted Living Independent Owner Council (Mar 14) held a luncheon in conjunction with the Independent Owners Conference in New Orleans where attendees networked and discussed topics unique to smaller owners and operators (10 buildings or less).
• NCAL’s Senior Living Executive Council (Mar 28) convened senior executives from some of the largest assisted living companies in the country in Washington, D.C. Topics discussed ranged from forecasting gubernatorial elections to addressing workforce challenges. 

Coming Up in the Next Quarter

As I previously mentioned, we believe Congress may move at a slower pace than this first quarter of the year, so they can return home to their districts and prepare for the November mid-term elections. Even so, we are going to remain watchful over this next quarter for any last-minute legislation that could impact the profession. We can’t rest and assume most of our issues will remain at the state level. We need your help to make sure we are proactive, rather than reactive, on the Hill.

Please join hundreds of your fellow providers in Washington, D.C. for Congressional Briefing (June 4-5) and meet with members of Congress from your home state. As a member of AHCA/NCAL, there is no registration fee to attend this event. If we want common sense policies, your representatives in Congress need to understand what you do, the residents you serve, and the role you play within your larger community. You can also use this opportunity to invite them to come tour one of your buildings when they’re back home during this critical election year.

The NCAL team is also looking forward to speaking at several of our state affiliates’ conferences in the second quarter, so we hope to see you there!

Thank you for all you do, and for getting involved at the state and national levels. We’re honored to represent you in D.C. and through our state affiliate chapters.

Sincerely,

Scott Tittle
NCAL Executive Director