Public Policy and Advocacy Update in Post-Acute & Long-Term Care

Suzanne Gillespie, MD, RD, CMD, AGSF, FACPAssociate Professor of Medicine, University of Rochester Associate Chief of Staff for Geriatrics, Extended Care & RehabilitationPresident Elect, AMDA The Society for Post-Acute Long-Term Care

Speaker Disclosures

Dr. Gillespie has no relevant financial relationships.

She is employed by the Department of Veterans Affairs. The views expressed in this presentation are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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3https://www.aarp.org/ppi/issues/caregiving/info-2020/nursing-home-covid-dashboard.html

Learning Objectives

By the end of the presentation, participants will be able to:§ Discuss important PALTC policy issues in 2021.§ Discuss opportunities for re-envisioning PALTC§ Explore opportunities to participate in advocacy on legislative

initiatives, health care reform, and payment policy.

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Nursing Home Commission Report

§ Commission released report Sept 2020 https://sites.mitre.org/nhcovidcomm/

§ Results were used more for political purposes rather than examining policy recommendations

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Jessica Kalender-Rich

David Nace

Advocacy Around COVID-19§ AMDA, others - weekly calls with CMS/CDC§ Continued conversations with Congressional staff § Partnership with IHI – Daily Huddles§ Project ECHO

§ Top PALTC Issues:§ Vaccine Administration

§ Monoclonal Antibody Therapy

§ Reopening Visitation

§ Public Medical Director Listing

§ Long-term impact

The Public Health Emergency started 1/31/20 and was renewed on• April 21 2020• July 23 2020• October 2 2020• January 7 2021• April 15 2021 (effective April 21, 2021).

Liability and COVID

§ Federal legislation has been introduced but nothing has passed

§ Large coalition including several health professional societies called Health Coalition for Liability and Access (HCLA) working on response

§ States may have COVID associated liability protectionsNew York:§ The Emergency or Disaster Treatment Protection

Act was enacted in 2020 to give health care centers (hospitals, NHs) and staffers additional protections.

§ April 2021 – protections repealed (S5177 passed)

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COVID-19 Vaccination

§AGS Commends work of CDC/FDAhttps://www.americangeriatrics.org/media-center/news/ags-commends-fda-and-cdc-work-covid-19-vaccinations

§AMDA Statement on Vaccination (2-25-21) http://paltc.org/sites/default/files/COVID%20Vaccine%20Administration%20Statement.pdf

§Many recommends COVID-19 vaccine distribution and administration that prioritizes residents and healthcare workers in post-acute and long-term care facilities & reduces barriers.§ AMDA recommends that the first dose of COVID-19 vaccine be

administered to short-stay and rehabilitation residents while they are in the nursing home.

§ Urging flexibility in Federal Partnership Program - involve local pharmacies!

§ Meetings with CMS, CDC, stakeholders…8

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Free without an AMDA membership

Politics

§New Federal Administration:§New chairs of relevant Congressional

committees

§New Administrative Leadership§ Xavier Baccera – Secretary DHHS (confirmed by 1 vote)§ Chiquita Brooks-Lasure – Director CMS

§ (nominated, pending confirmation)

https://www.mcknightsseniorliving.com/home/news/home-care-daily-news/nominee-for-cms-administrator-would-bring-solid-experience-home-care-leader-says/

Biden-Harris Admin Priorities – Nursing Homes§Publicly released plan https://joebiden.com/covid-nursing-homes/#:~:text=Joe%20Biden%20will%20protect%20residents,COVID%2D19%20pandemic%20and%20beyond

§ Require an infection disease specialist in every regulated setting§ Ensure access to PPE§ Ensure adequate staffing and staff training§ Allow long-term care workers the choice to organize a union and collectively bargain. Give them

paid leave, career ladders, and other benefits§ Increase frequency and scope of surveys and data collection so that families have sufficient

information to make choices§ Conduct adequate numbers of surveys and restore levels of penalties needed to obtain

compliance with quality standards § Reject limitations on liability. Ensure individuals harmed or killed due to NH negligence can hold

providers accountable by pursuing legal remedies§ Ban on forced arbitration agreements§ Require OIG audits of NHs cost and ownership data through the PECOS system§ Reauthorize Elder Justice Act 11

COVID-19 Relief Bill and Other Legislation

§ COVID Bill - American Rescue Plan (signed into law 3/11/21)§ $450m to support SNFs§ $250m for strike teams to assist with clinical care, infection control

and staffing§ $200m for infection control protocols

§COVID-19 Nursing Home Protection Act of 2021 § Sen. Casey (D-PA), Sen. Warnock (D-GA), Sen. Whitehouse (D-RI), Sen. Booker (D-NJ), Sen. Blumenthal (S. CT) § similar provisions

Senator Casey, Chair of the U.S. Senate Special Committee on Aging

Interest in PALTC during Confirmation HearingsSenator Warren (D-MA) asked several questions at HHS Secretary confirmation hearings related to NHs and AL

Hearing for Andrea Palm (Nominee, Deputy Secretary HHS) April 15, 2021§Nursing homes.

§ In response to Sen. Daines (R-MT) on prioritizing provider relief funds:

§ “To your point,” Palm told Sen Daines (R-MT), “our frontline health care workers have borne the brunt of this pandemic. When I was in Wisconsin, we added additional dollars to what the feds were providing to help ease the workload and the burden that they were facing.”

134/15 Senate Finance Committee

Interest in PALTC during Confirmation Hearings

§Home and Community Based Services. § Sen. Bob Casey (D-PA) that lawmakers need to invest more into

home and community-based services. Casey said the $551 million included in Bidens proposed budget builds on funding supplied under the American Rescue Plan.

“Just as our society needs bridges, waterways and roads, families --families need services and support to care for older family members,

to care for people with disabilities and to care for children”

“Adding more money into HCBS will create jobs and increase workers’ wages.”

144/15 Senate Finance Committee

Key Advocacy: Public Medical Director Registry/Listing

§Bi-partisan letter from Congress asking CMS to implement

§States have begun conversations to implement on state level

§Continued discussions with CMS

§Clear need given COVID/other crisis communication

§Public must have access to information on clinical leadership

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Telehealth & the Pandemic

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Telehealth & the Pandemic§ PHE 1135 waiver remains in effect! All telehealth is allowed with no limitations

§ Paid at the same rate as in person visit§ Use modifier 95

§ Nursing homes can bill per encounter as an originating site using code Q3014

§ After PHE:§ CMS finalized once every 14 days restriction on subsequent care nursing home codes (99307-99310)§ Initial visit codes (99304-99306) NOT included post PHE§ Added home/domiciliary established patient codes to telehealth list for the rest of the year in the year in which the

PHE ends§ Looking to test others§ No geographic restrictions

§ AMDA Telehealth workgroup working on use cases around telehealth§ Advocating for removal of barriers to telehealth § Advocating for RUSH Act re-introduction

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Medicare Telehealth

CMS finalized the addition of the following services to the Medicare telehealth list on a Category 1 (permanent) basis:• Group Psychotherapy (CPT code 90853)• Domiciliary, Rest Home, or Custodial Care services,

Established patients (CPT codes 99334-99335)• Home Visits, Established Patient (CPT codes 99347-

99348)• Cognitive Assessment and Care Planning Services

(CPT code 99483)

• Prolonged Services (HCPCS code G2212)• Psychological and Neuropsychological

Testing (CPT code 96121)• Visit Complexity Inherent to Certain

Office/Outpatient E/Ms (HCPCS G2211)

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Medicare Telehealth

Additionally, CMS finalized the creation of a temporary third category of Medicare telehealth services. Category 3 describes services added to the Medicare telehealth list during the PHE for the COVID-19 pandemic that will remain on the list through the calendar year in which the PHE ends. We finalized the addition of the following services to the Medicare telehealth list on a Category 3 basis:

• Domiciliary, Rest Home, or Custodial Care services, Established patients (CPT codes 99336-99337)

• Home Visits, Established patients (CPT codes 99349-99350)• Emergency Department Visits, Levels 1-5 (CPT codes

99281-99285)• Therapy Services, Physical and Occupational Therapy, All

levels (CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507)

• Hospital discharge day management (CPT codes 99238-99239)

• Continuing Neonatal Intensive Care Services (CPT codes 99478-99480)

• End-Stage Renal Disease Monthly Capitation Payment codes (CPT codes 90952, 90953, 90956, 90959, and 90962)

• Nursing facilities discharge day management (CPT codes 99315-99316)

• Psychological and Neuropsychological Testing (CPT codes 96130- 96133; CPT codes 96136-96139)

• Inpatient Neonatal and Pediatric Critical Care, Subsequent (CPT codes 99469, 99472, 99476)

• Subsequent Observation and Observation Discharge Day Management (CPT code 99217; CPT codes 99224- 99226)

• Critical Care Services (CPT codes 99291-99292)

Evaluation and Management Coding

§Drs. Chuck Crecelius/Bob Zorowitz represented AMDA/AGS on AMA CPT/RUC Evaluation and Management Workgroup

§ Same process that revised office outpatient office E&M that is in effect in 2021

§ Evaluation and Management codes for nursing home services are being redone similar to office codes

§ Post Acute Long Term Care Providers with good participation to survey…..

§ THANK YOU FOR YOUR input….stay tuned.

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New for Office Codes 2021

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Last year, CMS finalized aligning E/M visit coding and documentation policies with changes by the CPT Editorial Panel for office/outpatient E/M visits, beginning January 1, 2021. This includes:

−Code redefinitions that rely on time or medical decision-making for selecting visit level, with performance of history and exam as medically appropriate−Deletion of level 1 new patient code−A new prolonged services code specific to office/outpatient E/M visits

CMS also adopted revised medical decision-making guidelines adopted by the CPT Editorial Panel. Additional information about the American Medical Association (AMA) CPT changes are available here https://www.ama-assn.org/practice-management/cpt/how-2021-em-coding-changes-will-reshape-physician-note

In the CY2021 PFS final rule, CMS finalized revisions to the times used for rate setting for the office/outpatient E/M visit code set.

Medicare Physician Fee Schedule Reductions Jan-Sept 2020

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MPFS: Payment for Nursing Home Services§ AMDA advocacy helped avoid a nursing home/assisted living services, home

health, and therapy services faced upwards of 10% cut for 2021

§ AMDA members sent more the 1,000 letters to Congress talking about impact of cuts to nursing home/AL/home health services

§ Consolidated Appropriations Act of 2021 enacted December 27, 2020§ Provided a 3.75% increase in MPFS payments for CY 2021§ Suspended the 2% payment adjustment (sequestration) through March 31, 2021§ Reinstated the 1.0 floor on the work Geographic Practice Cost Index (GPCI)

through CY 2023§ Delayed implementation of the inherent complexity add-on code for evaluation

and management services (G2211) until CY 2024

Medicare Sequester COVID Moratorium Act

§ Congress has passed legislation to extend the Medicare sequester moratorium through end 2021 (Senate 3/25/2021,House 4/14/2021)

§ This delays a 2% across the board cut to all Medicare payments

§ However, the bill proposes to offset the change by increasing the sequester cuts in 2030.

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Revised Payment Rates for 2021

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CodeTotal 2021 2021 Payment Rate Total 2020 2020 Payment

RatePercentage

Change RVUs (CF=32.2605) RVUs (CF=36.0896) 2020-2021

99304 2.59 $83.55 2.55 $92.03 -9.21%

99305 3.73 $120.33 3.69 $133.17 -9.64%

99306 4.81 $155.17 4.73 $170.70 -9.10%

99307 1.27 $40.97 1.24 $44.75 -8.45%99308 2.01 $64.84 1.94 $70.01 -7.38%99309 2.64 $85.17 2.57 $92.75 -8%

99310 3.9 $125.82 3.83 $138.22 -8.98%

99315 2.12 $68.39 2.05 $73.98 -7.56%

99316 3.03 $97.75 2.99 $107.91 -9.41%

99318 2.78 $89.68 2.71 $97.80 -8.30%

%= (new-old)/old

CodeTotal 2021 2021 Payment Rate Total 2020 2020 Payment

Rate Percentage Change

RVUs (CF=34.8931) RVUs (CF=36.0896) 2020-2021

99304 2.59 $90.37 2.55 $92.03 -1.80%

99305 3.73 $130.15 3.69 $133.17 -2.27%

99306 4.81 $167.84 4.73 $170.70 -1.68%

99307 1.27 $44.31 1.24 $44.75 -0.98%

99308 2.01 $70.14 1.94 $70.01 0.17%

99309 2.64 $92.12 2.57 $92.75 -1%

99310 3.9 $136.08 3.83 $138.22 -1.55%

99315 2.12 $73.97 2.05 $73.98 -0.01%

99316 3.03 $105.73 2.99 $107.91 -2.02%

99318 2.78 $97.00 2.71 $97.80 -0.82%

Before Legislative Fix After Legislative Fix

Patient Drive Payment Model (PDPM) Insights

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/MLN_CalL_PDPM_Presentation_508.pdf

Patient Drive Payment Model (PDPM) First Year Insights

• Daily Rate on avg is better than anticipated, yet leaving $ on the table• Audits and Rug Pull haven’t manifested due to pandemic, still to come• COVID patients helping facilities take advantage of skilling in place• 3-day waiver under utilized• Accurate and comprehensive diagnosis coding is lacking (Missed

opportunities and Non Therapy Ancillary points)• Subpar involvement of medical team in the PDPM assessment/coding process• Medical provider collaboration with facilities is meaningful

• Parity Adjustment process underway.

Source: AMDA 2021, AMDA PGN Roundtable 12/7/20

Health IT

§ ONC Final Rule Implementing CURES Act – sweeping rule passes a year ago finalizing provisions on:§ Interoperability standards§ Data Blocking§ Patient Access

§ PACIO Projects:§ Working to standardize data flow from setting to setting

using new FHIR standard§ New Advance Care Planning project lead by Maria Moen

(ADVault) § Clinical must connect with technological – need your

expertise! § http://pacioproject.org/about/

§ Data Element Library/USCDI/TEFCA – all efforts by CMS/ONC to provide standardized data for developers to work from to create exchange of information

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https://www.healthit.gov/curesrule/

Antipsychotics

§CMS has not issued final rule on PRN Antipsychotics (proposed rule issued in 2019)

§Project PAUSE –“Psychoactive Appropriate Use for Safety and Effectiveness” § Collaboration with ASCP, Gerontological Society of America, Alliance for

Aging Research to develop an alternative process measure for appropriate use of antipsychotics

§ Regular meetings with CMS to discuss updates§ May be on the agenda for Congressional hearings

§ States also interested. NY informed consent legislation

COVID-19 State Advocacy

§Decisions are made locally

§AMDA members grassroots meeting to discuss best practices and share ideas

§AMDA State Advocacy Task Force § California legislation on medical director certification§ Pennsylvania plan for vaccine distribution§ Maryland Strike Teams and Post-Acute Summit§ Kentucky Governors Task-Force

NY State PALTC Legislative Actions SPRING 2021§ Patient Care Ratio Reporting: This bill, S.4336A sponsored by Senator Gustavo Rivera, directs the

Commissioner of Health to establish a "Direct Patient Care Ratio" that would require all nursing homes to spend at least 70% of a facility's revenue on direct patient care.

§ Publication of Nursing Home Ratings: This bill, S.553 sponsored by Senator James Sanders Jr., requires that the most recent Center for Medicare and Medicaid Services (CMS) rating of every nursing home be prominently displayed on the home page of the Department of Health's website and at each nursing home facility's website and displayed at the facility for view by the general public.

§ Reimagining Long-Term Care Task Force: This bill, S.598B sponsored by Senator Rachel May, enacts the “Reimagining Long-Term Care Task Force” to create a task force studying the state of both home-based and facility-based long-term care services in the state, and to make recommendations on potential models of improvement to long-term care services for older New Yorkers.

§ Long-Term Care Ombudsman Program Reform Act: This bill, S.612Asponsored by Senator Rachel May, creates "The Long-term Care Ombudsman Program Reform Act" by expanding the current program to be more accessible and available to seniors and their families, while promoting the volunteer advocate program, and improve interactions between DOH and the Ombudsman program regarding complaints.

§ Allowing Compassionate Care-Giving Visitors: This bill, S.614B sponsored by Senator Rachel May, creates a standardized program to allow personal care and compassionate care visitors at nursing homes.

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NY State PALTC Legislative Actions 2021§ Infection Inspection Audit: This bill, S.1783 sponsored by Senator James Skoufis, directs the Department of

Health to establish and implement an infection control inspection audit and checklist for residential care facilities.

§ Quality Assurance Committees: This bill, S.1784A sponsored by Senator James Skoufis, requires adult care facilities to include "quality assurance committees" in their quality assurance plans

§ Requirements for Transfer, Discharge and Voluntary Discharge: This bill, S.3058 sponsored by Senator Gustavo Rivera, creates requirements for the transfer, discharge and voluntary discharge of residents from residential healthcare facilities

§ Standards for Ownership of Nursing Homes: This bill, S.4893 sponsored by Senator Gustavo Rivera, requires more review of ownership of nursing homes through the certificate of need process - including consideration of past violations at other facilities by owners - and requires more notice to the public during the CON process.

§ Department of Health Death Records: This bill, S.3061A sponsored by Senator Gustavo Rivera, requires the Department of Health to record COVID-19 deaths of nursing home residents that died in hospitals to be recorded as a "nursing home" death and require the Department of Health to update and share data it receives with hospitals and nursing homes on communicable diseases.

§ Transparency of Violations: This bill, S.3185 sponsored by Senator James Skoufis, requires residential health care facilities to disclose in writing to potential residents and their family members the website where a list of violations and other actions taken against the facility can be found.

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Reimagining Long-Term Care Task Force S.598B

§Enacts the “Reimagining Long-Term Care Task Force” to create a task force studying the state of both home-based and facility-based long-term care services in the state, and to make recommendations on potential models of improvement to long-term care services for older New Yorkers.

“utilize the findings of its study on the impact of the coronavirus pandemic to formulate recommendations on how such skilled nursing and other adult-care facilities, as

well as home care service agencies, can better care”

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The reimagining long-term care task force shall consist of 26 members:§ the director of the office for the aging,

§ the commissioner of health,

§ the commissioner of labor, § the commissioner of the office for people with

developmental disabilities, § two members appointed by the governor;

§ two members appointed by the temporary president of the senate;

§ two members appointed by the speaker of the assembly;

§ one member appointed by the minority leader of the senate;

§ one member appointed by the minority leader of the assembly;

§ one from the AARP; § one from New York Caring Majority;

§ one from Home Care Association of New York State (HCA-NYS);

§ one from the Long Term Care Community Coalition; § one representative of 1199;

§ one from NYS State Nurses Association; § one from LeadingAge;

§ one from HANYS;

§ one from Association on Aging in New York§ one from the Empire State Association of AL

§ one from NYS Health Facilities Association/New York State Center for Assisted Living;

§ one from the New York Medical Directors Association;

§ one from NY Chapter of the ACP Geriatrics Committee;

§ one representative of Argentum New York.

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Reimagining Long-Term Care

Workforce Technology

Alternatives to Nursing Home Care (PACE, HBPC, MFH)

Finances: Transparency Incentives for

stellar care

39https://www.aarp.org/ppi/issues/caregiving/info-2020/nursing-home-covid-dashboard.html

Burdens of Caring

https://www.aarp.org/ppi/issues/caregiving/info-2020/nursing-home-covid-dashboard.html

Staffing Shortages (Percent of Facilities with a shortage of Nurse &/or Aides)

3/23/2021

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Staffing Requirements

§ According to Mueller et al. (2006) staffing is presumed to affect the quality of care and life of nursing home residents.

§ According to other literature, it remains inconclusive about staffing elements that directly impact the quality of resident care (Spilsbury et al., 2011)

§ The Nursing Home Reform Law of 1987 § facilities must have a RN 8 consecutive

hours, 7 days a week and licensed nurses available 24 hours a day, with “sufficient” nursing staff to meet residents’ needs.

§ The Payroll Based Journal (PBJ) 2016 § new insights to how nursing homes are

staffed, including variability between weekdays and weekends.

§ An ongoing challenge about what constitutes “sufficient” nursing staff remains, with a high degree of subjectivity.

§ 2017-2019 updates to OBRA regulations§ No mandates on staffing§ Includes revised regulations and

guidelines criterion for citing deficiencies in staffing

Staffing/Workforce§ AMDA’s last official position from 2002 https://paltc.org/amda-white-papers-and-resolution-position-

statements/position-direct-care-staffing-nursing-homes

§ Public Pressure:§ Center for Medicare Advocacy – staffing levels impact COVID deaths

https://medicareadvocacy.org/nursing-home-staffing-is-key-to-covid-deaths/§ More pressure on minimum staffing levels§ Full time infection control specialist § 24hr RN coverage§ Infection control specialist

AMDA statements: § Staffing and trained workforce are key to quality care§ Benefits/career ladders and training all factors for direct care workforce§ Continued support Geriatric Workforce Enhancement Program (GWEP) and

Geriatric Academic Career Awards (GACA)

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Nursing Home Nursing workforce turnover

§Mean annual turnover rates for total nursing staff ~ 128 %§Median annual turnover rates for total nursing staff ~94 %§Turnover rates were correlated with:

§ facility location, § for-profit status, § chain ownership, § Medicaid patient census, and § star ratings.

Gandi et al. Health Affairs. March 2021. HTTPS://DOI.ORG/10.1377/HLTHAFF.2020.00957

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https://www.nahcacna.org

Tailored Professional Development with Experts -> featuring UR stars

Local Approaches:

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Transformation

§ Career paths – recruitment and retention§ Building Knowledge § Public education campaigns§ Policy Reforms

§ Stories

https://phinational.org/worker-stories/

Financial Transparency in NH Post-COVID Nearly three-quarters of US nursing homes had related-party business transactions

§ Accounts for $11 billion of nursing home spending in 2015 according to Medicare cost reports.

§ As many as half of all nursing homes use separate management companies that are owned by the same owner(s)

§ These NHs employ less nurses, had more deficiencies vs independent

§ CMS, however, has no mechanism to audit the accuracy & completeness of the PECOS* ownership reporting system

§ Financial margins are unclear

50*Medicare Provider Enrollment, Chain, and Ownership System ( PECOS)

Finance Reforms in NYS Nursing Home Industry: April 2021

§New required to spend at least 70 % of revenues on direct resident care, including at least 40 % on nurses/staff who work with residents. § Estimates this change will lead

to an extra $500 million being spent on resident care

§Profits capped at 5%§Staffing hours/day expected

to be hot debate

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Home Based Primary Care

§Eligibility: Too sick to go to clinic §Medical Care: Interdisciplinary team to home§Technology: Tablets, remote monitoring

§Cost: § $0 to Veteran§ ~ $35,000/year to VA in staffing costs

Started in VA - similar model now in CMS as the Independence at Home Demonstration

§ Three year extension included in year end 2020 budget

Home Based Primary Care in the Independence at Home CMS Demo extends time living in the community by…

A. 4 months

B. 8 months

C. 1 year

D. 2 years

• Adult day care• Transportation• Interdisciplinary team • Medicaid/Medicare capitation• 2019 annual income limit $17,700 for

a couple

• Nationally 260 centers in 31 states• > 50,000 participants• Dual eligible (Medicaid + Medicare)

90%

Program of All-Inclusive Care for the Elderly

• Transportation Vans à meal delivery• Rehabilitation à virtual• No change in per-diem à stable financing • 2.2% COVID-19 across 66 programs

Sen. Casey Introduces PACE Plus Act (S. 1162) Legislation

WASHINGTON, DC – April 16, 2021§ Sen. Casey (D-PA) introduced the PACE Plus Act (S. 1162),

§ Seeks to expand access to Programs of All-Inclusive Care for the Elderly (PACE®).

§ the Milken Institute, a leading think tank, recommends PACE growth as a solution to the nation’s long-term care crisis

§ Embodies a recommendation in his 2020 report on “Reimagining Aging in America” that Congress should bolster the development of additional PACE programs and expand eligibility of enrollment to allow for a greater number of people requiring in-home supports to be eligible to receive care in their homes and communities.

§ In addition, PACE was mentioned as part of the 10 percent increase in state matching funds for HCBS under the recently enacted American Rescue Plan.

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PACE Plus Act (S. 1162) Legislation

§Facilitate creation of new PACE programs and the expansion of existing programs through federal grants and providing states with incentives to adopt the model of care or increase the use of it

§ Increase the number of seniors and people with disabilities who are eligible to receive PACE services

§Decrease the bureaucratic burden experienced by growing PACE programs

§Providing additional technical assistance resources for growing programs

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Well-Being Insurance for Seniors to be at Home (WISH) Act

§ Anticipated introduction by Rep. Tom Suozzi (NY 3rd District)§ Makes it more possible for working people to self-fund their period of

disability in old age and thereby keeps control in the older adult and less reliance on Medicaid.

Enable home and community based services.§ Conceptually, it is a targeted supplement to Social Security retirement

financing.§ Public: The Federal Government will collect a payroll tax of 0.5% (025% from

employees and 0.25% from employers) to fund catastrophic long-term care.§ Private: Having been alleviated of dealing with catastrophic levels of long-

term care, the private insurance market would be able to market a variety of affordable and appealing long-term care insurance products

https://www.umb.edu/mccormack.umb.edu/uploads/gerontology/Public_Catastrophic_Insurance_Paper_for_Bipartisan_Policy_Center_1-2

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Step By Step Advocacy

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Listen.Learn.Identify opportunities.

Discuss with Colleagues.Formulate opinions.

Write, email, call. Tweet.Meet.Work with your professional societies.Repeat.