NASUAD Public policy discussion and prioritization DRAFT UNFINALIZED VERSION

1. NASUAD Public policy discussion and prioritizationDRAFT UNFINALIZED VERSION Bea RectorDirector, Washington State Home and Community Services Division Damon TerzaghiSenior Director, NASUAD

2. Background • Every few years NASUAD works to update its public policy platform in order to include the most current and relevant information and legislative/regulatory recommendations • Now that the new Congress and State Administrations have been seated, we believe it is an appropriate time to update the platform • These recommendations will likely remain in effect as the official platform for the next two years • This is your chance to weigh in: • Be loud and be proud! • And be proud to be loud…

3. Process Overview • NASUAD Staff review prior recommendations with NASUAD’s Public Policy Committees: • Two committees: • Aging and Disability (focus on discretionary programs); • Medicaid and LTSS (focus on entitlements including Medicaid/Medicare/duals); • Committee membership is open to any interested state (Sign up today!) • Committees make recommendations for modification to platform • Board of Directors reviews resulting draft platform, provides additional recommendations, and moves to recommend approval • Membership provides feedback, additional comments, and moves for final approval to the platform • NASUAD takes these recommendations and builds formal narrative booklet We Are Here

4. Recommendations • Reauthorize the Older Americans Act • Note: NASUAD issued specific OAA Reauthorization platform in August 2018 based on membership recommendations • Increase Flexibility for States • Combine Title III-C1 & C2 into one program • Establish a demonstration program that allows states to evaluate providing OAA supports in a targeted, person-centered way • Support Programs that Assist Individuals to Age in Place: • Community Services Block Grant • Social Services Block Grant • Low Income Home Energy Assistance Program • HUD Housing Programs, particularly with a focus on affordable, accessible housing • Specific interest in III-B sustainability

5. Recommendations • Promote Elder Justice and Adult Protective Services: • Support the ACL APS Recommendations by establishing authorizing Federal Legislation and funding for APS • Enhance support for Ombudsman program • Support Research and Evaluation in the OAA and Aging Services • Establish/strengthen research arm under ACL to address both Aging and Disability • Either expand NIDILRR to encompass aging and disability; or • Establish corresponding aging-focused research entity in ACL • Support the NWD/ADRC initiative: • Continue to advocate for ongoing, increased appropriations for NWD • Allow III-B funding used to support NWD to serve individuals under 60

6. Recommendations • Align current policy allowing Tribal AAAs to set their own age eligibility threshold for Title VI services with Title III eligibility • Address workforce issues: • Increase allowable options to support caregivers under Medicaid HCBS • Provide grants and other funding sources to help develop innovative recruitment/retention models, including expanded telemedicine • Improve HCBS settings implementation • Allow new constructions subject to heightened scrutiny to enroll as Medicaid providers based upon approved plans that demonstrate compliance to address challenges with capacity • Provide timely responses and approvals to states that submit heightened scrutiny packages

7. Recommendations • Clarify person-centered planning requirements • Ensure that CMS applies consistent requirements nationally • Clarify that only essential hands-on providers are required to sign the plan and be included in plan distribution to reduce burden/red tape and protect privacy • Provide clarification on conflict of interest requirements, including a statement that entities are not conflicted from Medicaid case management if they deliver OAA services • Continue to allow Medicaid 1115 waivers to include HCBS/LTSS innovations • Provide employment supports for older workers and individuals with disabilities: • Programmatic improvements to Medicaid Buy-in programs • Expanded support via interagency workgroups • Increase availability of supports to older workers • Move SCSEP and ODEP to ACL • Increase Tribal VR appropriations to account for inflation

8. Recommendations • Improve electronic visit verification policy and issue clarifications regarding important issues, such as: • Shared living • Self-direction • APD approval • MECT processes • Error rates • Ensure that the EVV FMAP penalty only applies to specific services that are noncompliant

9. Recommendations • Medicare: • Expand policy allowing for short-term LTSS to be provided via Medicare Advantage plans to FFS • Provide states with flexibility to assure access to necessary DME • Expand Medicare billing standards related to professional certification to expand provider pool and align with state Medicaid programs (one such example could be licensed mental health professionals) • Include a Medicare dental benefit • Establish a demonstration project in CMMI that allows interested states to manage the Medicare funding for dual eligible individuals

10. Additional Discussion • Things we missed? • Concerns with proposed recommendations in the platform? • Modifications/edits to proposals discussed?

11. For additional information: Damon Terzaghi dterzaghi@nasuad.org (202) 674-8582 www.nasuad.org