Followed by calls to congressional offices throughout the week. We will help our participants to arrange meetings with Congressional Staffers via Zoom, help our members to understand how to use Zoom if they need it, and give you the advance materials and tools to make a strong presentation.

Last week, the Iowa Department of Human Services announced that they will be closing the Glenwood Resource Center, one of the state's two remaining state-operated ICFs, in the course of the next two years. VOR has been working with the families of the residents of Glenwood, and will continue to share our experience to help facilitate the best possible outcomes for everyone involved.

By State Representative Sandy Salmon, Waverly Newspapers, April 11, 2022

The Health and Human Services budget passed last week in the House and appropriates $2 billion state money for a total of $6 billion state and federal monies to Medicaid, child care assistance, family assistance, child and family services, Cherokee and Independence MHI’s, Glenwood & Woodward Resource Centers, Dept. of Human Services (DHS), Dept. of Public Health (IDPH), Dept. on Aging, Dept. of Veteran Affairs, and the Iowa Veterans Home.

It also provides for the merger of DHS and IDPH into a new agency Health and Human Services (HHS).

The Health and Human Services budget prioritizes community-based services for Iowans with intellectual disabilities as well as mental health services.

• Provides a $14.6 million investment (including federal match it is $38 million) in home and community-based services rates. This allows for a $2 raise to all direct support professionals, and this bill requires this increase to go towards our front-line workers wages.

• Provides a $7.4 million state investment to reduce the waitlist on the intellectual disability services waiver. This appropriation should add an additional 250 ID waiver slots.

• Intermediate Care Facilities for those with intellectual disabilities receive a total increase of $8.2 million, and also require these funds to go directly to direct support professional wage increases.

• Provides a $4 million appropriation to create a new home health rate structure that provides an incentive for providing care to rural Medicaid members.

By Maribel Slinde, Corridor Business Journal, April 11, 2022

The demand for direct care workers (DCWs) will increase substantially in the coming years as the population of older adults and people with disabilities in Iowa increases. DCWs go by different names, often determined by their work and the populations they support or serve.

Regardless of their title, they provide most hands-on care in settings that range from in-home care, assisted living, nursing homes, and hospitals to residential care facilities, supported living, adult day services and hospices.

Our state has struggled to maintain an adequate direct care workforce. This is a challenge that we share with every state in the country, but an especially vexing problem in Iowa due to our slow population growth. More than 59% of Iowa’s nursing homes report they are short-staffed, according to a February AARP Nursing Home COVID-19 Dashboard. Attracting and retaining DCWs to meet Iowa’s present and future needs is impossible with the wages currently paid. DCWs’ median hourly wage is below $15 an hour, with 15% living below the poverty guidelines according to PHI National. Twenty-eight percent work more than one job to make ends meet. Caring for and supporting other human beings is a beautiful calling, but should not require people to take a vow of poverty to do so.

By Christie Netherton, Messenger-Inquirer, April 6, 2022

D&S Residential Services, a residential care provider for individuals with disabilities, will close its doors April 9, resulting in between 60-70 clients having to move.

The residential facility, at 1102 Triplett St. in Owensboro, was forced by the Department for Medicaid Services to close. The facility and its owner, Sevita Health, declined to comment on the reasons for the closure.

With limited options for residential services available, not only in Owensboro, but statewide, individuals in need of the services already face the possibility of having to move outside Owensboro and possibly away from family and loved ones, according to Amanda Owen, executive director for Puzzle Pieces, a possibility that becomes more looming as residential services experience closures, staffing shortages and other issues that have been brought on by the COVID-19 pandemic.

Puzzle Pieces is a nonprofit serving individuals with intellectual disabilities and a provider of residential services.

“Kentucky is really in a state of crisis,” Owen said. “COVID caused agencies across Kentucky — a lot of long-term housing — to close.”

There are several providers outside of D&S locally, including Puzzle Pieces, Wendell Foster, Strategic Partners and Bridges of Kentucky. However, Owen said, despite the presence of other residential services, it is unlikely that any one facility would be able to take on 60-70 new clients at once due to the closure of D&S.

Opinion by By Christopher White – CEO, Road to Responsibility, Boston Business Journal

April 10, 2022

After decades of “getting by” (sometimes just barely) due to a large population of young people seeking to enter the job market complemented by a vast pool of legal immigrants, the day has arrived where the human service system has effectively reached the point of failure because we can’t hire enough workers.

This may sound hyperbolic, but how would you describe a situation where there are thousands of people with various disabilities needing services, there is money to pay for those services, yet those people cannot access them? That’s precisely what’s happening across the state.

The state Department of Developmental Services (DDS) has over 7,000 people waiting to return to the services they were receiving pre-pandemic. This doesn’t include the many young adults who are now aging out of school-based services and looking forward to moving on to adult services. Unfortunately, most of them learn there are no services to be had due to the workforce shortage. There is no foreseeable solution in sight for this problem unless something significant changes.

Why is this happening now? The pandemic has accelerated the pace of baby boomers retiring. Subsequent generations, being much smaller, aren’t sufficient to replace those retirees in normal times, and these aren’t normal times. It also forced millions of women out of the workforce to care for young children or other family members. I

n the past, this problem was masked by a relatively abundant flow of legal immigrants. Unfortunately, legal immigration was largely curtailed under the Trump administration, and the Biden administration hasn’t meaningfully addressed it. This dynamic has led to a massive shift in the labor market.

Businesses like Target ($24 per hour), Bank of America ($20 per hour), Amazon ($18.50 per hour) and Hobby Lobby ($18.50 per hour) are all offering a higher starting wage to perform jobs of less societal importance and impact than the essential work performed every day, pandemic or not, by our human services workforce. If Target is short-staffed, we are inconvenienced. When human services are short-staffed, the lives of our members and their families are jeopardized. 

The primary issue is money. Companies like Road To Responsibility can’t compete in this market without significant increases to the rates the state uses to purchase services. Using one-time funds (primarily a PPP loan) we have increased our starting pay to $17 per hour and have added recruitment and retention bonuses of $2,500. However, our state contracts will only support an entry-level wage of $15 to $16.79 per hour. While our efforts have helped to stabilize us, they haven’t significantly decreased our vacancies (we still have more than 27% of our positions vacant). This is happening across the field — children, mental health, developmental disabilities and elder services.

By Kimberly Marselas, McKnight's Long-Term Care News, April 11, 2022

The Centers for Medicare & Medicaid Services will adjust nursing home payment rates downward by 4.6% to account for unintentional overpayments in the transition to the Patient Driven Payment Model, the agency announced late Monday. That $1.7 billion decrease will result in a new, $320 million annual decrease after accounting for a market basket increase and other factors, officials explained.

“To do this during a pandemic is actually heartless. We were comfortable with them spreading it out and thought that would be the case,” Rick Matros, president and CEO of Sabra Health Care REIT, told McKnight’s Long-Term Care News.

In issuing its 2023 Skilled Nursing Facilities Prospective Payment System, CMS also said it was proposing a 3.9%, or $1.4 billion, payment boost for the sector. That includes a 2.8% market basket update and a 1.5 percentage point forecast error adjustment, as well as a 0.4% lower productivity adjustment. The 3.9% Part A adjustment is significantly more than CMS proposed for providers in recent years.

Combined, the two adjustments will result in an estimated aggregate decrease of about $320 million in Medicare Part A payments to SNFs in fiscal 2023.

In the same announcement, CMS also addressed two separate workforce issues.

By Danielle Brown, McKnight's Long-Term Care News, April 12, 2022

Providers are struggling with the federal government’s “heartless” decision to decrease pay for skilled nursing facilities by $320 million in fiscal 2023. 

Officials said Monday’s announced nursing home pay rule is an attempt to compensate for overpayments that started with the introduction of the Patient Driven Payment Model in late 2019 and lingered throughout the pandemic. 

The proposed net payment reduction has industry stakeholders worried how SNFs would be able to provide adequate care if nothing is changed after what is expected to be a very active comment period. 

“Many nursing homes already face imminent closure, and this Medicare cut could force more seniors across the country to relocate and find alternative care farther away from family and loved ones,” Mark Parkinson, president and CEO of the American Health Care Association, said in a statement to McKnight’s Long-Term Care News on Monday. 

“It is critical that Medicare remain a reliable funding source and reflect the increasing costs providers are facing,” he added. 

By Kimberly Marselas, McKnight's Long-Term Care News, April 13, 2022

The release of a proposed 2023 pay rule Monday afternoon reiterated the Centers for Medicare & Medicaid Services’ commitment to implementing a minimum staffing rule after more than 20 years of debate on the issue. Staffing-related provisions include a new value-based incentive element for total nurse staffing and an official request for comment on the coming direct care staffing requirements. 

CMS, however, has much to consider in a yearlong study leading up to an officials staffing rule set to be proposed early next spring.

The agency Monday asked stakeholders to weigh in on at least 17 related issues. They range from how to calculate the measure to who to include and how to account for labor challenges to how much the requirement will cost — and if better outcomes, such as lower hospitalization rates, might provide an offset.

“It’s obviously very important that we have standards of care and that facilities should be meeting those standards,” Ashvin Gandhi, Ph.D., a UCLA health economist who studies staffing and turnover, told McKnight’s Long-Term Care News. “CMS does have to think really carefully about whether and to what degree facilities are going to be able to financially meet staffing requirements. You could have unintentional consequences.”

Florida nursing homes now have more staffing flexibility after Gov. Ron DeSantis (R) signed a measure Wednesday that “modernizes [the state’s] outdated staffing requirements.” 

“This legislation will bring more individualized, comprehensive care to residents while easing the burdens posed by significant staffing challenges,” Emmett Reed, CEO of the Florida Health Care Association, said in a statement. 

His comments came after DeSantis signed HB 1239 into law, following weeks of uncertainty. The measure, which was supported heavily by provider advocates in the state, reduces the minimum number of hours of direct care per resident day provided by CNAs to 2. It also accounts for time other workers, including therapists, spend with residents.

Florida currently requires certified nursing assistants in the Sunshine State to provide a minimum of 2.5 hours of direct care per resident/patient day. CNAs and licensed nurses also are required to provide a weekly average of 3.6 hours of direct care per resident/patient per day.

Please help us to continue to speak truth to power about the need for a diverse range of services, increased funding, and a full continuum of care to meet the needs of all people with I/DD and Autism.

We have contacted attorneys from the Department of Justice’ Civil Rights Division concerning increased mortality rates among people with I/DD in wake of the closing of state operated intermediate care facilities in Virginia. We have met by Zoom with the same DOJ attorneys concerning their current action in to move people out of ICFs in Iowa. Just today, we met with leadership of the Administration for Community Living to discuss our mutual concerns and to offer paths forward to help serve all people with I/DD,

H.R. 4779 & S. 1437 - Recognizing the Role of Direct Support Professionals Act - To require the Office of Management and Budget to revise the Standard Occupational Classification system to establish a separate code for direct support professionals, and for other purposes.

H.R.6075 - The HEADs UP Act - To amend the Public Health Service Act to expand and improve health care services by health centers and the National Health Service Corps for individuals with a developmental disability as a Medically Underserved Population (MUP).

H.R.4761 - A bill to amend the Rehabilitation Act of 1973 to ensure workplace choice and opportunity for young adults with disabilities.

H.R.4762 - A Bill to amend the Rehabilitation Act of 1973 to clarify the definition of competitive integrated employment.

VOR OPPOSES:

S. 3417 - The Latonya Reeves Freedom Act of 2021 - This bill may be seen as the offspring of the Disability Integration Act from the 116th Congress. It misrepresents Olmstead, and contains provisions that would be harmful to the existence of ICFs, including a section that would promote lawsuits against larger congregate care facilities.

H.R. 603 & S. 53 - The Raise the Wage Act - These bills are aimed at raising the minimum wage, but they also have provisions to phase out and ultimately eliminate vocational centers and 14 (c) wage certificates over the next six years and to immediately stop the issuing of any new certificates. VOR believes the issue of employment options for individuals with intellectual disabilities should not be buried in a bill for raising the federal minimum wage. Both issues deserve clean, stand-alone bills.

H.R.1880 - To amend the Deficit Reduction Act of 2005 to make permanent the Money Follows the Person Rebalancing Demonstration.

H.R. 2383 & S. 3238 - The Transformation to Competitive Integrated Employment Act - this bill purports to assist employers providing employment under special certificates issued under section 14(c) of the Fair Labor Standards Act of 1938 in transforming their business and program models to models that support individuals with disabilities through competitive integrated employment, to phase out the use of these special certificates. We feel that, if enacted, tens of thousands of people with I/DD and autism will still be forced out of opportunities they currently, needlessly, and left without viable alternatives to occupy their time or address their needs and their abilities.

H.R.4131 & S.2210 - The Better Care Better Jobs Act - To be clear, we don't oppose this bill. We object to the fact that it excludes the most vulnerable members of the I/DD population.

While the Better Care Better Jobs Act would greatly increase the amount of federal funding for people with I/DD, it only supports those in waiver programs receiving Home and Community Based Services. It unjustly discriminates against those who have chosen Intermediate Care Facilities as the necessary and proper form of residential treatment. By giving a 10% increase n federal matching funds only to HCBS clients, and providing training and increased pay only to direct support professionals working in HCBS facilities, the act deliberately favors one form of treatment over another, one ideology over another, and one set of people with I/DD over another.

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