AHCA » Advocacy

ABOUT AHCA/NCAL

The American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) represent nearly 11,000 non-profit and proprietary facilities, including nursing facilities, assisted living residences, sub-acute centers and homes for people with developmental disabilities. AHCA/NCAL member facilities range from small, independent-owner facilities to regional, multi-facility chain corporations.

We recognize that a majority of Americans—because of social needs, disability, trauma or illness—will require long term care services at some point in their lives. AHCA/NCAL is proud to represent those who provide that kind of professional, compassionate care for millions of frail, elderly, and disabled Americans.

OUR FOCUS

Quality is first at AHCA/NCAL. Since 1949, AHCA has been working to improve the standards of the long term care profession and promote a better understanding of what comprises a supportive, quality-focused care environment. That environment happens to be one of the most highly-regulated in the country because Medicare and Medicaid fund the care of nearly 80% of long term care patients in the United States. Whether we are working with Congress to preserve much-needed funding for long-term care services or with the Administration on initiatives to enhance quality, AHCA/NCAL is mindful that our membership cares for some of our country’s most vulnerable citizens—the average nursing home resident is an 85-year old woman with cognitive or functional impairments and multiple co-morbidities that typically require 9 medications daily. That knowledge—added to the realization that 77 million baby boomers are edging toward retirement—keeps us focused on encouraging:

• A financing system that enhances quality long term care,
• An oversight system that is fair, consistent and rewards quality,
• A workforce that meets the growing needs of our profession and our nation, and
• A national long term care system that meets the needs, choices, and expectations of a growing frail, elderly, and disabled population.

PRIORITY ISSUES

Policymakers need to realize that changes to our health care system must be developed and implemented now if we are to address the looming demographic realities ahead. Here are AHCA/NCAL top priorities:

Quality: AHCA/ NCAL illustrates its ongoing commitment to enhanced quality through its leadership and involvement in initiatives, including the profession’s Quality First program, the Advancing Excellence in America’s Nursing Homes campaign, and the Center for Excellence in Assisted Living.

Medicare & Medicaid: Financial stability is critical to sustaining quality long term care services for the millions of frail, elderly and disabled Americans cared for in long term care settings each day. Congress can help to ensure stable funding by:

• Opposing Medicare cuts to the skilled nursing facility market basket update and allowable bad debt;
• Developing and implementing a new, permanent payment system for Medicare Part B outpatient therapy services, and extending the current exceptions process in the interim;
• Supporting full, uninterrupted implementation and enforcement of the 75% Rule;
• Opposing imposition of revisit user fees charged to facilities to cover the costs incurred by the Centers for Medicare & Medicaid Services (CMS) for revisit surveys on deficiencies;
• Supporting a moratorium on CMS’ Cost to Public Provider regulation that would restrict the way states are permitted to generate funding for their share of Medicaid costs;
• Opposing any reductions in Medicaid as they would exacerbate the fact that, nationally, nursing homes are already under funded by $4.5 billion annually; and
• Passing The Home and Community Services Co payment Equity Act of 2007 (S. 1107), which would eliminate Medicare Part D copayments for dual eligibles in assisted living residences and encouraging companion legislation in the House.

Workforce: We must address a critical shortage of nurses and critical caregivers—evidenced by more than 100,000 job vacancies in long term care—by amending the Nurse Reinvestment Act; and by supporting comprehensive immigration reform legislation that creates a viable and workable guest worker program; waives the cap on employment-based visas for nurses and physical therapists; and provides for a reliable, real-time system for employers to verify employee status.

AHCA/NCAL seek Congress’ help in creating an environment that encourages continuing quality improvement and removes existing regulatory and legislative barriers by improving the current survey and certification process, encouraging investment in health information technologies, addressing long term care workforce shortages, and modernizing Medicare payment policy. 

2007 ADVOCACY ISSUES

• Address the Shortage of Nurses & Critical Caregivers for Long Term Care by amending the Nurse Reinvestment Act to include educational financial assistance to caregivers in all healthcare settings, to establish a national nursing database, and to enhance the number of nurse educators.
• Revisit User Fees Will Divert Critical Funds for Nursing Facilities Away from the Bedside; Congress should stop implementation of CMS’ revisit user fees by including statutory language in the FY2008 Labor, Health and Human Services, and Education (LHHS) Appropriations bill and oppose any new language that would continue user fees in FY2008.
• Medical Liability Reform Needed to Preserve Access to Long Term Care; Congress should introduce comprehensive medical liability reform legislation that: places limits on the amount of non-economic and punitive damages awarded from any one health care provider in a claim; provides alternative venues for tort claims (such as health courts); and places limits on the admissibility of survey and other quality assurance documents.
• Ensure Medicare Part B Outpatient Therapy Services for Skilled Nursing Patients; Congress should direct CMS to modernize the payment policy for Medicare Part B outpatient therapy services by developing a permanent, condition-based payment system. In the interim, the current exceptions process must remain in place for outpatient Part B therapy services so that access to such critical therapies is not jeopardized.
• Reform the Federal Stafford Act to Include All Health Care Providers by amending the Stafford Act to permit all long term care providers – including private for-profit facilities – access to disaster relief funding to ensure that all critically ill Medicare and Medicaid beneficiaries have access to essential long term care services during natural disasters or catastrophes.
• Medicare Part D Copayments Unfair for Dual Eligible Assisted Living Residents; Congress should pass the Home and Community Services Copayment Equity Act of 2007 (S. 1107) to eliminate Medicare Part D copayments for dual eligible beneficiaries living in assisted living residences.
• Reductions in Medicaid IGTs Harmful to Frail, Elderly & Disabled who Require Long Term Care Services; CMS should place a moratorium on the implementation of the Medicaid IGT Rule: Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions to Ensure the Integrity of Federal-State Financial Partnership.
• Ensure Adoption of Health Information Technology by Long Term Care Facilities; Congress should pass legislation that encourages establishing interoperable standards for HIT and provides appropriate financial mechanisms to ease the financial burden on long term care facilities and assist in the adoption of appropriate technologies.
• Immigration Reform will Ease Long Term Care Workforce Shortage; Congress should support comprehensive immigration reform legislation that creates a viable and workable guest worker program; waives the cap on employment-based visas for nurses and physical therapists; and provides for a reliable, real-time system for employers to verify employee status.
• Full Sprinklering in Nursing Facilities Saves Lives; Congress should introduce fire safety legislation that assists all of our nation’s nursing facilities in becoming fully sprinklered.
• A Change in Long Term Care Facility Capital Improvements Tax Depreciation Will Enhance Quality Care & Services; Congress should improve the tax depreciation for qualified long term care facility capital improvements by establishing a statutory 15-year recovery period for the improved property placed in service after date of enactment.
• Medicare Allowable Bad Debt Critical for Nation’s Nursing Homes; Congress should oppose the Administration’s FY 2008 Budget proposal to eliminate bad debt reimbursement
• Proper Diabetes Management is Critical for Patients in Long Term Care Settings; Congress should instruct CMS to amend the final rule on glucose testing in nursing facilities to provide appropriate Medicare coverage that supports finger stick tests and clinically appropriate diabetes management.