Advocacy

Background Information

ANCOR supports the nearly $150 billion investment in Medicaid Home and Community Based Services (HCBS) included in the Build Back Better Act.

Below are the key ANCOR priorities currently included in the bill:

• Medicaid HCBS: The bill maintains the historic investment of nearly $150 billion for Medicaid HCBS, which would provide a 6 percentage-point increase in the federal matching (FMAP) rate over a 10-year period and a potential additional 2 percentage-point increase in the FMAP rate for states that implement a program for self-directed care.
• Payment rates: The HCBS provision also includes a requirement that states will review payment rates, starting two years after the approval of each state's HCBS improvement plan and then every three years thereafter.
• Money Follows the Person and Protections Against Spousal Impoverishment: The draft text includes permanent reauthorization of the Money Follows the Person and Protections Against Spousal Impoverishment programs.
• Direct care workforce investments: The Senate language maintains the $1 billion grant program to invest in strategies to recruit, retain, and advance the direct care workforce.
• Competitive integrated employment: The Senate language also maintains the $270 million grant program for states to assist employers that choose to transition from 14(c) certificates to competitive integrated employment programs.
• Assistance to Intermediate Care Facilities (ICFs): The Senate bill provides $800 million for the Improve Staffing and Infection Control in Long-Term Care Institutional Settings grant program (funds may be used to provide wage or benefits enhancements, improve and develop training and career development opportunities, and to expand staffing of one or more types of eligible workers so as to increase staffing ratios). The language also increases the funding for the Nursing Home Worker Training Grants, which include ICFs as eligible entities, to $1.6 billion (funds may be used for wage subsidies, student loan repayment or tuition assistance, affordable and accessible child-care, obtaining appropriate transportation).

SF 2968/ HF 3268

Relieve Pressure on Staffing Shortages

In the 14 years since Alternative Overnight Supervision (AOS) was put in place, the technology has evolved greatly, driving a need to update AOS policy and regulations. ARRM's language will remove the need for a separate AOST license and instead utilize the protections and procedures that are currently place within 245D, the Monitoring Technology usage policy and Remote Supports procedures.

HCBS Scholarship Funds

Allowing our staff to access scholarship grant dollars while working as a Direct Support Professional is a way to incentivize workers into the profession and provide the tools for career growth. Our proposal would open up the current HCBS Scholarship process to Direct Support Professionals supporting individuals with disabilities and provide additional funding for the program.

5% ICF Rate Increase

ICF services face the same workforce pressures as other care based services. A 5% rate increase will allow providers the resources to continue raising the wages of their Direct Support Professionals.

Retain Care Providers

With over two-thirds of DSPs leaving the job within the first year, staff retention is a top concern for providers. ARRM supports the Best Life Alliance proposal to utilize one-time federal dollars from the American Rescue Plan for retention bonuses for staff.

DSP Child Care Grants

One of the top reasons a DSP leaves the profession is the growing cost of child care. Many state that they are working just to pay for their kids’ child care expenses. ARRM proposed using one time funding to provide up to 12 months of child care grants to qualifying DSPs to help with the cost of child care.

SF 2771/ HF 3100

Fixing Rate Adjustment Inequity

Currently, DWRS reimbursement rates, a key driver of DSP wages, are adjusted based on data that is 30 months and 1 day old. By the time rate adjustments are made, the data used is outdated, leaving service providers and staff in a constant state of playing catch-up. ARRM and our allies in the Best Life Alliance propose using current data available from the Bureau of Labor Statistics to make rate adjustments, allowing our rates to reflect current economic conditions and costs.

Additionally, the Legislature created the Competitive Workforce Factor (CWF) to help address low wages, but it hasn’t been adjusted since its creation in 2019. We propose adjusting the CWF to reflect recommendations from DHS in 2024 and every two years after.

SF 3128/ HF 3163

Expand Choice to Meet Individual Needs

Currently, Respite provided under 10 hours a day is billed in 15-minute increments and is subject to the DWRS framework rate versus the daily option which is a market rate service. ARRM is proposing making Unit Based Respite a market rate service, in alignment with how Daily Respite is currently operating. This will eliminate an unnecessary inconsistency, while allowing providers to design programs that meet the unique needs of their community and work with counties on a payment rate that reflects the service, while providing greater access to the service.

Support to Stay in Own Home

Currently, in order to meet the definition of “Own Home,” a provider cannot co-sign a traditional lease with an individual. One exception is a Transitional Lease, which allows the provider to sign with an individual who is living in their own apartment for two years. Transitional Leases have the option for one, two-year extension. ARRM is trying to address what happens after that two-year extension, if the landlord will still not allow the individual to be on the lease by themselves for whatever reason, including not meeting minimum income requirements, background checks and landlord hesitancy. ARRM is proposing allowing up to four, two-year extensions on a Transitional Lease.

Reduce Administrative Error Opportunities

Under Waiver ReImagine, there is a new tiered level of services called Individualized Home Supports. These services are provided to individuals that are living in their own home, outside of a provider-controlled setting. The most utilized of these services is Individualized Home Supports with Training, which can only be billed in 15-minute increments, or what providers call Unit Based Services, or as Daily Rate, if the service is provided for exactly 6 hours each day.

Tracking what can be upwards of 70 Units of service each day vs. what used to be one Daily Rate has posed administrative hurdles for providers. ARRM proposes eliminating the Daily Rate option for this service and instead creating two different units of service, the 15-minute unit and an hourly unit. This will have no impact on the individual receiving service but will make the billing process simpler for the service provider.