Supporting Senior Living Funding in Washington, D.C.

Bob Hillis at Podium

Direct Supply leads and supports the most important efforts shaping national policy for Long Term Care. Our investment is substantial – millions of dollars annually.

For over a decade, Direct Supply founder and CEO, Bob Hillis, has made his voice heard in our nation's capital. Today, you'll find Mr. Hillis and our executive team raising awareness in Washington, D.C., securing funding for Senior Living and participating in the political process on your behalf. Ultimately, the success of eldercare organizations is our only business, and we’re thrilled to be at your service.

Direct Supply’s efforts ensure your organization has the resources it needs to continue caring for America’s seniors.

Washington Update

Some Highlights of the 2015 Calendar

2015 has been a year full of legislative and regulatory change. With new leadership in the House of Representatives and a presidential election looming, the industry is committed to advocating for meaningful reform. The history-making bills of 2015 are just the beginning. As the House leadership pushes for a return to regular order, we have an opportunity to advocate for essential patient-focused solutions. Some highlights of the 2015 legislative and regulatory calendar are listed below.

April 16: President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015, also known as the ‘doc fix’. This legislation revised the flawed and outdated payment system for doctors serving Medicare patients that was established in 1997 and avoided a massive 21% cut. This landmark bill was the product of incredible bipartisan leadership and brought an end to the string of 17 short-term patches that Congress was forced to make. It includes a capped payment increase of 1% in FY2018 to Skilled Nursing Facilities (SNFs) as well as therapy reforms including a two-year extension of the therapy caps exceptions process and manual medical review (MMR) relief.

June 24: The Supreme Court of the United States upheld the federal tax credits in the Affordable Care Act (ACA) for eligible Americans living in states with exchanges and states with federal marketplaces. Without Congressional action or action in the states, there was the potential to cut off subsidies for over 6.4 million Americans. Upholding these income-based subsidies was critical to the success of the law and to making health insurance more affordable. As a result, an act of Congress and a presidential signature will be required to change the ACA going forward.

July 16: CMS issued a proposed rule on Requirements of Participation for Skilled Nursing Facilities. Comments were due on October 14, 2015 for the over 400-page rule that seeks to micromanage compliance and ethics programs, quality assurance and performance improvement (QAPI), and reporting of suspicious crime requirements. Not only are the demands completely out of scope according to providers, but so is the timeline and cost of implementation. The industry has submitted thousands of substantive comments in opposition of the rule and the dialog with CMS is ongoing.

August 3: Senator Thune (SD) introduced the Rural Health Care Connectivity Act of 2015 (S.1916). The Universal Service Fund’s Rural Health Care Program (RHCP) provides funding for telecommunication and broadband services used to provide healthcare to rural areas. S.1916 specifies that Skilled Nursing Facilities be included in the definition of healthcare providers that are eligible for this funding. This would allow beneficiaries to better connect remotely to all healthcare providers.

August 6: President Obama signed into law the Notice of Observation for Treatment and Implication for Care Eligibility (NOTICE) Act (H.R. 876). It was introduced in the House by Representative Doggett (TX-35) and Representative Young (IN-9) and followed with Senate leads, Senator Cardin (MD) and Senator Enzi (WY). The NOTICE Act requires hospitals to notify Medicare beneficiaries of their outpatient status within 36 hours, as a patient’s status affects their ability to receive Medicare coverage for post-acute services.

October 29: Speaker Paul Ryan (WI-1) is sworn into office and subsequently Representative Kevin Brady (TX-8) is elected as the new Chairman of the House Ways and Means Committee.

November 2: President Obama signs into law the Bipartisan Budget Act of 2015. This law suspends the debt ceiling until March 2017 and will fund the government for nearly two years. The only pay-for that will affect SNFs is the extension of the Medicare sequester an additional year, until 2025. There is also a cap on Medicare Part B premium increases included. The law repeals section 18A of the Fair Labor Standards Act (FLSA) which would have required employers with more than 200 employees to enroll new full-time hires in an employee health plan. This was a provision included in the Affordable Care Act.

November 11: CMS finalized a new rule to establish the Comprehensive Care for Joint Replacement (CJR) program. This calls for a bundled payment program for all hip and knee replacement procedures in 67 Metropolitan Statistical Areas (MSA) throughout the country. The hospital will hold the bundle for the entire episode of care, which is defined as the time of surgery through 90 days after discharge. This rule allows for all SNF providers with a three-star rating or higher to apply for a waiver of the three-day stay requirement beginning in year two of the program. This five-year program is scheduled to begin April 1, 2016.

December 18: President Obama signed into law the Consolidated Appropriations Package, which is a combination of the $1.1T Omnibus spending bill and the tax extenders bill, totaling almost $2T. The Package has approximately $3.5B of healthcare offsets and includes Medicare imaging cuts as well as a two-year suspension of the medical device tax.

Industry Partners

Direct Supply works with some of the top organizations in the industry to positively impact the future of Senior Living.

Leading AgeACHCA
NCALStrategic Policy GroupCEAL