Medicare Reimbursement for Adult Day Services—Not Just a Pipe Dream
But it will take effort!
I traveled to Washington D.C. last week for the NADSA Public Policy Conference to advocate for Adult Day Services. Although officially, this visit was a business trip, the amount of joy and renewed energy I experienced while immersed with others just as passionate about adult day services as I, this trip was pure pleasure.
A group of about forty, super committed, Adult Day professionals visited over sixty-five legislative offices on May 5, 2015 to make specific requests regarding improving access to ADS by veterans, and to support two specific bills which would allow Medicare to begin covering Adult Day Services.
I am happy to report that those with whom I met, including the staff of Barbara Boxer, Dianne Feinstein and Nancy Pelosi were incredibly receptive. When we showed them the graphic “Adult Day Services: the most cost-effective option in long-term care today”, indicating the savings and added value of ADS over other long term care options, they got pretty excited, and seemed almost baffled as to why they’d never really heard of Adult Day Services, or knew of the savings. (My thoughts always!)
There are currently three bills related to ADS that have been introduced to the legislature and two companion bills which need a sponsor. I’ll detail the bills below, but first I am going to make a major shout out to those who made all of this possible.
The reason, I believe, there is so much action regarding ADS “on the Hill” is due wholly to the efforts of NADSA, our National Association and our fearless and powerful policy consultant team headed by Senator Roy Afflerbach, ret. There is no doubt in my mind that without the work of NADSA and the Afflerbach team there would be little chance these bill passing, let along having been written in the first place. Would you like Medicare reimbursement for Adult Day Services? Would you like increased recognition for Adult Day Services? Then I make a simple plea to you; Join NADSA. Simple as that. Support Adult Day Services on a National Level, even if you are a member of your state association, join NADSA. There are multiple other benefits of joining NADSA, but I want to keep my blogs short, and the list of benefits is exhaustive (and also on their website)! Joining NADSA is very inexpensive, but the payoff is major. In order for our industry to grow and flourish as we know it must, we need to be at the table; NADSA is the table.
The three bills;
Community Based Independence for Seniors Act: Senate Bill 704, introduced by Sen. Grassley, Chuck (R-IA). This bill establishes a demonstration program to target HCBS care to eligible Medicare beneficiaries. Most importantly, ADS are specifically included as one of the Medicare options. This bill is sponsored by a member of the new Senate Republican majority. The great importance of this bill is that it is an opportunity for ADS to fit legislatively into Medicare as and institutional option! This bill needs a companion bill to be introduced in the house—know anyone? Give them a call and ask–Let ‘em know it’ll be great for their political career!
Medicare Adult Day Services Act: House Bill 1383, introduced by Rep. Sanchez, Linda T (D-CA-38)
This bill amends title XVII of the Social Security Act to: cover certified Adult Day Services furnished in a certified adult Day Services center and meeting specified requirements. This bill allows for consumer choice; those who are qualified may choose to attend an ADS program instead of home health or skilled nursing and Medicare would be the payer source. Again, the great aspect of this bill is that it is an opportunity for ADS to fit legislatively into Medicare as an institutional option. NADSA has drafted a similar bill, with better hopes of passage, and needs a senate sponsor. Know anyone? Give them a call and ask–Let ‘em know it’ll be great for their political career!
Veterans Access to Extend Care Act of 2015: House Bill 1369 & Senate Bill 730.
Although the Veteran’s Administration is currently permitted to contract with Adult Day Health and Adult Day Social Models, the reporting requirements in excess of CMS requirements discourage these contracts. This bill simplifies the contracting process between the VA and the Adult Day Health and Adult Day Social models to vastly improve veteran’s access to ADS services.