NCAL Executive Director Scott Tittle

National Center for Assisted Living Executive Director Scott Tittle recently took the time to answer some of our pressing questions.

Q: Now that the midterm elections are over, do you think senior living is safe from additional Medicaid reform efforts by Congress?

A: For the time being, thankfully, yes. With a Democratic majority in the House, it is unlikely Congress will take another stab at repealing and replacing the Affordable Care Act.

We’ll still need to continue to keep an eye on larger budget deals. Sometimes, Medicaid issues, like providers’ assessments or other supplemental payments, could be slipped in as a pay-for.

Q: Will NCAL and its members continue to advocate for adequate Medicaid financing?

A: Absolutely, but Medicaid battles will primarily be fought at the state level. We’ll continue to support our affiliates should they face any challenges on that front.

While adequate rates are key in covering the cost of care, that’s only one piece of the puzzle. We also need to make sure accessibility to Medicaid home- and community-based services (including assisted living) is preserved, if not expanded.

The HCBS Settings Rule is an example of this, where the intention of the rule is a noble one — to promote integration and empower the individual. But in doing so, the Centers for Medicare & Medicaid Services could exclude certain assisted living communities that do not meet rigid criteria under that rule. The concerning result will be a lack of consumer choice, especially in rural areas. NCAL is going to continue to advocate that assisted living communities be recognized as a critical HCBS setting.

Q: What other issues concern NCAL at the federal level?

A: With a divided Congress, it’s unclear how much bipartisan legislation will be able to reach the president’s desk. If they can take up a meaningful discussion about immigration reform, we hope to see policies that will help us address the workforce crisis many senior living providers are facing. But we’ll probably turn much of our attention toward the administration where policies can be issued and implemented impacting the profession.

For instance, we are still waiting on additional guidance from CMS about the HCBS Settings Rule regarding the heightened scrutiny process. We’re also waiting for a final rule from the IRS clarifying whether certain assisted living providers and all nursing homes can take advantage of a 20 percent business income tax deduction under the tax reform bill that passed last year. Next year, we’re anticipating a revised overtime rule from the Department of Labor.

Q: Are there any particular issues at the state level that NCAL is closely monitoring?

A: Our state affiliates do a great job advocating for commonsense state regulations and reimbursement for assisted living providers. NCAL monitors high-level changes through our annual State Regulatory Review. What’s interesting about our latest findings is the sheer number of states updating their regulations in some form or fashion. More than half – 29 – states did so this past year, and on a wide number of areas.

It just goes to show that the state-based regulatory model is a really robust one.

We’re also encouraged to see more innovative and collaborative regulatory models like you see in Oregon, New Jersey and Wisconsin.

Here’s where state regulators, providers, consumers and other stakeholders came together to establish quality metrics and reporting requirements, combined with a focus on improvement rather than punishment. We believe this could be the future of oversight, because it truly encourages high-quality care and creates a better relationship between providers and regulators. 

Q: Heading into 2019, what do you believe are the biggest issues facing senior living operators?

A: Assisted living providers must step forward to tell their story. As the assisted living profession grows, we should continue to anticipate scrutiny from the public, press and policymakers. We need to clearly demonstrate how we are a low-cost, high-quality long-term care option.

We’re going to have approximately 80 new members of Congress in the 116th, many of whom have never held political office before. Whether they know much about assisted living will remain to be seen, but it’s on us to help educate them about the care we provide and the policies that could impact us.

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