Some provisions in the most comprehensive update to the Older Americans Act in 36 years raise concerns about potentially stifling innovation and creating undue burdens on service providers, according to a provider association.
Tuesday, the US Department of Health and Human Services’ Administration for Community Living released a final rule to update regulations for implementing its OAA programs. It’s the first substantial update to most OAA program regulations since 1988, aligns regulations with current statutes and clarifies some requirements, according to Deputy Assistant Secretary for Aging Edwin L. Walker.
Key parts of the final rule are meant to clarify provisions for meeting OAA requirements for prioritizing people with the greatest social and economic needs; specify the broad range of people who can receive services, and detail how funds can be used and fiscal requirements.
According to the ACL, the world has changed dramatically since the last update, with the population of older adults almost doubling and people living longer than before.
Creating an HCBS infrastructure
Walker said that the OAA, passed in 1965, has “enjoyed incredible success” in creating the infrastructure of home- and community-based services for older adults. The network serves more than 12 million people a year, or one in five older adults in the country.
“Research shows those who receive services are truly those at risk of institutionalization or at risk of entering into the hospital through emergency rooms, and they have multiple chronic conditions and an array of limitations with activities of daily living,” Walker told McKnight’s Senior Living.
Walker said that services are not based on where someone lives as much as their needs and fitting into those categories of being in the greatest social and economic needs. The goal of the OAA, he added, is to help people maintain the ability to live in their own homes or community and remain engaged in the community, with a focus on combating social isolation.
Walker recommended that senior living providers become active with the local Area Agency on Aging, which is the planning entity that contracts with local service providers to address the greatest social and economic needs of the local population.
There are 615 Area Agencies on Aging across the country, he said, and providers can determine whether their residents would benefit from services. Walker also invited senior living leaders to lend their skills by serving on boards or advisory committees to ensure that programs and dollars serving older adults are responding to the needs of the larger community.
“We are encouraging people to coordinate with local Area Agencies on Aging and be a part of what’s going on — be connected,” ACL Director of the Center for Regional Operations Amy Wiatr-Rodriguez told McKnight’s Senior Living. “There are so many opportunities for residents in the different settings to participate in all the different programs.”
Provision could lead to ‘onerous policies’
One provision in the final rule that raised concerns for LeadingAge is a requirement for state agencies to approve commercial agreements and contracts undertaken by area agencies on aging, regardless of whether the contract was for an OAA-funded service or program. LeadingAge Director of Medicaid Georgia Goodman said Wednesday during the organization’s policy update call that she was “disappointed” to see this language in the final rule.
In its August 2023 comments to ACL, LeadingAge said that it was concerned about rules affecting the authority for state units on aging to have expanded oversight into Area Agency on Aging, or AAA, contracts.
“We believe backlogs or slow processing by state units on aging could cause unnecessary administrative burden and bureaucracy for AAAs, causing downstream contractual roadblocks and delays,” Goodman wrote at the time. “These delays, in turn, will lead to limited service availability and further dampen older adults’ access to critical services.”
LeadingAge said the “overly broad language” in the then-proposed regulation could compel state units on aging to create “onerous policies” under which contractual engagements using OAA funding are reviewed.
“While administrative oversight can be useful in some cases, in this case we are concerned that service delivery and availability would be slowed unnecessarily — we don’t see a need for [state units on aging] to have oversight over contracts not involving OAA funds,” Goodman wrote. “Onerous processes for contract and commercial relationship execution will likely drive AAAs out of some business lines, further hampering access to services in the local communities served by the AAA.”
The final rule is scheduled for publication in the Federal Register on Feb. 14 and is available as a PDF now. It takes effect March 15, but regulated entities have until Oct. 1, 2025, to comply.
