Lawmakers hope to succeed the second time around. On Thursday, Sen. Bob Casey (D-Pa.) and a host of other cosponsors reintroduced the Better Care Better Jobs Act in the Senate.
The other legislators included Rep. Debbie Dingell (D-Mich.), Energy and Commerce Ranking Member Frank Pallone (DN.J.), Rep. Jan Schakowsky (D-Ill.), Rep. Doris Matsui (D -CA.) and 39 co-sponsors in the Senate.
The Better Care Better Jobs Act was originally introduced last year and was intended to pump billions of dollars into the home care industry. The legislation would improve Medicaid funding for home care and the caregiving workforce, as well as help serve the 650,000 people on waiting lists for home and community-based services.
In addition, it would increase pay rates with the goal of improving recruitment and retention, increasing wages, and developing and upgrading training opportunities.
Currently, the home care workforce earns an average wage of $13 per hour, according to data from the Economic Policy Institute. Additionally, about 18% of home care workers live below the federal poverty line, according to PHI data.
The reintroduction of the Better Care Better Jobs Act should come as no surprise to those who have been paying attention.
On Monday, William A. Dombi, president of the National Association of Home Care and Hospice (NAHC), told attendees of the Home Care 100 conference that they could expect to see the return of legislation this year. However, he cautioned that the legislation may not have the easiest road ahead.
“He’ll be back in 2023, it’s not going to be an easy climb to success for that,” he said.
The reintroduction of the bill has already drawn praise from industry advocates such as Washington, DC-based LeadAge, an association representing more than 5,000 nonprofit senior service providers and organizations.
“This bill would mean better wages and benefits for care professionals, when nearly half of home care worker households must currently rely on some form of public assistance,” said LeadingAge President and CEO Katie Smith Sloan, in a press release. “Increasing compensation is a critical component to recruiting and retaining these valuable workers. Equally important is investing in programs to help train and develop direct care workers and encourage professional development. We look forward to working with Congress on this necessary legislation to ensure older adults and their families can access the help they need.”
Legislative wish list
The Better Care Better Jobs Act isn’t the only thing on the minds of home care industry stakeholders. At NAHC, the final rule is a key area of focus, Dombi told Home Health Care News.
“In terms of the major issues on the home health side, we will do everything we can to prevent the rest of the permanent adjustments, and then the temporary adjustments that are on the books, from not happening by 2024,” he said. .
Along with this, the NAHC would like to see a broader set of reforms that address subsidy from payers like Medicare Advantage (MA) and Medicaid.
“There are a variety of ways you can get there that can then allow cuts to the traditional Medicare payment rate to happen, but without destabilizing home care,” Dombi said. “If you were to reduce Medicare payment rates by 10%, but all other payers paid the equivalent of Medicare payment rates, that’s really good in the much longer term.”
More generally, NAHC will advocate for improvements to the home health program under Medicare.
This includes a possible move for hospice care to be recognized within the home health benefit as a specialty care area, according to Dombi.
“The concept is that palliatives are not just for the end of life,” he said. “I expect all medical care to have some palliative element, so we’ve rewritten Medicare’s coverage standards to include that, since the word palliative doesn’t appear anywhere right now. We’re looking to do that as a way to modernize the perk a bit, or make it what it should have been in the first place.”
Through legislative and regulatory action, there is also hope that the needle can be moved on the telehealth front in home care.
On the legislative side, Congress needs to revise Medicare payment requirements, which does not allow telehealth to be considered in the reimbursement model.
Ultimately, moving forward with many of these priorities can lead the way to a more modern version of home health care services.
“We’d love to see a complete home health modernization so we can incorporate the Choose Home concept, but the degree to which that’s a priority will depend on how much it needs to be stabilized today,” Dombi said.