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Archive December 2022

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Maine House and Senate Announce Committee Assignments

The Maine House and Senate leadership have appointed the committee assignments for the 131st Session. Below are details about the committees that are most relevant to our work. 

Do you have a strong relationship with any of these elected officials? Members are encouraged to share this information with MHCA Director of Public Affairs, Ben Hawkins, at bhawkins@mehca.org.

Health and Human Services
Senator Joe Baldacci, Chair (D-Penobscot)
Senator Henry Ingwersen (D-York)
Senator Marianne Moore (R-Washington)
Michele Meyer, Chair (D-Eliot)
Colleen M. Madigan (D-Waterville)
Margaret Craven (D-Lewiston)
Samuel Lewis Zager (D-Portland)
Daniel Joseph Shagoury (D-Hallowell)
Anne P. Graham (D-North Yarmouth)
Kathy Irene Javner (R-Chester)*
Abigail W. Griffin (R-Levant)
Michael H. Lemelin (R-Chelsea)
Ann Fredericks (R-Sanford)

Appropriations and Financial Affairs
Senator Peggy Rotundo, Chair (D-Androscoggin)
Senator Jill Duson (D-Cumberland)
Senator Rick Bennett (R-Oxford)
Melanie F. Sachs, Chair (D-Freeport)
Jessica L. Fay (D-Raymond)
Benjamin T. Collings (D-Portland)
Ann Higgins Matlack (D-St. George)
Rebecca J. Millett (D-Cape Elizabeth)
Drew M. Gattine (D-Westbrook)
H. Sawin Millett, Jr. (R-Waterford)*
John E. Ducharme III (R-Madison)
Mark John Blier (R-Buxton)
Nathan M. Carlow (R-Buxton)

A Message from the President & CEO Mark Parkinson: CONGRESS PASSES 2023 BUDGET

SNFs Left Alone; Wind Down of Enhanced FMAP to States

Congress today passed the FY 2023 budget, preventing government shutdown. The 4,000-plus page budget includes two areas in which I want to share an update due to the impact on skilled nursing and assisted living providers. 
  • SNFs and ALs have been left alone. There were attempts to include some of the onerous SNF regulatory provisions that Congress considered in mid-2021. We have been successful in thwarting those attempts in this legislation. We still have a battle on our hands with CMS, but the Congressional threat is close to over. There is nothing negative here.
  • The budget phases down the additional federal resources that states have been getting for Medicaid during the pandemic. This is the enhanced Federal Medicaid Assistance Percentage (FMAP) included in the Families First Coronavirus Response Act. Until now, states have been getting an additional 6.2% FMAP. The bill phases out the enhancement during 2023:
    • From April to June, the increased FMAP would be 5%. 
    • From July to September, it would be 2.5%. 
    • From October to December, it would be 1.5%. 
    • On December 31, 2023, the enhanced FMAP ends entirely.
In order to maintain the ability to draw down the enhanced FMAP in 2023, states must take certain steps towards redeterminations for beneficiaries to ensure continued Medicaid eligibility and, therefore, Medicaid payments to providers.

The phase down of the enhanced FMAP is both good and bad news for the states. Currently, the enhancement is tied to the COVID-19 Public Health Emergency (PHE). The prevailing thought has been that the PHE will end on April 11, which would mean the enhanced FMAP would go away all at once at the end of that quarter. With passage of this budget, a portion of it will continue through 2023. On the other hand, it is possible that HHS will keep the PHE going beyond April 11. If that’s the case, this is less money to the states.  

There are states that continue to have enhancements tied to the PHE, and this should not impact those states. But as states receive less federal Medicaid dollars, it will be increasingly difficult to keep the state funds flowing. Of note, the 3-day stay waiver is not affected and remains tied to the PHE.

I’ve said it before, but I am truly thankful for everything you do and the amazing care you provide for the residents. We will continue to fight for you in D.C. in 2023. Have a wonderful holiday season. 

Long Term Care a Focus During First Legislative Hearing of the Session

On Wednesday, December 21, the Maine legislature held a hearing to fund a heating bill. The committee's final vote concluded in unanimous support of distributing money to Mainers to help heat their houses. Although no funding went to long term care facilities, legislators regularly pointed out their concerns about ensuring our facilities are better compensated.

As noted in the Bangor Daily News, "Democrats left Wednesday’s meeting promising to do more to fund key health care services, saying it would be a priority for the Mills administration. Republicans vowed to hold the administration accountable on that point." 

Improving Maine's COVID-19 Booster Rate for Residents

Since the start of the latest Biden Administration campaign to promote booster vaccines, Maine's LTC facility resident booster rate has risen by approximately 5%. Despite this progress, Maine is still below the national average, and more than half of residents do not have the latest booster. 

COVID-19 boosters are proven effective in protecting individuals from serious illness, hospitalization, and death. Improving Maine's LTC booster rate will improve our residents' safety as well as further our partnership with national leaders. 

In addition to vaccinating residents, it is crucial to ensure the data is accurately submitted. Facilities are encouraged to verify the accuracy of your posted vaccination and booster rates, which can be found on the CMS COVID-19 data website. If not accurate, you can check your NHSN reporting process and update your NHSN vaccination data for the next reporting period. If the posted rates are low, facilities should prepare for outreach from the state survey agencies to ensure compliance with QSO-21-19-NH.

Related resources
  • AHCA/NCAL has developed a new #GetVaccinated handout to help long term care staff discuss the value of the bivalent booster with their residents. 
  • White House Releases Winter Playbook for LTC: The Biden Administration recently announced a COVID-19 Winter Preparedness plan, which involves several strategies to expand access to testing, vaccines, and treatments. Read More
  • CDC Expands COVID-19 Provider Vaccine Agreements to LTC Facilities: The CDC is now allowing LTC pharmacies to transfer COVID-19 vaccine/boosters to LTC facilities in single dose vials to directly vaccinate residents and staff by waiving some of the reporting requirements LTC pharmacies had to follow. This move comes after strong advocacy by AHCA/NCAL. Read More 
  • COVID-19 Vaccination and Therapeutics in PALTC Toolkit: Resources for Clinicians
Staff contact: bhawkins@mehca.org

Opportunity for Performing an eMDRO Preparedness Prevention Review

MeCDC Healthcare Epidemiology is collaborating with The Association for Professionals in Infection Control and Epidemiology (APIC) Consulting Services, Inc to provide facilities in Maine the opportunity to perform an eMDRO preparedness prevention review. This opportunity will allow facilities to review their internal preparedness processes and identify any opportunities for improvement and consult with subject matter experts while mitigating high-priority gaps. This free service offers the expertise and knowledge of the Infection Preventionists at APIC Consulting Services, Inc. who will also provide follow-up consultation to help your facility address infection prevention opportunities.
 
APIC Consulting Service, Inc. will contact your Infection Prevention and Control Departments/Leadership in the coming weeks to schedule this virtual review. We hope each facility will take this amazing (and free) opportunity to ensure their facility is prepared to prevent and respond to eMDROs. 

Process:
  1. APIC’s knowledgeable Infection Prevention and Control Consultants will be reaching out directly to hospitals and nursing to offer a virtual assessment to assess the readiness and provide guidance for readiness and prevention of emerging multi-drug resistant organism, such as Carbapenemase-producing organisms (CPOs). 
  2. The following domains are areas to be reviewed/discussed:
    1. General IPC program setup and resources
    2. Healthcare worker education & training
    3. Surveillance & disease reporting
    4. Standard & Transmission-Based Precautions
    5. Multi-Drug Resistant Organism Prevention & Enhanced Barrier Precautions (Nursing Homes)
    6. Personal Protective Equipment
    7. Environmental Cleaning  & Disinfection
    8. Communication
  3. A report of discussion and providing of any guidance, resources, and opportunities for improvement will be provided
  4. APIC Consultants will follow up with facilities after to assist with any action plan development, barriers, or address any further questions.
CPOs have been identified in at least 13 out of 16 counties in the state of Maine. Additionally, the U.S. CDC released new guidance this past fall for nursing homes on how to manage MDROs. The new guidance is different from previous actions and this ICAR opportunity will allow facilities to be best prepared for MDRO prevention and response.
 
We thank you for your support in preventing HAIs and slowing the spread of eMDROs.  If there are any questions, please feel free to reach out to MECDC.HAI@maine.gov.

Staff contact: bhawkins@mehca.org

National Nursing Home Stakeholder Call

CMS and the CDC are hosting a call on Thursday, January 5, 2023 at 3:00 pm ET. Long-term care providers, facility staff, and resident advocates are encouraged to attend. This event is open to the public and registration is required. Register here.
 
Staff contact: awesthoff@mehca.org

CDC Expands COVID-19 Provider Vaccine Agreements to LTC Facilities

The Centers for Disease Prevention and Control (CDC) announced it is taking steps to make it easier for LTC facilities to administer the COVID-19 vaccine to staff and residents. The CDC is now allowing LTC pharmacies to transfer COVID-19 vaccine/boosters to LTC facilities in single dose vials to directly vaccinate residents and staff by waiving some of the reporting requirements LTC pharmacies had to follow. This move comes after strong advocacy by AHCA/NCAL. 

To receive single dose files from the LTC pharmacy, you will need to sign the CDC COVID-19 Sub-Provider Vaccine Agreement for LTCF located on the CDC website. Most of the requirements outlined in this agreement are steps you already follow for other vaccines such as influenza. Read more here.
 
Staff contact: awesthoff@mehca.org

Additional Funding for Workers Needed to Meet a Potential Federal Nursing Home Staffing Minimum Mandate

The American Health Care Association (AHCA), representing more than 14,000 nursing homes and other long term care facilities across the country, released an updated report from accounting and consulting firm CLA (CliftonLarsonAllen LLP) regarding a potential federal staffing mandate for America’s nursing homes. Due to increasing labor costs and pervasive workforce shortages nationwide, CLA now estimates more than 191,000 nurses and nurse’s aides are needed at the annual cost of $11.3 billion in order for nursing homes to meet a staffing minimum of 4.1 hours per resident day (HPRD). This is up from July 2022, when CLA estimated an additional 187,000 caregivers and an annual cost of $10 billion would be required.
 
The report also found:
  • 94 percent of nursing homes would be unable to comply with a potential 4.1 HPRD staffing minimum.
  • Nearly 450,000 residents (more than one-third) may be at risk of displacement if facilities are unable to increase their workforce and must reduce their census in order to comply with a 4.1 HPRD staffing minimum.
“This report once again highlights how our nation’s policymakers should be investing in our long term caregivers, not mandating quotas,” said Mark Parkinson, president & CEO of AHCA. “Nursing homes have been doing everything they can to recruit and retain staff—including increasing wages—but it has not been enough to stem the tide. If Washington wants to increase staffing in nursing homes, then they need to put their money where their mouth is. Otherwise, we’ll fail to address the underlying issue here, and our residents will have fewer long term care options.” Read more.
 
Staff contact: awesthoff@mehca.org

Congress Working on Budget Deal and Details Emerge on Phase out of FMAP

Congress is trying to get a FY 2023 budget passed before the end of the year to prevent a government shutdown. Congress is making progress and is likely to get this done this week.

In the 4,000 plus page bill (also known as the omnibus package), nursing homes and assisted living providers are generally left alone and AHCA/NCAL reports that there is nothing negative included. However, there will be forthcoming battles on the regulatory front, particularly with CMS.
The Omnibus bill does outline the phase out of the enhanced Federal Medicaid Assistance Percentage (FMAP) that was included in the Families First Coronavirus Response Act. Until now, states have been getting an additional 6.2% FMAP. The bill phases out the enhancement during 2023:
  • From April to June, the increased FMAP would be 5%.
  • From July to September, it would be 2.5%.
  • From October to December, it would be 1.5%.
On December 31, 2023, the enhanced FMAP ends entirely.The FMAP is tied to the public health emergency. The prevailing thought has been that the PHE will end on April 11, which would mean the enhanced FMAP would go away all at once at the end of that quarter. With this omni proposal, a portion of it will continue through 2023. On the other hand, it is possible that HHS will keep the PHE going beyond April 11, and if that’s the case, this is less money to the states. As additional information is available, we will be sure to share it with members.

Staff contact: awesthoff@mehca.org

Holiday Message from CEO:

As the holidays are quickly upon us, I wanted to take a moment to say thank you for your ongoing support of Maine Health Care Association and best wishes for a happy and healthy new year! The holiday season means different things to different people, as it can represent wonderful and joyful times loved ones, but it can also be overwhelming. I hope you all have an opportunity to reflect and recharge.  
 
With the ongoing staffing and funding challenges, we are keenly aware of the continued strain on long term care providers. As we approach the upcoming legislative session, MHCA has a robust legislative agenda and will be educating newly elected officials and fiercely advocating for increased resources and regulatory changes. I highly encourage you to engage with your local senators and representatives, share your stories and even invite them for a facility tour. We have tip sheets on our website to guide you, and as always, please reach out with any questions so we can assist you.
 
2023 will be another year of change, with opportunities for transformation and hopefully our year for some recovery!
 
From all of us at MHCA, we wish you a very happy holiday season!
 
With gratitude,
 
Angela
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