16 SLN Session 103 PPT - Home | LeadingAge … in publicly-assisted hsg • Reimburse for more...
Transcript of 16 SLN Session 103 PPT - Home | LeadingAge … in publicly-assisted hsg • Reimburse for more...
1
Senior Living Now
LeadingAge Minnesota – July 21, 2016
Colleen Bloom, Director for Housing Operations
LeadingAge, Washington D.C.
National HUD Update
my.leadingage.org
Tailored subscriptions for
personalized areas of interest, critical
news and member-to-member
listservs
LeadingAge Housing Agenda
2
A Quick Federal Funding
and Legislative UpdateLeadingAge Affordable Senior Housing Policy Agenda:
• Hold the line on appropriations, especially Project-Based
Section 8, PRAC, SPRAC renewals
• Support the President’s budget request to expand RAD
program eligibility to include PRACs
• Advocate for continued growth of Service Coordination
• Promote full preservation strategy for the Section 202 PRACs
• Protect the 4% Low Income Housing Tax Credit (LIHTC)
• Explore new financing alternatives for affordable housing
development
• Continue support for the National Housing Trust Fund
• Push for an alternative to sequestration
Housing as a Platform for Senior HealthBiPartisan Policy Center:
Healthy Aging Begins At Home
Priority recommendations include:
• Adequately fund Section 202 (subsidy/SC)
• Support aging-in-place/community retrofit
• CMS to coordinate health care /
LTSS for Medicare beneficiaries
living in publicly-assisted hsg
• Reimburse for more telehealth
3
LeadingAge Senior Housing Priorities
Affordable Housing Financing Cabinet
• New Flexible Capital Options
• New Platforms & Subsidies
• Wrapping Housing with Services
Public Policy Congress
• Finding Champions on Capitol Hill
PRAC Preservation Strategy
• RAD for PRAC
PRAC Preservation
• Workgroup formed - October 2014
• Survey conducted - Spring 2015
• LeadingAge discussed regulatory options with
HUD (Summer/Fall 2015)
• Task Force preliminary recommendations
drafted – October 2015
• Dialogue on asset management reforms
• Senate already supports RAD for PRAC
Recent Victories on the Hill !!
• RAD for PRAC clears Senate appropriations
• Older Americans Act
• Tax Credit – 9% made permanent
• National Housing Trust fund not repealed –
first funding due to go to states this summer
More Notable Developments
• HOME funding increased
• Rural Rental Assistance (RA) shortfalls restored
• Energy & water conservation demo
• 3-year certifications approved
4
Government Funding for Low-Income Rental
Assistance and Housing Development ProgramsAffordable Senior Housing Legislation
(FY17 and Beyond):
• HR 3700 – HOTMA (AHSSIA; SESA; SEVRA) –
continued efforts at Section 8 reforms
• Addressing PRAC Preservation
• Energy Efficiency
• Sequestration
• Congressional Strife
• Election Year
HR 3700/HOTMA
• Raises elderly/disabled standard deduction to $525 (from $400) and indexes it to inflation in future years**
• Allows/Raises deduction for medical and disability expenses above 10% of income (instead of 3%)
• Leaves dependent deduction unchanged, but indexes it to inflation in future years
• Includes hardship provision **
**HUD proposal does not include
More on HOTMA
• Eliminates temporary disregard of earnings increases
for voucher holders with disabilities and public
housing residents
• Only requires inclusion of imputed income from
assets above $50K (compared to $5K today)
• Excludes veterans’ aid and attendance expenses from
income
5
HOTMA – Rents Process Changes
Changes would reduce administrative burden for agencies and owners and encourage work
• Interim recertification only for income reductions and unearned income increase above 10%
• Prohibit interim reertification for earnings increases(unless the increase comes after a downward recertification for an earnings decrease)
• Requires use of prior-year income, except when a family first receives assistance and for interim recertifications
• Allows housing agencies to rely on income determinations from SNAP and other means-tested programs
Appropriations 2017
• Challenges:
– Time crunch, Zika fight, amendment
clampdown, left-over bills, defense disputes
If another omnibus/micro-bus, some
administrative (HOTMA) Section 8 reforms might
be included
What YOU Can Do
Tell your story; tell resident and client stories –
educate on “real” value of housing in community
• Get Lawmakers to Visit Residents/Sites
• Look to the tools on LeadingAge website
– Contact Congress; Congress to Home
– Sign-up for LeadingAge Housing Advocacy list
– Sign-up for Senior Action Network
• Communicate specific messages to key legislators(recommendations will be sent to your state staff!)
Seniors Action Network
6
Operations Update
• Transformation Enters Final Wave
• PBCA Rebid and MORs ssssssssssssssssssssss
• Service Coordinator Funding ……….……………...
• ………………….Latest Operational Directives
• ..
• REAC Inspections
• Smoke Free ……………………………
• Homeless Preference
• Energy Efficiency and Benchmarking
HUD Changes
Waves 4 and 5 in progress now
7
PBCA Rebid
• Current contracts in 42 states extended
through Dec 2017
• Procurement protocol and new attention to
“grants management” processes
• Risk-management implementation (3-2-1)
Criminal Screening
• NO blanket policies blocking applicants for
simply having arrest record or criminal history
• Must individualize for timing and severity
• FHEO largely focused on drug related crime
(possession, not distribution)
• Violent crimes NOT targeted, but….
• Still need to explore extenuating
circumstances
Rent Comparability Studies
Proposed Changes Comment submitted in April
• Increasing influence of RCS in rent setting
• Market is market, yet HUD proposed caps on
non-shelter service adjustments
• Proposed changes not yet in effect
• LeadingAge seeking broad-based stakeholder
discussion, including appraisers
Service Coordinators
• Payment moving to Calendar Year(get all renewals through Dec 31 to HUD ASAP!)
• Reporting in a timely manner will be tied to
timely payments
• HUD preparing for more consistent policies
(desk audits
8
REAC Inspections
• New “Industry Standard Repairs”
– for effect Aug 1
• Integrating use of photos into inspection
processes, and appeals
• No “currently licensed UPCS inspectors” as
site-based contractors
HUD Recommendations
• Offer a preference for homeless,
collaborate locally ssssssssssssss
• Go smoke free
• Explore Energy Efficiency upgrades,
and benchmarking tools
• Preserve your properties!
Homeless Preference Encouraged
• Distinct phenomena – expanding need; early aging
• Notice H 2013-21 – provided flexibility in owner
choice and definition
• Toolkit issued Nov. 2015 – guidance and tools for
coordinating access and resources
• Google: HUD, opening doors, homeless toolkit
9
Housing Plus Services:
Expanding the Future of Aging
Services
Engaging Health Partners to Serve
Low-Income Older Adults
Housing with Services
• Health and long-term care reform
efforts at national and state level
• Goal: Improve health care outcomes for all
Americans, particularly vulnerable populations
• Affordable senior housing residents represent
the vulnerable individuals population-based
health reform efforts are designed to target
Supportive Services Research Demo
Develop a housing-with-services demonstration program for low-income elderly to test models that demonstrate the potential to delay or avoid the need for nursing home care.
Produce evidence about the impact of housing w/ services on:
• housing stability
• wellbeing
• health outcomes of HUD-assisted elderly residents costs to the health care system
10
LeadingAge Housing Agenda MacArthur Study – Jan 2016
• Previous research: “A Picture of Housing and Health”
• Matched 2008 HUD tenant-level with Medicare and Medicaid
admin data for individuals receiving HUD assistance in 12
areas (HHS/HUD dataset)
– Almost 70% of HUD-assisted adults age 65+ identified as
Medicare beneficiaries were dual eligibles
– 55% of HUD-assisted, dual eligible older adults had 5+ chronic
conditions, compared to 43% of peers not receiving HUD
assistance
– HUD-assisted, dual eligible older adults had 16% higher FFS
Medicare costs and 32% higher FFS Medicaid costs than peers
not receiving HUD assistance
Available Services Staff, 2008
69%
26%
13%
25%
Service Coordinator Activity Coordinator Nurse No Staff
SC
44%
SC/AC
14%
SC/N
5%
SC/AC/N
5%
AC
5%
AC/N
1%
N
1%
No Staff
25%
Available Onsite Services, 2008
27%
3%
10%
10%
19%
24%
31%
64%
66%
49%
33%
44%
74%
Podiatry
Dental
Mental health
Primary health care
Medication assistance
Personal care
Homemaker assistance
Health screening
Health education
Exercise and fitness
Congregate meals
Transportation
Social activities
11
Findings
• Presence of service coordinator associated with decreased
odds of hospital stay
– Supports previous research indicating positive effects of role
– Policy implications: potentially valuable role in health reform for
vulnerable older adults
• Other findings less clear
– Health education associated with increased ED visits
– Mental health associated with increased odds of hospital visit
– Medication management associated with lower Medicaid
payments
• Additional research needed on actual utilization of services
and exposure to services over time
Affordable Senior Housing Opportunities
Collaboration
• Networking and Advocacy
• Private funders and non-profits
• LeadingAge (state and National)
Helping people is the solution, not the
problem.
Housing and Healthcare Partnerships
Resources
• http://www.leadingage.org/Center_for_Housi
ng_Plus_Services.aspx
• https://www.youtube.com/watch?v=FqGvbAr
aQxk&feature=em-subs_digest
• http://www.leadingage.org/Affordable_Senior
_Housing_Plus_Services_Program_Slows_Gro
wth_in_Medicare_Costs.aspx
12
Contact Information
Colleen Bloom
LeadingAgeDirector, Housing Operations
(202) 508-9483