The State of America’s Direct Support Workforce Crisis 2022
IMPORTANT FACT: Members of ANCOR’s Government Relations Committee really like watching Miraculous: Tales of Lady Bug and Cat Noir on television. Well, only one member mentioned his kids’ devotion to the show, but I bet the name caught your attention!
As to how we came across this stellar television recommendation…I guess you had to be there! However, since we know Baltimore in January isn’t for everyone, this article recaps the juicy federal updates that were shared and highlights from important policy discussions we had during ANCOR’s 2019 Government Relations Committee Retreat, which took place early last week.
The event, hosted in the Hotel Monaco in Baltimore, has always been deeply productive. This year was no exception.
First, the U.S. Department of Labor wants you to know you are not alone in grappling with compliance issues. Michael Kravitz, Director of Communications (and Acting Assistant Director) for the Department of Labor’s (DOL) Wage & Hour Division (WHD), discussed how the agency is increasingly initiating its own compliance investigations, rather than responding to complaints. As part of his Q&A with participants, Michael flagged WHD’s outreach and compliance assistance resource for employers, which includes several guiding documents and videos. The resource also includes the publication of fact-based opinion letters – a development ANCOR flagged in 2017. Please note, however, that ANCOR CEO Barbara Merrill recommends that you consult with ANCOR for advice if you are considering requesting an opinion letter, as the framing of your request could carry unintended consequences for other providers across the nation, given DOL’s federal reach.
Speaking of DOL, the Department is expecting the new Overtime Rule to be proposed in March. Although March 2019 was Michael’s best estimate for when the proposed rule would drop, and although we know that DOL has sent the proposed rule to the White House for further review, Michael also acknowledged that other rules expected in December 2018 remain in the queue. In other words, temper your expectations about the timing of the Overtime Rule. ANCOR has been following this issue closely, and will keep members informed of opportunities for action. We will also be requesting a joint meeting between DOL and the Centers for Medicare and Medicaid Services (CMS) when the rule is released (a meeting Michael indicated he is open to). Other topics discussed during the Q&A included the join employer rule and regulations surrounding contractors.
From elsewhere in the Administration, we learned about upcoming leadership changes at CMS, as well as the latest news on key I/DD policies. Melissa Rice and perennial GR Retreat favorites Melissa Harris and Ralph Lollar joined us to talk about what was on CMS’ mind. Among the highlights:
- Melissa and Ralph gave us the “scoop” that Chris Traylor will be the Acting Director of CMCS to replace Mary Mayhew after her departure; they had just learned this information themselves when they shared it with ANCOR. Chris Traylor is a former director of Texas’ Medicaid program.
- The announcement of the National Center for Advancement of Person-Centered Practices and Systems became public on the eve of the GR Retreat.
- CMS representatives confirmed that, despite delays, the HCBS Settings Rule guidance on “heightened scrutiny” can still be expected within the next six months.
- On the ICF/IID front, Melissa Rice shared a list of resources, including information about the new surveyor process and a fabulous online data resource, QCOR.
Ralph and Melissa also participated in a vigorous discussion with attendees on EVV and the HCBS settings rule. They encouraged providers to email EVV-related information, questions and comments to a designated mailbox: [email protected]. Separately, knowing that CMS’ emergency preparedness rule for ICFs has been a subject of interest for ANCOR, Melissa Rice shared how the survey process evolved to include a greater emphasis on observations and a smaller sample size, among other changes. She also shared resources on training for compliance and heard from participants about their concerns regarding the rule.
In the advocacy column, ANCOR’s contract lobbyists, Al Guida and Rodney Whitlock, want you to do in-district introductory and “check-in” visits as the new Congress starts. If you want to be technical about it, Gary Blumenthal, Chair of ANCOR’s Grassroots Work Group, brought up congressional visits, and Doris Parfaite-Claude, ANCOR’s grassroots staffer, shoe-horned it into this paragraph because she’s shameless that way.
In reality, Al and Rodney gave their forecast for 2019, including challenges and opportunities facing providers in their Congressional advocacy. One of the challenges they identified was the “downstream effect” of Medicare for All; as Medicaid for All proposals become more popular, there could be impacts for policy discussions surrounding the existing iteration of the federal Medicaid program. One potential impact? Chaos caused by budgetary battles such as debt limit legislation.
Meanwhile, one of the opportunities Al and Rodney identified was that, with I/DD being a lesser-known aspect of Medicaid, it’s somewhat I/DD provisions are somewhat shielded from deep partisan battles. As a result, there may be opportunities MFP, EVV and workforce legislation because these issues aren’t nearly as polarizing. There are also things that Congress perceives must get done this year, so there’s an opportunity to add our priorities to that must-do legislation.
Finally, in the category of opportunity and challenge, Rodney articulated simply and clearly, “The 2020 election is already underway.” Toward that end, we will let members know when action is needed – and when we will have updated resources on our Digital Lobby Page, such as congressional contact sheets and one-pagers.
We also heard from coalition partners on their advocacy to protect WIOA from being re-opened. Nicole Jorwic of the Arc of the United States and Heather Sachs from the National Down Syndrome Congress stressed the importance of keeping the definition of “competitive employment” as currently written in the WIOA regulations intact and defending against existing efforts to reopen the rule to amend that section. The panel shared that the language as written in the current regulation is the result of much work and compromise within the I/DD community, and should therefore be respected as such; the rule should not be reopened. Nevertheless, we expect to see the reopening of the rule later this month or in early spring.
We were also privileged to have several discussions facilitated by ANCOR members, including:
- A presentation of ANCOR’s newest white paper on alternate payment models. (Editor’s Note: ANCOR members are getting a sneak peak of the paper in this edition of LINKS ahead of the paper’s official release tomorrow!)
- A preview of our newest Grassroots Work Group initiative – a national “DSP for a Day” event in August – along with the opportunity to provide feedback. Stay tuned for more details soon!
- Table Talks, a time during which participants got together in small groups, divided by topic, to share their states’ latest developments. Topics for Table Talks included workforce, EVV implementation and integrated care.
The crowning event at the GR Retreat, however, took place on Wednesday morning when participants discussed how to strengthen ANCOR’s Policy Principles. Every year, the core exercise of the GR Retreat is for GR Committee members to evaluate whether our principles still offer sufficient guidance on all the policy issues ANCOR encounters, and to decide on the policy priorities for the year. GR Committee members can expect a fuller debrief via the ANCOR Connected Community (ACC) soon. The GR Committee is open to all, so if you wish to participate in the shaping of ANCOR’s policy agenda and learn more about our work, please email Doris Parfaite-Claude at [email protected] to get added to the ACC’s GR Committee space.
We are always grateful for the dedication our members show in flying from all over the country to meet us in wintry Baltimore every year to share their wisdom and ideas with us. Your participation is what empowers us to achieve our legislative and regulatory wins throughout the year, so it is only fitting to wrap up this article with a heartfelt THANK YOU!
Esmé Grewal, Esq. is Vice President of Government Relations at ANCOR.