The Short Story – Fiscal Year 2021 Appropriations: The final version of the FY 2021 Labor, Health and Human Services, Education, and Related Agencies appropriations bill included in the giant pandemic/appropriations package provides geriatrics programs (GWEP/GACA) $42.737 million for FY 2021. This is a $2 million increase. The House had provided $2 million and Senate provided a $4 million increase. We got the lower level, but the fact that the Senate provided the $4 million helped us get what we did. NAGE advocated for $51 million for FY 2021 throughout the process.
The bill provides Title VII Health Professions and Title VIII Nursing Workforce Development programs with $754 million for fiscal year (FY) 2021, a $19.5 million (3%) increase from FY 2020 enacted levels. Attached is the HPNEC funding chart with HRSA programs. The House Labor-HHS bill provided $782.5 million for the programs, a $48 million (6.5%) increase, and the Senate bill would have provided $750.6 million, a $16 million (2.2%) increase over FY 2020.
We have not identified any additional funds for GWEP sites in other parts of the pandemic package, but we will advocate for additional resources with HRSA.
The Long Story
The Pandemic Relief Bill
President Trump signed the $900 billion pandemic relief bill on Sunday night, December 27, 2020, but not before subjecting the public and congressional leaders to very real angst about expiring unemployment assistance, the government shutting down, and non-existent stimulus checks. The stated reason? “I simply want to get our great people $2000, rather than the measly $600 that is now in the bill,” the president tweeted. “Also, stop the billions of dollars in ‘pork’.” The President signed the bill, but he was not happy about it; see his statements here: https://www.whitehouse.gov/news/
So, the House and Senate continue to grapple with the $2000 issue. Speaker of the House Nancy Pelosi led the House to approve increased coronavirus disaster relief payments for Americans to $2,000 per person on Monday, December 28. “Now, the president must immediately call on Congressional Republicans to end their obstruction and to join him and Democrats,” Pelosi said. “Every Republican vote against this bill is a vote to deny the financial hardship that families face and to deny the American people the relief they need.” The bill was approved by a vote of 275-134 vote, with the support of 44 Republicans. The Senate is less likely to approve the bill, but there may be a vote this week.
This is a Very Large Package:
By almost any standard – except the other pandemic bills – the bill passed and signed into law by the President is a huge package of supports and benefits with implications for much of the nation. The bill, Consolidated Appropriations Act (CRA) of 2021, is a 5000 plus page measure that combines a $1.4 trillion omnibus government (appropriations) spending bill with a $900 billion COVID-19 pandemic relief package.
The momentum for the bill was created by a bipartisan group who assembled the proposals that became the key elements of the $900 billion package. The bipartisan group given credit for developing the package was led by Senators Susan Collins (R-ME) and Joe Manchin (D-WV), in addition, Senators Mark Warner (D-VA), Jeanne Shaheen (D-NH) and Maggie Hassan (D-NH), Angus King (I-ME), Lisa Murkowski (R-AK) and Bill Cassidy (R-LA), along with House members Tom Reed (R-NY), Josh Gottheimer (D-NJ), Anthony Gonzalez (R-OH), Dusty Johnson (R-SD), Fred Upton (R-MI), Abigail Spanberger (D-VA), and Dean Phillips (D-MN) contributed. The work of the group pressured the leadership, particularly Majority Leader McConnell, to bring a version of the bill to the floor.
The core elements of the bill have been the focus of negotiations for the last few weeks: a $300 boost in weekly federal unemployment benefits, $600 relief checks for individuals, more than $300 billion for small business aid, including additional money for the Paycheck Protection Program (PPP), and boosted funding for health care facilities, schools, COVID-19 testing and tracing, and vaccine distribution. There was a great deal of back and forth on two issues that were left out of the final package – pandemic-related liability protections for businesses (among others) and about $160 billion in aid for state and local governments.
Some of the provisions in the bill:
- Additional funding for “hardest hit” businesses to receive a second Paycheck Protection Program (PPP) loan if they have 300 or less employees and have sustained a 25% percent revenue loss in year-over-year revenue.
- Simplification of the PPP loan forgiveness process for those with loans of $150,000 or less by only requiring a one-page attestation form.
- The extension of funding for key federal health programs, including Community Health Centers, the National Health Service Corps, the State Health Insurance Assistance Program (SHIP), GME Teaching Centers, and others.
- 3-year extension of the Money Follows the Person (MFP) program. Funds to help transition those residing in long-term care facilities back into their homes and communities.
- A 3-year extension of the Independence at Home (IaH) demonstration. IaH is a successful home-based primary care model that focuses on chronically and seriously ill Medicare beneficiaries.
- “Surprise billing” legislation that would hold patients harmless from large unexpected medical bills for out-of-network care. The bill requires arbiters to settle disputes between providers and insurers.
- A one-time, one-year increase in the Medicare physician fee schedule of 3.75%.
- $3 billion in additional funding for the Provider Relief Fund.
- Inclusion of the HOSPICE Act to impose new program integrity standards and intermediate remedies and penalties on hospice programs that are out of compliance
- Increased funding for telehealth services, including $250 million for the Federal Communications Commission COVID-19 Telehealth Program.
- 15% temporary increase in individual monthly Supplemental Nutrition Assistance Program (SNAP) – Food Stamps.
- Additional funding for Older Americans Act nutrition services.
- $8.75 billion in funding for the CDC, states, and localities to support vaccine distribution, administration, and tracking efforts
- $12 billion in targeted emergency investments to organizations such as community development financial institutions (CDFIs) and minority depository institutions (MDIs) to help low-income and minority communities.
- $100 million to address abuse, neglect, and exploitation of the elderly, including adult protective service (APS) and long-term care ombudsman activities
- $10 million per year for FY 2022-2026 for Project ECHO-like technology-enabled learning collaboratives intended to spread health care training and resources for underserved areas and patient populations.
Other Provisions in the FY 2021 Appropriations Part of the Bill:
- $2.3 billion for the Administration for Community Living, which is $35 million above FY 2020. This amount includes: $952 million for nutrition programs and $200 million for Family Caregivers Services. And modest increases in programs serving individuals with disabilities:
- $3 million increase for Developmental Disabilities Programs.
- $500,000 increase for assistive technology.
- $1 million increases for the National Institute on Disability, Independent Living, and Rehabilitation Research.
- The bill includes an increase of $67 million for the Social Security Administration’s base administrative expenses.
- To read the full text of the bill: https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-116HR133SA-RCP-116-68.pdf
- To read a summary of the COVID-19 Relief provisions: https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/Summary%20of%20H.R.%20133%20Coronavirus%20Relief%20Provisions.pdf
- To read a summary of the appropriations provisions: https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/Summary%20of%20H.R.%20133%20Appropriations%20Provisions.pdf
- To read a summary of the authorizing provisions: https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/Summary%20of%20H.R.%20133%20Authorizing%20Matters.pdf
- Joint Explanatory Statement (report): https://docs.house.gov/billsthisweek/20201221/BILLS-116RCP68-JES-DIVISION-H.pdf
Other Legislation and Executive Branch Actions of Interest:
The BENES Act – S. 1280 – passed as part of the pandemic package and “modernizes Medicare enrollment, closing archaic and harmful coverage gaps written into the law more than 50 years ago”. https://www.congress.gov/bill/116th-congress/senate-bill/1280?q=%7B%22search%22%3A%5B%22BENES+Act%22%5D%7D&s=2&r=2
Lifespan Respite Program Reauthorization: The House and Senate passed the Lifespan Respite Reauthorization bill and sent it along to the President on December 24. H.R. 8906 was introduced by Representative James Langevin (D-RI) in the House and authorizes $50 million for Lifespan Respite over five years ($10 million annually) through fiscal year 2024.
RAISE Act – Next Meeting January 19 12:30 – 4:30 pm Eastern and Recommendations Released Link: https://acl.gov/programs/support-caregivers/raise-family-caregiving-advisory-council
Health Care Spending: The pandemic is causing an unprecedented drop in health care spending; read more in the column by Kaiser Family Foundation’s Drew Altman: https://www.axios.com/the-pandemic-is-causing-an-unprecedented-drop-in-health-spending-b4801ec8-8da5-42a5-a66c-68c78dbd6e13.html?utm_campaign=KFF-2020-Drew-Columns&utm_medium=email&_hsmi=101605255&_hsenc=p2ANqtz-_bTM9bM_gLDqv8m7cCZn4MTQ1ALR0EhLuPb.
From the Administration for Community Living: the Program Year 2019 Annual Report on Centers for Independent Living is now available:
Cartoon on the pandemic relief bill: https://www.politico.com/cartoons/2020/12/10/the-nations-cartoonists-on-the-week-in-politics-000193?slide=10&nname=playbook&nid=0000014f-1646-d88f-a1cf-5f46b7bd0000&nrid=0000014e-f0f7-dd93-ad7f-f8f765940000&nlid=630318
Stay well and safe, and Happy New Year!
Submitted December 30, 2020
Brian W. Lindberg, NAGE Public Policy Advisor
1612 K Street, NW, Suite 200
Washington, DC 20006