Major disagreements remain, but renewed dialogue between factions within the Democratic party has Congressional leaders more optimistic a deal can be reached.

While the overall cost remains the key question, many rank-and-file Members of Congress appear to be coming to terms with a narrower bill than originally anticipated. Multiple sources have indicated that the final bill is likely to include $2 trillion in spending, down from the $3.5 trillion originally envisioned. Narrowing the package by that amount will intensify the debate around what programs should be included, and how long those programs should last, with Members of Congress and advocates fighting harder for their priorities.

For his part, on Tuesday, President Biden issued a list of several priorities he would agree to cut in order to craft a narrower package. While resources to address the workforce shortage and expand home- and community-based services were not included on that list, nothing is certain until a final package is agreed upon. That is why Lutheran Services in America continues to advocate for key provisions that would help address the acute workforce shortage and expand access to home and community-based services. Specifically, we are advocating for a final package that includes:

• $250 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
• $1.48 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

Please join us in this effort through our advocacy alert.

By Sarah Dobson, Senior Director of Public Policy and Advocacy, and Josh Dubensky, Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network

Bipartisan Infrastructure Bill Passes Following Intense Back and Forth Between Progressives and Moderates

Following hours of intense negotiations Friday within the Democratic House majority, progressives agreed to support the bipartisan infrastructure bill in exchange for a public commitment from moderates to support the Build Back Better Act, if the expected analysis by the Congressional Budget Office (CBO) aligns with current cost projections. This agreement led to the final passage of the bipartisan infrastructure bill late Friday night, sending it to President Biden for his signature, and a procedural vote on the Build Back Better Act to prepare for the eventual final vote which is currently scheduled for next week.

The $150 billion for home and community-based services remains in the Build Back Better Act, but there will likely be changes made as it advances through the Senate. Lutheran Services in America will continue to advocate to keep key provisions that would help address the acute workforce shortage and expand access to home and community-based services including:

• $150 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
• $1.48 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

Please join us in this effort through our advocacy alert.

Biden Administration Releases Vaccine Mandates for Workers

On Thursday the Centers for Medicare and Medicaid Services (CMS) and The Occupational Safety and Health Administration (OSHA) released long-anticipated mandates for worker vaccinations. Both rules have a number of intricacies, but broadly speaking, the CMS rule applies to health care facilities operating all or part of their services under Medicare and Medicaid Conditions of Participation (CoPs), and the OSHA rule applies to employers with 100 or more employees. LSA is finalizing summaries of the full scope and details of the mandates, but more information can be found on the CMS rule here, and on the OSHA rule here.

If you have a specific question about the mandates that you cannot find online, please e-mail Josh Dubensky at jdubensky@lutheranservices.org and Sarah Dobson at sdobson@lutheranservices.org.

By Sarah Dobson, Senior Director of Public Policy and Advocacy, and Josh Dubensky, Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network

Updated Nov. 15, 2021

A group of House Democratic moderates is withholding support until the full cost of the legislation is determined.

The timeline for passing the Build Back Better Act remains uncertain. It is unlikely the House will be able to advance the legislation until a full cost analysis from the Congressional Budget Office is released, likely after Thanksgiving.  Because there will likely be changes made as the bill then advances through the Senate, Lutheran Services in America will continue to advocate to keep key provisions that would help address the acute workforce shortage and expand access to home and community-based services including:

• $150 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
• $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

Please join us in this effort through our advocacy alert.

Biden Administration Issues Vaccine Mandates for Workers

Following the release on November 5 by the Centers for Medicare and Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) of vaccine mandates with a final compliance deadline of January 4, 2022, for facilities governed by the Medicare and Medicaid Conditions of Participation (CoPs) and employers with 100 or more employees, respectively, Lutheran Services in America has published detailed summaries of the mandates and what they mean for members of our network. We encourage you to review both our CMS and OSHA summaries.

It is important to note that the CMS mandate takes precedence over the OSHA mandate: if a given facility meets the eligibility requirements for both, it should follow the CMS mandate.  Also, subsequent to the filing of multiple lawsuits objecting to the OSHA mandate, that rule is under an emergency stay, with the Fifth Circuit Court of Appeals ordering that OSHA “take no steps to implement or enforce” the mandate “until further court order.”  Nevertheless, OSHA has urged providers subject to that mandate to plan as though it will take full effect and be prepared to meet the first compliance deadline of December 5.  While multiple lawsuits have also been filed against the CMS mandate, no emergency stay or injunction has yet been issued on that rule.  Lutheran Services in America will be submitting official comments on both mandates and we encourage you to share your questions or concerns with us to inform those comments by emailing Sarah Dobson, Senior Director of Public Policy and Advocacy, at sdobson@lutheranservices.org .

Upcoming Congressional Town Hall Meetings

Members of Congress continue to hold virtual town hall meetings to address constituent concerns about coronavirus relief. Here is a look at upcoming sessions (click links below to find out how to join):

By Sarah Dobson, Senior Director of Public Policy and Advocacy, and Josh Dubensky, Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network

The Congressional Budget Office (CBO) completed its full cost analysis earlier than expected, paving the way for passage in the House.

Progress on passing the Build Back Better Act, the legislative vehicle for President Biden’s $1.75 trillion “human infrastructure” framework, has taken a big step forward. On Thursday the CBO released its full cost estimate of the legislation, clearing a key hurdle for House moderates to support the bill. This cleared the way for final passage in the House Friday morning. The Build Back Better Act now heads to the Senate where negotiations around the House’s inclusion of paid family leave, immigration, and clean energy provisions are expected to delay swift passage. It is likely some of these provisions will be removed from the Senate version in order to garner the 50 votes needed for passage. A final vote in the Senate is not expected until mid-to late December.

The $150 billion for home and community-based services remains in the package, but there will likely be changes made as the bill advances through the Senate. Lutheran Services in America will continue to advocate to retain key provisions that would help address the acute direct care workforce shortage and expand access to home and community-based services including:

• $150 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
• $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

 Please join us in this effort through our advocacy alert.

Biden Administration Issues Vaccine Mandates for Workers

Following the release by the Centers for Medicare and Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) of vaccine mandates with a final compliance deadline of January 4, 2022, for facilities governed by the Medicare and Medicaid Conditions of Participation (CoPs) and employers with 100 or more employees, respectively, Lutheran Services in America has published detailed summaries of the mandates and what they mean for members of our network. We encourage you to review both our CMS and OSHA summaries.

It is important to note that the CMS mandate takes precedence over the OSHA mandate: if a given facility meets the eligibility requirements for both, it should follow the CMS mandate.  Also, subsequent to the filing of multiple lawsuits objecting to the OSHA mandate, that rule is under an emergency stay.  Nevertheless, providers subject to that mandate should plan as though it will take full effect and be prepared to meet the first compliance deadline of December 5.  While multiple lawsuits have also been filed against the CMS mandate, no emergency stay or injunction has yet been issued on that rule.

If you have questions about either mandate, please e-mail Josh Dubensky at jdubensky@lutheranservices.org.

Build Back Better continues to advance, but a number of hurdles remain.

Senate Majority Leader Charles Schumer announced he is planning to pass the Build Back Better Act before Christmas, but several hurdles remain. Senate Democrats need to come to agreement on paid family leave, immigration, and clean energy provisions to garner the 50 votes needed for passage. They also need to await a final ruling from the Parliamentarian, who will decide what provisions can be passed through the budget reconciliation process. Finally, there is likely to be a lengthy amendment process that will need to be navigated before the final vote can take place.

We continue to hear that the $150 billion for home and community-based services remains in the package for now, but Lutheran Services in America will continue to advocate to retain key provisions that would help address the acute direct care workforce shortage and expand access to home and community-based services including:

• $150 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
• $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

However, there are two provisions which are problematic for our members providing skilled nursing services which we’re asking Senators to oppose and remove:

•  Mandating a registered nurse on staff 24 hours a day at skilled nursing facilities (from 8 hours/day), a late addition to the House bill and one that doesn’t include additional funding
• Requiring a three-year study of minimum skilled nursing staff levels and that the minimums be met within one year and without additional funding  Please join us in raising our voice to Senators on these issues through our advocacy alert.

CMS Vaccine Mandate Temporarily Halted Nationwide by Courts

On Tuesday, November 30, the U.S. District Court for the Western District of Louisiana granted a preliminary injunction effectively preventing the Centers for Medicare & Medicaid Services (CMS) from enforcing its vaccine mandate rule nationwide.  While the Court’s ruling was based on a lawsuit brought by only 14 states, given the scope of the mandate and the previous injunction granted Monday, November 29, by another District Court preventing enforcement in 10 other states, the Louisiana court indicated that its ruling would cover all remaining states not already under the previous injunction “due to the need for uniformity.”

While the Biden Administration has indicated that it plans to appeal the rulings, as of now, CMS is prevented from requiring compliance with the vaccination mandate’s Dec. 6 deadline for most healthcare workers to have first round shots completed. The final deadline for full vaccinations was set at Jan. 4.

This court ruling follows a three-state (Kentucky, Ohio, and Tennessee) injunction against enforcement of a vaccine mandate for federal contractors and a nationwide injunction on enforcement of the similar mandateissued by The Occupational Safety and Health Administration (OSHA.)  Lutheran Services in America has submitted commentson the OSHA mandate. 

Lutheran Services in America has prepared a summaryof the CMS rule, and will be submitting commentsto CMS sharing questions and concerns from our network members.

 If you have questions about either mandate, please e-mail Sarah Dobson at sdobson@lutheranservices.org and Josh Dubensky at jdubensky@lutheranservices.org.

Updated Dec. 15, 2021

Following the passage of legislation that allows Democrats to raise the debt limit and avoid a federal default on the nation’s debt by circumventing a GOP filibuster in the Senate, Congress voted on Tuesday to increase the debt ceiling by $2.5 trillion. Final passage of a compromise $768 billion defense policy bill is expected this week as well. These agreements clear up much needed time for lawmakers to focus on the Build Back Better Act, the last major piece of legislation anticipated before the end of year.

To advance Build Back Better, Senate Democrats still need to come to agreement on paid family leave, immigration, and clean energy provisions to garner the 50 votes needed for passage. They also need to await a final ruling from the Parliamentarian, who will decide what provisions can be passed through the budget reconciliation process.

We continue to hear that the $150 billion for home and community-based services remains in the package, but Lutheran Services in America will continue to advocate to retain key provisions that would help address the acute direct care workforce shortage and expand access to home and community-based services including:

• $150 billion to incentivize states to deliver or improve home- and community-based service programs, including through increasing wages and benefits for direct care workers;
• $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

 However, there are two provisions which are problematic for our members providing skilled nursing services which we’re asking Senators to oppose and remove:

•  Mandating a registered nurse on staff 24 hours a day at skilled nursing facilities (from 8 hours/day), a late addition to the House bill and one that doesn’t include additional funding.
• Requiring a three-year study of minimum skilled nursing staff levels and that the minimums be met within one year and without additional funding.

Please join us in raising our voice to Senators on these issues through our advocacy alert.

Worker Vaccine Mandates Temporarily Halted Nationwide by Courts

As of December 7, all three major vaccine mandates impacting employers have been at least temporarily halted nationwide.  Following previous court rulings preventing both The Centers for Medicare and Medicaid Services (CMS) and The Occupational Safety and Health Administration (OSHA) from enforcing their vaccine and testing mandates for employers, a federal court has now ruled that a similar mandate, applicable to most federal contractors and issued via Executive Order, may also not be enforced at this time.  The final deadline for full vaccination for all eligible employees under each of the mandates had been set at January 4, 2022.  While the Biden Administration has indicated that it plans to appeal the rulings, and most experts suggest that covered employers should continue planning as though they will eventually have to comply, currently none of the mandates may be enforced.

Lutheran Services in America has submitted comments on the OSHA mandate.  Lutheran Services in America has prepared a summary of the CMS rule, and will be submitting comments to CMS sharing questions and concerns from our network members.  Please contact Sarah Dobson, Senior Director of Public Policy and Advocacy, at sdobson@lutheranservices.org to share your input as we prepare our official comments on the CMS mandate.

Upcoming Congressional Town Hall Meetings

Members of Congress continue to hold virtual town hall meetings to address constituent concerns about coronavirus relief. Here is a look at upcoming sessions (click links below to find out how to join):

 By Sarah Dobson, Senior Director of Public Policy and Advocacy, and Josh Dubensky, Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network

Senator Manchin made the surprise announcement on Sunday that he could not vote for the Build Back Better Act, which will force a large-scale rewrite of the legislation. 

Despite months of negotiations, Sen. Joe Manchin (D-WV), the moderate Democrat whose vote was seen as key in the evenly divided Senate, announced he would not vote for the Build Back Better Act, citing concern with the roughly $2 trillion price tag and how the legislation would be paid for. While Sen. Manchin’s decision is a significant setback, Democratic leaders and the White House are planning to regroup and have vowed to try and salvage the legislation after the holidays. It is unclear exactly what the next version of the legislation will look like, but a vote on a reformulated package could come as early as January.

Although the legislative path forward is uncertain, the advocacy priorities for Lutheran Services in America remain the same. We will continue to advocate for the inclusion of at least $150 billion for home and community-based services in the next legislative package, as well as key provisions that would help address the acute direct care workforce shortage including:

• $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

Court Lifts Injunction on OSHA Vaccine Mandate

The Department of Labor’s Occupational Safety and Health Administration can enforce its COVID-19 vaccinate-or-test mandate for employers with 100 or more workers, at least for now, following a ruling by the 6th U.S. Circuit Court of Appeals on Friday lifting an existing nationwide enforcement injunction. The decision was quickly appealed to the U.S. Supreme Court on Saturday morning by 27 Republican state attorneys general, as well as dozens of companies and organizations.

OSHA said it will begin enforcing the rule’s requirements a week later than scheduled: OSHA will not cite employers for not complying with any requirements of the standard before January 10 and will not cite employers for not complying with the standard’s testing requirements before February 9, “so long as an employer is exercising reasonable, good faith efforts to come into compliance with the standard,” the department said, adding that OSHA will work closely with employers to assist them with compliance.

This ruling follows a December 15 decision by the Fifth Circuit Court of Appeals scaling back an injunction on the Centers for Medicare and Medicaid (CMS) mandate that all eligible staff at specified health care facilities that participate in the Medicare and Medicaid programs be fully vaccinated against COVID-19 by January 4, 2022.

Under the new ruling, the injunction remains in place only for those states where judges have directly applied it. These states are: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia, Wyoming.

As the major mandates make their way through various court challenges, industry stakeholders and legal experts seem to agree that the best practice for providers is to prepare to meet the final deadlines as court challenges play out.

Senate Delays Consideration of Build Back Better Act, Negotiations Continue

Following Sen. Joe Manchin’s (D-WV) announcement last month that he would not vote for the Build Back Better Act in its current form, Democratic leaders and the White House continue to seek the best path forward for the legislation. Private negotiations are continuing, with Congressional aides saying the legislation will likely not be ready for floor action until February at the earliest. Stakeholders have conceded that the final legislation will be changed and likely pared back in its final form. However, given Sen. Manchin’s public support for the $150 billion for permanent funding for home- and community-based services (HCBS) currently included in the package, it seems likely that it could be included in a future bill.

Lutheran Services in America will continue to advocate for the inclusion of at least that $150 billion for HCBS in the package, as well as key provisions that would help address the acute direct care workforce shortage including:

• $1 billion for a grant program funding strategies to recruit and retain direct care workers; and
• the provisions of the WORK NOW Act to create a $50 billion grant program supporting nonprofits in paying wages and benefits.

We also continue to urge Senators to remove provisions which would worsen workforce shortages:

• An unfunded mandate increasing the amount of time a Registered Nurse must be on duty at a Skilled Nursing Facility (SNF) from 8 hours per day to 24 hours.
• A requirement that the Department of Health and Human Services conduct a study on establishing certain minimum staff to resident ratios in SNFs and to mandate the implementation of the study’s recommendations without providing additional funding for providers.

Join us in advocating for these issues.

Supreme Court Blocks Biden Administration’s Workplace Vaccine Rule

The Supreme Court blocked enforcement of the Biden administration’s Covid-19 vaccine-or-test mandate for workers at large businesses but allowed enforcement of a similar mandate for certain health care workers. While challenges to the mandates from businesses and Republican-led states were returned to lower courts, the ruling suggests that the justices are likely to rule against the business rule if the case reaches the court again, but would look more favorably on the mandate for health care workers.

By Sarah Dobson, Senior Director of Public Policy and Advocacy, and Josh Dubensky, Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network