Netsmart CareThreads
Netsmart CareThreads

Episode · 5 months ago

American Rescue Plan Act Overview – How to move quickly to participate

ABOUT THIS EPISODE

Congress passed and President Biden signed the $2 trillion American Rescue Plan Act. How will it affect your organization?


In this episode of Netsmart CareThreads, Tom Herzog, Chief Operating Officer for Netsmart, and Kevin Scalia, EVP, Corporate Development at Netsmart Technologies, discuss this significant legislation. What's included in it? What does it provide for the human services and post-acute provider communities we serve?


Here's what Tom and Kevin talked about:

- Funding and grant opportunities for human services and post-acute care providers in the American Rescue Plan Act.

- The impact of COVID-19 on the scale of this legislation.

- How Netsmart collaborated with leading industry associations to build a common agenda to highlight the funding needs of providers who need technology as the bridge to fully integrate with other key components of the healthcare ecosystem.

- Potential future legislation with levels of funding that could fundamentally change the way Netsmart clients deliver Home and Community-Based Services.

- Move fast: Some providers wait too long to put together a business plan and strategy. Lots of money being allocated, it will be spent fast. Also non-traditional competitors are moving into the space.

- Think big: Look beyond vertical thinking like opening new facilities…to horizontal thinking like how to leverage current service lines and expertise in new settings

This discussion with Kevin Scalia was taken from our show Netsmart Care Threads. If you want to hear more episodes like this one, check us out on Apple Podcasts.

If you don’t use Apple Podcasts, you can find every episode here.

Welcome in that smart care, threads, apodcast were human services and post ocute leaders across the health carecontinuum come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimprove the quality of care to the communities we serve? Let's get intothe show wet welcome to today's podcast. My name is Tom Herzog and I'm the hosthere today, I'm also the chief operating officer for Netsman. I'mreally excited about our guests today. He has taught me a time he's a mentor,I'm fortunate. Our paths have been able to cross he's known by many in the callfor the cause and communities that we serve, and you know a man s Kevin Skayahe's our executive if President of corporate development- but I would tellyou, he's a person who gets a lot of things done, he helps connect ourcommunities at all levels, the things that are happening with the governmentto our providers, to those who need bridge in connection in understandingand how we're able to get things done. Our topic today is going to be on theAmerican rescue plan. act. Lots of discussion around this and we alwayslook to Kevin, really to provide what does it actually mean? What can we bestdo and how we serve our clients and broader community, and what does itmean for each of you as you look to participate or really press in to whatmay or may not be available so before we get started Kevin Welcome. Thank youfor joining. You know this is I've had an opportune coming up on almost tenyears now it doesn't feel like you is feels like we've known each other muchlonger than that and I'm looking forward to today's discussion, butbefore we jump into a cab, I thought I understood what advocacy was you'vetaught me. What have the case? Is that it's more than just speaking to what wehope to do? It's really around the deeds behind it. So if you don't mind,can you share a little bit about what advocacy means to you what it means toour the communities we serve and how net smart it's a key part of who we areye? Well, thanks Tom, and thanks for the Nice introduction to me, I hadnever really done advocacy till the high tech and or legislation was passedand what we saw. What happened? They were putting all this funding intoacute care and primary care to get those providers digitized, so that theywould be ready when value based care and care. Coordination and populationhelp started rolling out the we're going to start measuring people basedon outcomes and they left human services and posted cute providers out.So we thought that that was patently unfair and I went to Washington and Istarted talking with Patrick Kennedy...

...when he was still lookin Congress andsaid you know how do we? How do we address this, and he said one of theproblems we see is that there are so many different demands from all thevarious groups around behavioral hell while- and he is a big supporter ofbehavior- help. There's nobody saying here's what we ought to do so, sincemany of our clients are and were tend to be smaller organizations, weaggregated their voices and took their thoughts and went to Washington and wemet with a number of the big trade associations, the National Council,National Association of Behavioral Health, both of the APA NationalAssociation of Social Workers or clients like center stone, consumeradvocacy groups like metal out America. And we said we need to come at thisproblem with one voice, not with fifteen or twenty or thirty voices. Andso we formed a group called the behavioral health. It coalition, whichyou can find information at a Bhit coalition, dot or- and we said, let'sput together an agenda of what it is. You all need, as providers and consumerorganizations and as trade associations, to make sure we're providing a clear,concise and simple list to vote the congress and the Senate, as we ask forcorrections to this legislation and it putting everybody in a room andagreeing on what we're going to be. The top priorities was not easy, but itworked out great and it's gone on for more than ten years now, we've workedthrough five congresses. We've moved a ton of legislation, you know- and Ithink it's all coming together, if you look at all the little things that havegone on around privacy and technology and others in what we now see with theroll out nationally in many ways of the CCROOBY and we'll talk about some ofthat later on, so I think before we jump into Thatt Cap, I want to just askyou one: You know, inside or example, when you talk about the one voice. Ithink that was something that I learned when I joined net smart was that wehave an obligation and also an opportunity to serve our community bybringing together our collective voices. What is that me? I know that'ssomething you're very passionate about, and it's also made a difference. Canyou just give a little more insight into that yeah? I mean it's. It's kindof the opposite of, what's going on in Congress right now, where theRepublicans and the Democrats won't speak to each other. You know all ofthese various organizations and providers payers that we work with allmany of them have different agendas, but when we all sit down in a room andsay we can only present three or four or five things, how do we compromise onwhat would be best for everybody and pick the things and move those forward?And it's that that working together to come up with a common theme, which isnot always easy? It makes it much...

...easier to go to Congress, then and sayhere are the three things we want. We want you to fund these things this yearand here's the benefit to the nation, to the providers, most importantly tothe consumers of care of why this is all in their interest. So having thosegroups together and getting common opinions from all the constituencies,it is very important to moving something forward. So I'm going to savethis for probably another podcast, it's my way to get you to do another one ofthese. So we can talk more about what this means. What has worked, whathasn't worked and really, I think, as we look towards the future kind of thethings we need to be doing, but I'm told I need to say focused on the topicand task in hand. So I'm going to come back to a let's move: Go ahead and moveinto. Can you walk us through some of the areas American rescue act providefor the communities that we serve, what the opportunities are for our humanservices partners, as well as our post, acute providers as well sure you knowso we're talking about a two trillion dollar bill and I never thought thosewords would be leaving my mouth when we started this a long time ago, butthrough the efforts that we've put together, the Rescue Act has puthundreds of billions of dollars into areas that will help our clients, thepopulations they serve. So it's a huge opportunity, bigger than anything wehad thought I would ever see or anything. I thought I would ever seethrough what we were doing so starting on the uman services side. The rescueact puts four billion dollars or gives four billion dollars to SAMSA. A bigchunk of that four hundred and twenty million dollars is going to expand theCCA propriate and the approach Congress took with this is they're, basicallygoing to fund up to two hundred brands of two million dollars each toorganizations that applied to be a CCCS and for whatever reason, we're notselected. If you remember in the beginning, CCHIU was a pilot program ineight states and then we've expanded it through some other legislation to tenstates, and there were provided organizations that wanted toparticipate, and there was not enough money to go and do it under that. Sothis provides additional funding and basically we're going to be funding.Everybody who applied to be a C C BHC. So that alone is huge. If you thinkabout that as being the future model of community beaver health, especially forthe severely mentally in the United States, it has three billion dollars in blockrants to the state. So a billion and a half increase in the mental healthblock grant a billion and a half dollar increase in the substance of use, blockrant and to put that, in perspective, the tire mental health block rent tothe states in two thousand and nineteen was seven hundred and fifty milliondollars. So this is more than two...

...hundred percent higher than what thetotal block ran was before I'll. Come back to my thoughts on that, in alittle bit on the Post Ect side, the C M s is going to increase the F map, thefederal matching percentage for Medicaid. This is how the feds fund tomedicate in the states by ten per cent, which is a thirteen billion dollarincrease for home and community based services, and that's going to be overthe next year. So it's got to be spent relatively quickly and put it that inperspective, it's the single largest increase in home, the community basedservices. Since the program was started and when you think about how these HCprograms were used, it's basically an entitlement that funds, nursing homesand other things under Medicaid. But there was no entitlement for home andcommunity based services, and so all the studies are showing people aregetting better outcomes at a much lower cause if you can treat them in thecommunity, which is one of our central themes, and this provides funding to goand do this so the Kays, our family foundation did some work around. Howwould some of these funds, or how could some of these funds be used upon aprovider organization, so you can use it to support the work force soincreasing direct care worker payment rates and you're hearing a lot aboutthat in the infrastructure bill. Now you can do pain, sick leave, hazardovertime or paid t differentials, hire new workers to expand services and thenretainer payments to help you preserve your your network, you can offer new orexpanded community based services. You can pay for emergency supplies on PPE,assiste technology. You can add mental health and Rehab Services, which werenot typically offered under some of those services. Some of our humanservices- CLIENTS DO IDD services under this, but this could be an expansionfor that and then cost you can offset cost use to transition people out ofinstitutions and into individual homes and then just pure expansion of serversto adding services, people who need it in the community, who would much ratherbe there who who are on waiting lists right now offering them services thatthey desire. So this is a key thing, is there's a way more people who wantthese services than a currently can be funded by it. So this would create theopportunity to offer people services on from leading lists into the communitythere's three hundred and sixty billion dollars of funding going to states andlocal government so for our county clients, sixty five billion dollars ddeposited directly into the county budget over the next four years, butmost of that funding coming very rapidly. The funding will come withinsixty days of the bill signing, but it has to be used by two thousand andtwenty four and you have to continue to maintain your current level of servicesas well, and then there's also...

...increase ms, is offering up five yearincrease in the F map. The and eighty five percent F map for states who offercommunity based mobile crisis intervention. So a lot of us were goingon with the police and other things for people who are experiencing a mentalhealth or subtenses disorder crisis. So it's important as you think about thisis to develop plans to secure the expertise in the technology and theservice to deliver this services. So once your state turns this on, you areready to go with proposal in the hand and ready to kick off the programshouldn't be when they announced the program shouldn't be the first time youstart thinking about it, so get when I, when we look throughthose numbers, and I and there's a lot of intentionality around these sayings.But if you and I are candid- we've seen programs work effectively, we seen thembe a good thing. We've also seen them be a bust we've seen them challenging.Someone ask for you to offer some opinion, as you look at what's going onhere. What do you like in what are some of the red flags or things that you'reconcerned about before we get into some of the strategy and tactics that peopleneed to be executing here soon? I think that you know my experience of twenty yearsin this field has been the many organizations wait too long to startdoing something. This is one where, in many cases, the states, the countiesMedicaid, the feds are going to be given blocks of money that they have tospend legslation a time window and in many cases like I talked about theblock rands in scale that they've never had before. So they have to move fast.You have to move fast, so putting together your business plans, yourstrategy, the business plan of how are you going to do this? How are you goingto recruit people if you're adding new services start recruiting them nowstart the recruiting process start putting the plans at place? Put thetechnology in place that needs to do it, because if you wait till the time theygo through all their Peterman and processing, it may be too late. You maynot have enough time to spend the money you make at to me. That's one of thebigger issues I think you're also going to see non. Traditional competitors come intoyour market place, so a common one from a behavioral health provider we hearwhom we have or heath providers as F hs, say that they can do everything, and Iheard a great line the other day where somebody said nobody says I have stagethree lung cancer, I'm going to go to my ff and get it taken care of, butnobody seems to blink twice when those same FAC say we can do SMI patients, wecan do scitare n by polar and we're going to take those in siphon thosepatients off so making the case for why a Community Mental Health Center inthis case is uniquely qualified to treat these highly acute patients, butthe other side of it is how do you take your services to less acute patient, sounder the OVID epidemic before Ovid?...

Let's say about twenty percent of thepopulation would have a mental health issue in a year. That's no more thandoubled under Ovid, and many of those people are not your typical SMI ormedicate patients. So how do you create programs and scale your work forceusing technology or digital applications, or what have you toaddress this vast increase in the number of consumers and demand fromconsumers for services that you may be, uniquely capable of providing, butyou've been focused on the very acute population for so long? How do yourethink Your Business Model to address that part of it which may providefunding to help you achieve your mission with the SMI population? Sothere's going to be a big push from up the first come in the end to go aftersome of this money to expend their businesses, so you have to beaggressive. A big red leg is: How do you become aggressive enough to putthese things in place before your current or new competitors come in anddo it to you? You know I'm going to recap on a couple of things. I think,first of all, several years ago and people saw nets wor, it's been aroundfor over fifty years now, we've largely served the human services communityduring that entire time. A few years ago, we made this move to startsupporting an additional community often called to as postice, but isreally home, held the Long Term Care, specialty type care and we're startingto see those things more and more compliment each other, and I think theinteresting thing is some of the same needs around providing care outside thetraditional four walls. Mobility, data and analytics are definitely needs forboth communities and what I heard you say- and this is we've both seen- it is,if there's any miss in some of these programs are opportunities. Is Peopledon't play offense fast enough or think big enough? I would even say andthey've been discussions, but then, by the time they get around to it it's toolate, either those fundings aren't there or to the red flag comment thatyou spoke about, others have moved in, and so there's been an expansion and alot of times. Expansion has sort of what we'll all open up more facilities,it'll be more of a vertical scale when the challenge or the opportunity isalso horizonal care scale, is offering more modalities of care, and what otherthings that I might be able to do, and maybe I partner with someone in thebeginning. Maybe those are things that we go out there and do so kept. I thinkthat's great advice, I think it. You know, griefful, it's really kind ofunderscored why we've pursued the things, because our hope is that we'reable to support the needs of our community out there, wherever thatmight take them things that they've been doing for a long time or places atneed they that they would like to go. So I'm going to ask you go ahead, so Iwant to add and to what you just said, because it's a great point in a givencommunity, a skilled nursing facility,...

...an nursing home, assisted living, hasincredible demand for behavior health case services. In a many cases, itdoesn't even know where to get it. The Mental House Center has incredibledemand for primary care, nurses and nurse practitioners and doctors toprovide those services in the home. In many cases they can't fund it. So howdo you get together with these providers? Who all of you have demandin your markets, that the others have skills for and figure out how you canpartner and new and unique ways? While this funding is there- and I would alsosay the other part- is people start late because they say well, this isreally a one, a one year grant or it's a two year grant. Is it really going toto be there for the long term, and I think that the demand, the consumerdemand is so high right now that Congress is going to find a way tosolve this problem and you're either going to be a winner in this or you maynot survive to get to the other side, because somebody else is going to getthe business. Well, you I mean you and I could talk on this all day. If we'veseen we've seen, coved challenge us in many things. One thing it absolutelyhas done is accelerated and driven the awareness of what our communities needand if people remember back to a year ago now the challenge of coved in thereality first sat in and some of our long term care living facilities andwhat was happening and then, as time moved on. We've seen the challengesaround mental health and wellness and though, in those things now, in my mind,have gotten rid of some of the sigma. The barriers and people are saying. Yes,this is part of what we've got to address and has an employer we've seenthat we've seen a desire and an appetite more for those services attraditionally more consumed by very many people. So I think, on thepositive we are going to move to this more wellness, mindst approach and thatphysical health of Cavis you've been saying for years. There is no physicalhealth without mental health and that those two things must be combined and Ithink the goodness is many of us have been doing work now for twenty plusyears, laying the digital foundation collectively together and when youstart thinking about scaling and what you can go, do we're ready and we'reready with dilutions. We know we're also ready to connect and collaborateon the solutions that we need to develop so game, I'm going to move intoanother question, and that is what impact his coved had on the scale ofthe rescue act and other funding for these providers that are sometimesoverlooked, despite being key links in the health careism ye. That's a greatquestion. So, if you think go back to when we started on question number onearound the the High Tech Act, when hi tech was passed, it was a thirtybillion dollar program to implement it across health care, and that was seenas a giant whale of a program and...

...thirty billion dollars was almostunheard of to come through in a single belt. Well, just think about the lastyear, we've had two point: two trillion dollar CARAZA. We had a nine hundredbillion dollar Consolidated Appropriations Act. We have one point:Nine trillion dollars for the art built and we're talking about another twopoint: two trillion dollar infrastructure bills, so the moneybeing spent now is a generational change and a generational opportunityand how we think about community based care in the United States, and I thinkthat those who lead through this will fundamentally change the way we deliver.All of all of the care you just describe whether it's behavioral healthsenior living home care hospes. What have you will fundamentally change? Ifyou, you know in various presentations we've given over the last several years,we've talked about the aging baby boomers coming in. In this you know:Twenty thirty, forty million people who are going to be retiring and need muchmore care over the next several years Congress, as I talked about before, isacting. You know. Part of the infrastructure bill is four hundredbillion dollars for home and community based services to provide home care,hospice private duty services in people's home to keep them out of theout of the community. So when we talked before that you're either going tosolve this problem or somebody's going to solve it for you, so Congress issending we're not going to put. We don't have enough senior livingfacilities to put people in nursing homes, we have to treat them in theirhome. So what is the air? And I'm doing this with air quotes the infrastructurerequired to support them in terms of private duty AIDS and paying parents,or you know, pair paying children to take care of their parents or othertypes of services, so their fundamentally think changing thinkingabout how they care for the aging population in the United States, andthat could be an aging population with Alheim R's disease with mental illnesswith addiction problems with developmental disabilities, all ofwhich our clients take care of and which had complexity to the general,I'm just a healthy person, who's getting older type of population. So you've seen these the congress usingthis opportunity to pump a ton of funding, and I think, while some ofthis may be time gauged in terms of it's going to go on for two years orfour years, there is a tremendous amount of talk about making many ofthese things entitlements to address the pop. You know the changes inpopulation that we have coming down stream and to focus on doing more andmore and more of this care in the community when I think in some respectscab, you know if we do this right, because I know everyone goes to sometain ability and is is just on one and done, and this is one of the reasonswhy we've been so passionate. We've got to show the outcomes I'll go back tothe Kevin Scaly. For those who know you...

...flying me is that we're more focused onoutcomes and efficiency than ever in our ability to be able to show thatthis absolutely does work, that some of the analog approaches that we've usedfor decades won't carry US forward like they need to, and as I look atopportunities like this, while this time has been are the resistance hasbeen significant if we work and collaborate together, we're going toshape the health care ecosystem in a way that we've been dreaming about fordecades, and I know for many of US- our passion lies not just on getting thingsdone, but providing a health care system that is better than we've foundit and I'm excited yes, it's daunting. Yes, it hard what we've been challengedwith has been more than any of us have imagined, but if we focus on the goodthere's going to be some really positive things that come out of thisand I'll go back to an acceleration of things, and you know- and I think havethe easiest one. I can point to this tell a help. How long have you and I'vebeen talking about- tell help we've been talking about for years andmagically overnight when it became hey? This is the way we're going to have todo things. It became the most rapid, easily adopted technology or solutionout there to fundamentally Gan change how people were going to contumely way.Now is a perfect, no we'll have to adapt and iterate on it, but it didbecome a way of seeing you know what we can't do it this way, but we can dothis and we all linked arms to go make it happen so kept on that thought in mylast question here before we get into some closing comments, is I want you toget out of your pistol ball? You real you're, always really good at this. YouChallenge me as you look forward to what the possibilities might be. You'vealready mentioned that some of them the infrastructure bill, that's coming up,you know, what's what's going to happen with cccs other things, can you predictthe future a little bit or at least give when you see the weather patterns?To be that we should be thinking about yeah? I think that some of this stuff,especially around the care in the home, is here to stay. If you think about thepolitical dilemmas that we've had in the past, where the Democrats say theywant to increase everybody's wages at home care age should get fifteendollars an hour while at the same time the Republicans to pick on the otherside are saying we got to cut Medicaid spending, so you, as providers, arebeing forced to pay more for your staff, while the governors are cutting therates that they're paying you. So that's a a rapid death spiral of how doI put my provider business out of my providers out of business and you're,starting to see structural change here where they're say? Okay, you got to paypeople fifteen dollars an hour to do some of these hunca services, but we'regoing to increase your rate and we're...

...going to build that statutorily intothe funding. We've got things around like rumors. Around senators met SuiStavan Allan Blunt proposing to make CCHANGED and providing an F map for it,so that States can fund it. We got a very positive score in terms of costback from the Co and I think if it holds at that level, that would getfunded so things like, and if you talk to our clients that have done cccs,they are all saying it provides more funding. They've been able to expandservices, they've been able to co ordinate care. So it's a win for theconsumer. It's a win for the providers who needed the capital to expand. Sosome of these structural things I think, are going to come out of this covedepidemic and fundamentally changed the way we deliver health care in thecountry and, more importantly, where we deliver health care in the country backtowards people's homes in a way that they want to. Nobody wants to grow oldand die in a hospital, and so the ability to get treated with your familyat home or in a community based provider organization, so your family,who may be taking care of you, can continue to work and have their livesas well. I think this is a once in a lifetime opportunity for providers toreshape the way you deliver care and expand the population to which youprovide that care. So I think it's a great opportunity and we have to movefast to protect our part of health care. Okay, have you said it? I mean I'mgoing to use the. I know it's a cliche once in a lifetime, but it really is-and I think I can see it- we are on the verge of moving from a payment centricsystem to a person centric system that no longer is primary care. Just amedical model mind set primary is what I need when I need it, how I need itand who I need to see it from and if we work together, we are going to makethis happen in a more expeditious way than we thought you no longer decades,no longer years down the road, but in the weeks months and the year before us,we collectively can go show how to make that happen. We collectively have knownwhat continuity of care has been before it became a buzz word and we can showpeople when you look at a person when you work with a person and a personcentric way, we can deliver better outcomes and we can do it moreefficiently. So Ka on that note, has we land here and I give some finalthoughts. What else would you like to say encourage or leave people with inour conversation here? I think it's read or anning what I said before startthinking about the planso. How do you...

...think differently about how you'regoing to deliver the care, and I would use the last year as an example? Youknow a year and a half ago when we said you couldn't have a remote worth orforce when you couldn't do tell a health you couldn't provide many ofthese services over the phone. Everybody was adamant that it couldn'tbe done. Well, we just been doing it for the last year when forced to do it,so I think, taking all your preconceptions and smashing them on thefloor and saying if I had to start from scratch and do it the way my staffwants to do it. My consumers want to be treated in a model that works best foreverybody. How would I actually go and do that to your point about being paidfor outcomes? I think every provider is going to be at risk some time in thefuture, and I think that we've been saying that for years and you're seeingit come up in pilots, it's going to happen. The future, as you said, maynot be weeks away for all of that, but I would say it's years away now, asopposed to decades away, so getting ready to do that and fundamentallyrethinking how you're delivering that care and where you're delivering it isgoing to be the test of those who survive over the next four or fiveyears. So Kevin want to thank you great thoughts, great challenges in sight,and you know on a personal note. I just want to thank you for being an advocatefor our community. As I look back, I'm grateful for the Opportunity arepassive cross. You challenge me to be better and to do better, and I knowmany in our community feel that same way. I also want to thank you for beingan ally, professionally vocationally, we're fortunate when the past we crossacross people who shape us to be better, and you have definitely done that forme and on a personal note, I just wanted to give my thanks publicly andand just right here to you. It has we're talking and then what I wouldlike encourage. Everyone else is well hope. You are enjoying these podcast.This is just another way for us to share connect and collaborate. Thisisn't meant to be an Infomercial, and hopefully you didn't. You didn't hearthat today. This really speaks to wherever you find it find yourselfwhether you're a net, smart client or not. Our Passion is to speak to thewind sheld, the items that are immediately in front of us, thelandscape, those just before us as we've talked about, but also thehorizon. Those aren't is that those that are coming and are going to ask usto do more or to be better and if you've enjoyed this podcast. If youtake a moment, hopefully giving us that five start writing it's a way for us toget the word out there and we'll continue to press in and engage or ifyou have topics or things that you like to share with us. Please do willinclude many items in the show, notes, links and other valuable informationthat we've spoken about to day and lastly, most importantly, may we allremember when we work together when we...

...think together when we action together,we are always better together. Thank you for the time. That's a rap andwe'll let him land today's session. Thank you, Kevin like at net smart. Weunderstand the challenges facing provider organizations. Our team willhelp you navigate changing value, based care models with solutions and servicesthat make person centered care or reality will equip you with technologyand services that provide holistic, real time. Views of Care Histories thatinform better decision. They it and better outcomes visit us today at nTsom net smart serving you, so you can serve others thanks for listening tothe net smart care, threads podcast through collaboration and conversation,we can work together to make health care more connected than ever beforeand better support the communities we serve to ensure you never miss anepisode. Please subscribe to the show in your favorite podcast player, if youuse apple podcast, we'd love for you to give us a quick rating for the show.Just have the number of stars that you think the podcast deserves until nexttime.

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