« Health Innovation Highlights: June 10, 2021 Issue

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New Rhode Island Law Raises Nursing Care Staffing Levels to Highest in Nation, Boosts Pay

Raise the Bar on Resident Care coalition members surround certified nursing assistant Adelina Ramos as she introduced Rhode Island Gov. Daniel McKee (right foreground) before he enacted the Nursing Home Staffing and Quality Care Act.

Center partners Rhode Island Organizing Project (RIOP), Senior Agenda Coalition of Rhode Island and The Economic Progress Institute (EPI) achieved a stunning and progressive victory very early on in their work related to the Voices for Health Justice Project, a collaboration with Community CatalystCommunity Change and the Center on Budget and Policy Priorities. Rhode Island’s nursing home staffing levels consistently ranked near the bottom, at 40th in the nation and last in New England, for hours of direct daily resident care. That’s why, nearly two years ago, RIOP, Senior Agenda and EPI joined the Raise the Bar on Resident Care coalition to boost staff-to-patient ratios in the state’s nursing homes and to provide a minimum standard of care in a 24-hour period.

On May 27, Gov. Daniel McKee signed into law the Nursing Home Staffing and Quality Care Act, marking a huge step forward in improving the quality of nursing home care for thousands of Rhode Island residents and their hardworking caregivers. This major achievement would not have been possible without countless letters, phone calls, town halls, rallies and legislative visits by so many individuals organized through the Raise the Bar Coalition. 

The new law will require an average of at least 3.58 hours of direct nursing care per resident, per day, starting on Jan. 1, 2022, and 3.81 hours starting on Jan. 1, 2023. In addition, it will provide caregivers a pathway out of poverty by ensuring that 80 percent of Medicaid rate increases go directly to wage boosts for staff who work at nursing homes. Adelina Ramos, a certified nursing assistant at the Genesis Healthcare nursing home in Greenville, who introduced Gov. McKee at the signing event, said of the bill, "More staff will be such a relief in our bodies, minds and spirits.” “It will allow us to focus on better care... and by raising wages we will be able to attract more caregivers to the field who will know their work is valued and fairly compensated."

You can read more about this legislative victory here and here.

Illinois Medical Debt Legislation Passes Unanimously

Center partners in Illinois, The Illinois Coalition for Immigrant and Refugee Rights, Mujeres Latinas en Accion, Southwest Suburban Immigrant Project, Mano a Mano Family Resource Center, Enlace Chicago and Legal Council for Health Justice scored a major legislative victory with the unanimous passage of the Hospital Financial Assistance Accountability and Transparency Act (SB 1840). This bill will ensure that most ho

This advocacy effort was part of the Center’s Community Benefit & Economic Stability Project, which supports grassroots organizations in working with health systems to change billing and collection practices, as well as financial assistance programs, so that people are better served by the hospitals in their communities.

RAISE Family Caregiving Advisory Council Stakeholder Listening Sessions

As part of our work with the RAISE Family Caregiving Advisory Council, and under the auspices of the National Academy for State Health Policy (NASHP) and the Administration for Community Living, Center staff co-presented with University of Massachusetts Boston faculty about stakeholder listening sessions with aging and disability organizations held in the fall of 2020. The listening session findings will help inform the work of the Council, which is tasked by Congress to develop a national family caregiving strategy. Slides are available of the presentations given by the six collaborating organizations that make up the Older Adults’ Equity Collaborative.

Guest Blog Roundup: Center Partners’ Local Work in Their Own Words

Over the last month we've published three guest blogs that offer an opportunity to get first-person reporting of what's been happening on the ground for our partners during the grueling 15 months since the COVID-19 pandemic began. The first blog, "Georgia’s Health Care Transportation Crisis: James and Lamar County," was originally published on the website of our partners at Georgians for a Healthy Future (GHF), a partner in the Center’s Consumer Voices for Innovation 2.0 grant program. Each CVI 2.0 partner focused on an area of consumer engagement related to housing security, food security or transportation. This blog braided a 2020 analysis conducted by GHF and a conversation with James, an advocate for supporting the intellectual and physical disability community. 

The next two posts come from partners working on the Center’s Building Community Capacity to Shift Health Care Investment, funded by the Kresge Foundation. The first, “Community Is A Ham Bone,” was authored by Theresa Trujillo, director of community organizing at Colorado's Center for Health Progress. Through the delightful metaphor of a delicious ham bone, Theresa describes how grassroots organizers, community members and partners have been critical to their success in cultivating community and building power, all while providing tangible resources and community connection. The final guest blog, “The People Closest To A Problem Are Closest To The Solution,” was co-authored by three staff members, Kyle Brown, Lynn Buske and Gloria Godchaux, at Wisconsin-based JONAH - Joining Our Neighbors, Advancing Hope. In this blog, they collectively write about the work JONAH is doing in several of its programs, specifically related to housing for formerly incarcerated individuals and addressing social justice issues for those who experienced trauma. These last two blogs demonstrate the value of investing in local communities, in these cases by the Kresge Foundation, to solve their own problems.


Study: Medicare Advantage Dual-Eligibles Less Likely to Miss Care

An article in Modern Healthcare [subscription required] reports on a study by NORC at the University of Chicago finding that dual-eligible beneficiaries enrolled in Medicare Advantage plans were less likely to experience care disruptions during the COVID-19 pandemic than those in traditional, fee-for-service Medicare.Medicare Advantage dual-eligibles are more likely to be older, more ethnically diverse and have chronic conditions – all placing them at a greater risk for contracting COVID-19. These findings shed light on how Medicare Advantage is meeting the needs of one of the most vulnerable patient populations.

LTSS: Charting the Challenges of Caring for an Aging Nation

A Kaiser Health News article and infographic details the substantial growth of aging adults in the United States and the challenges ahead for providing and paying for long-term services and supports (LTSS) for this cohort The report highlights how the number of adults 65 and older in America is expected to nearly double in the next 40 years, and that more than half of people turning 65 will need long-term care services at some point. Data visualizations in the report illuminate the rising cost of facility and in-home care services, as well as the financial burden this will place on older adults who have no retirement savings and lack the financial resources to pay for basic needs.

State Opportunities to Strengthen HCBS Through the American Rescue Plan

The American Rescue Plan of 2021 provides states with enhanced funding to increase access to home and community-based services (HCBS). An article by the National Academy for State Health Policy (NASHP) summarizes guidance given by the Centers for Medicare & Medicaid Services to states on how to use this new funding. The article also describes opportunities for states to strengthen HCBS by bolstering the long-term care workforce, addressing equity, supporting family caregivers and investing in behavioral health recovery.

CMS Issues Guide to Using Its Health Communities Health-Related Social Needs Screening Tool

The Centers for Medicare & Medicaid (CMS) released “A Guide to Using the Accountable Health Communities Health-Related Social Needs Screening Tool: Promising Practices and Key Insights.” It describes the health-related social needs (HRSN) Screening Tool from the Accountable Health Communities Model and shares promising practices for universal screening. HRSNs are individual-level, adverse social conditions that negatively impact a person’s health or health care. HRSNs are distinguished from social determinants of health and can be identified by the health care system and addressed in partnership with community resources. Identifying and addressing HRSNs can have many benefits, including improvements to individuals’ health and reduced health care spending. CMS prepared this guide for health care and social service providers who are increasingly adopting the practice of universal HRSN screening.

The guide includes the tool in its three available versions: (1) a standard, self-administered version, (2) a proxy version in which questions are adapted to enable someone to answer on behalf of the patient, and (3) a multiuse version that includes language for a proxy as well as for patients answering for themselves.

Using Prospective Payment to Support Advanced Primary Care: Opportunities for States

The Center for Health Care Strategies published a new blog post in their learning series on Strengthening Primary Care through Medicaid Managed Care. This post discusses the potential for prospective payment models to support primary care practices in offering more comprehensive care. This model – upfront payments not tied to specific service codes – may allow providers more flexibility and the financial stability needed to implement more innovative primary care models including integrating physical and behavioral health care, addressing health-related social needs (HRSNs), and creating opportunities to advance health equity.



Legislation is on its way to the governor’s desk that will limit hospital bills and monthly payments for every Coloradan at or below 250 FPL. Hospitals will be required to screen every uninsured patient for eligibility for public coverage and discounted care. Billing practices and screening processes will be simplified and made uniform in hospitals across the state. Consumers will be given information in their primary language about their rights in the billing process. Additionally, strong enforcement mechanisms will be in place to allow patients to have legal tools to enforce their rights to receiving discounts, screening and other fair billing practices before being sent to collections.


Nevada, Gov. Sisolak enacted S.B. 248 which requires collection agencies to notify consumers no less than 60 days before taking any collections action on medical debt. Collection agencies will also be prohibited from initiating civil action if the amount of the medical debt is less than $10,000. Collectors will be prohibited from charging fees of more than 5 percent of the total medical debt, excluding interest, late fees, collection costs, attorney fees and other costs. 

New York

In New York, Gov. Cuomo signed legislation to protect residents from having their stimulus payments garnished by debt collectors. All relief payments to New Yorkers, including stimulus payments, tax relief, rebates and tax credits will be protected. Any persons subject to money judgements enforced against their bank account will receive a notice of these protections and if their account has been frozen by a creditor, they should return a form included with the notice to get the funds released.

North Carolina

Last month, the North Carolina Department of Health and Human Services selected organizations to serve three regions of the state as a part of their Healthy Opportunities Pilot. The goal of the program is to integrate non-medical interventions into the delivery of health care to reduce costs and improve the health of Medicaid beneficiaries.

South Carolina

South Carolina’s Healthy Connections (the state’s Medicaid program) collaborated with the Centers for Medicare & Medicaid Services in December 2020 and January 2021 to conduct in-depth interviews with a sample of participants in Healthy Connections Prime, the state’s duals demonstration program, including members in urban and rural areas of the state. Key findings reported from members are:

  • high satisfaction with the program and appreciated the outreach from their care coordinator;
  • peace of mind from full benefits coverage and the health plans’ attention to the members’ health care needs; and
  • access to high quality and compassionate care providers and helpful care coordinators and waiver case managers.


The goal of a new program in Tennessee is to help patients work out a deal with medical providers. Thousands of medical debt cases are filed every year but frequently patients don't show up for court appearances, often resulting in a default judgement in favor of the bill issuer. The default judgement allows hospitals and other creditors to start garnishing wages without the patient's knowledge beforehand. Hamilton County is testing a new online dispute resolution program to help patients work out a deal without having to come to court or talk during business hours. This free platform allows patients to text the hospital and contest charges. The state will also provide a mediator at no cost to either party. The Tennessee Med Debt Pilot Program is funded by the Tennessee Supreme Court Access to Justice Commission. It’s starting in Chattanooga and only with Erlanger Health System, which has agreed to work with patients through the portal. But the hope is to eventually expand statewide.


Last month, the State of Reform reported that the Texas Legislature may pass a bill aimed at permanently expanding telehealth services previously put in place due to the pandemic. If this bill passes, public health insurance programs will be required to cover certain services provided via telehealth, such as preventive health services and physical therapy. 


Wednesday, June 16 (1:30-3 p.m. Eastern) - Webinar: The Biden-Harris Administration's Caregiving Initiative: Investing in Medicaid HCBS, presented by Brandeis University. Please register for the webinar.  

Wednesday, June 16 (1:30-3 p.m. Eastern) - Webinar: Integrator Organizations: Bridging Health Care and Social Services, presented by Manatt, Phelps & Phillips, LLP. Please register for the webinar.  

Wednesday, June 16 (2-3 p.m. Eastern) - Webinar: Recommendations on Increasing the Uptake of Shared Decision-Making in Integrated Behavioral Health Care, presented by the Primary Care Collaborative. Please register for the webinar.  

Thursday, June 17 (2-3 p.m. Eastern) - Webinar: What it Takes to Age in Place: Bringing Housing and Home & Community-Based Services (HCBS) Together, presented by the National Center on Law and Elder Rights. Please register for the webinar.

Thursday, June 17 (3-4 p.m. Eastern) - Webinar: Shared Measurement: Collaborating with Communities Toward Equitable Health Outcomes, presented by the National Center for Complex Care and Social Needs. Please register for the webinar.

Tuesday, June 22 (1-2 p.m. Eastern) - Webinar: Inverting the Burden: A Health Equity Strategy for Delivering Complex Care, presented by the National Center for Complex Health and Social Needs. Please register for the webinar.

Tuesday, June 22 (1-2 p.m. Eastern) - Webinar: Quality and Accountability in Medicaid Managed Care - Where We Stand in 2021, presented by the National Health Law Program. Please register for the webinar.

Thursday, June 24 (1-3 p.m. Eastern) - Virtual Release Event: First Stop Enrollment: Getting it Right for Medicare-Medicaid Enrollees, presented by the Center for Consumer Engagement in Health Innovation. Please register for the event.

Monday, June 28 (2:30-3:45 p.m. Eastern) - Webinar: Uprooting the Structural Drivers of Health Inequity: Policy Solutions for a Values-Based Food System, presented by ChangeLab Solutions. Please register for the webinar.