A former top adviser to Gov. Eric Holcomb on health care issues has taken a new job as head of Indiana’s largest association of nursing homes, with responsibility for lobbying the state’s legislative and executive branches.
Paul Peaper starts July 1 as president of the Indiana Health Care Association, which represents more than 485 long-term and post-acute care facilities across the state, the organization announced Wednesday.
In his new position, Peaper will lobby the state legislature, as well as administrative and agency officials on matters affecting Indiana’s nursing homes. It is a heavily regulated industry that takes in hundreds of millions of dollars in government money, much of it from the federal Medicaid program, which is funneled through state agencies.
Peaper declined to comment to IBJ, through a spokeswoman from Indiana Health Care Association.
Peaper had served as Holcomb’s senior operations director for four years, serving as liaison between the governor’s office and numerous health agencies, including the Indiana Department of Health, the Family and Social Services Administration, the Department of Child Services and the Department of Insurance.
Peaper left state employment in February 2021, or 16 months ago, thus fulfilling Indiana’s one-year “cooling-off period” before taking his new job in an industry he helped oversee.
Indiana law requires state employees to wait for a year after leaving government to take a job as a lobbyist or with an organization with whom they negotiated any contracts or made decisions that affected their new employer.
For the past year, he has worked as executive director for strategic affairs and corporate partnerships at Indiana University Health, the state’s largest hospital system.
Peaper requested a formal advisory opinion from the State Ethics Commission on whether his move would be allowed by state ethics laws. The panel voted 4-0 on June 9 in favor of formal opinion that says Peaper’s new job would not violate any restrictions that bar former state employees from working on contracts, business transactions, licenses, public works projects and similar matters.
Peaper told the ethics panel that he did not have contracting authority, nor did he make regulatory or licensing decisions in his work for the governor.
Even so, Peaper’s move raised questions from the leader of one government watchdog group, who said a one-year cooling-off period seems low for such a transition from the governor’s office to an industry that has come under close scrutiny in recent years.
“A year is not a long time,” said Julia Vaughn, policy director for Common Cause Indiana, a nonpartisan organization that promotes open and ethical government conduct. “Nursing homes have come under so much scrutiny lately. This industry is heavily regulated for a reason.”
For instance, several executives at the state’s largest nursing home chain, American Senior Communities, were convicted in a massive overbilling and kickback scheme in 2018.
Also, many nursing homes across Indiana were plagued with large outbreaks of COVID-19 during the pandemic.
According to a press release from the Indiana Health Care Association, Peaper helped coordinate all aspects of Indiana’s response to the COVID-19 pandemic, including testing, tracing and overall strategy.
“Paul’s extensive professional accomplishments, deep understanding of our state’s regulatory, legislative and reimbursement landscape, and a contagious passion and energy for public service make him a perfect addition to [IHCA’s] strong team,” Yvonne Tanner, the organization’s board chair, said in a written statement.
Peaper will begin his new job as Indiana’s nursing-home industry is moving into a so-called “managed care model” that will allow elderly Hoosiers to stay at home and get care through state programs as they age.
Indiana has about 1.9 million members in Medicaid, the federal program that pays for medical care, hospitalization, drugs, skilled nursing and other services for low-income and disabled people. But only 19% of the state’s spending on long-term care goes to home-based and community-based services, while the bulk of it goes to nursing homes, according to figures the state provided last year.
Indiana officials said their goal is to get up to 60% of the state’s elderly who need long-term health care the ability to get it in their homes, rather than in nursing homes. Currently fewer than half of the elderly Hoosiers get home care.
Peaper holds a law degree from Indiana University McKinney School of Law, where he teaches health-care business and revenue systems to law students.
He succeeds Zach Cattell, who left the organization this spring after 11 years, including seven years as president. Cattell now works as chief strategy and legal officer at CarDon & Associates, a private company based in Bloomington that runs senior living communities.