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SNF Digest|Clinical|Finance|Reimbursement|Compliance|Operations

SNF Digest #101

Freestyle4 min readSep 1, 2024

Happy Labor Day!

WHITE HOUSE:


As we approach Labor Day and the end of the summer, it’s been quiet in DC. The White House focused this week on making permitting easier for solar energy production, the Administration’s high-level meetings with China, and the 53rd Pacific Islands Forum. One item of interest for us:

  • Continuing the theme of the Administration on drug pricing, the White House publicized a decision by Eli Lily to make one of their weight loss drugs more affordable for consumers. While the drug may not specifically impact the long-term care population, it’s a sign of the Administration’s continued intent to do whatever is necessary to drive down drug prices, something that is relevant to the long-term care sector.

CONGRESS:

With Congress in the final weeks of their August recess, and set to return to the Hill on September 8th, talks are starting to heat up on funding. It’s been the theme throughout the last few months, but with messaging bills being bandied about, there’s a real threat that it’s going to cause problems with the upcoming spending fight. Congressional leadership is pushing hard to ease the process, though, and the likelihood remains that a short-term funding bill that will take us till after the election will see us through. Elsewhere in the political world:

  • While there’s been little recent movement at the federal level on AI, California’s extensive bill passed the Legislature earlier this week. The bill is now headed to the Governor’s desk, and there’s been little indication as to whether he’s going to veto it. The bill, which has strong supporters and detractors, represents the most extensive piece of legislation governing the use of large language models and machine learning. Should the Governor sign it, it will become the standard for AI bills nationwide.

  • California also passed a PBM bill, which will regulate the drug pricing and disclosure requirements for PBM’s. The bill can be found here.

  • While the focus is on the Presidential election, the control of Congress remains very much up-for-grabs.

  • Some musical chairs going on in Congress, following the passing of longtime Rep. Bill Pascrell, with NJ State Senator Nellie Pou chosen as the replacement for Bill Pascrell, while Nevada’s Congressman Steven Horsford is likely to replace him on the Ways & Means Committee.

  • One interesting CRS report from the week: we’ve been tracking the federal effort to reclassify marijuana to a Schedule 3 drug. The CRS analyzed what that would mean practically in terms of financial services for marijuana businesses. You can access a copy here (PDF).

AGENCIES:


During court filings this week in a lawsuit between the DOJ & United Health, it was revealed that CMS backed off on requiring Medicare Advantage plans to refund the government for overpayments.

HHS, via SAMHSA, awarded more than $65 million to help tackle youth mental health and substance abuse issues. A full list of programs and funding opportunities can be found at the link.

CMS gave formal approval to Kansas State Plan Amendment (PDF) to expand Medicaid Dental benefits to those over 20.

FROM THE NOTEBOOK:

  • Massachusetts also fined two staffing agencies for failing to comply with the state’s rate limits for temporary staff.

  • A good, if lengthy, read from JAMA on the state of federal agency action from CMS and Congress on steps that are being taken to rein in Medicare Advantage.

  • An in-depth look at New York’s plan to use Medicaid for social determinants of health, like housing, transportation, and food.

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SNF Digest #101

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