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SNF Digest #87

Freestyle8 min readMay 5, 2024

Minimum Staffing Rule:


As we had no Digest the week following the release of CMS’ Minimum Staffing Rule, here’s an update on the latest:


This is the official announcement from the White House, originating out of the office of the Vice-President. This is HHS’ press release as well as the fact sheet from CMS. The rule is scheduled to be published to the Federal Register on May 10th, which is the formal date that will be used for implementation of the specific timelines laid out in the rule. A prepublication copy of the rule is available here (PDF).


Zimmet Healthcare has prepared an in-depth analysis of the minimum staffing rule. It’s a great way to get a handle on how ill-advised the minimum staffing rule is, as well as understand the forecasted financial impact it will have on SNF’s across the country. You can find a link in the first item in our “Tools & Resources” section.


If you’re an AHCA member, you can find a recording of their webinar on the rule here. They’ve also prepared a full summary and guideline that are available via your state associations or from AHCA directly.


Other coverage:



WHITE HOUSE:


Over the last two weeks, the White House focused on new efforts for teacher recruitment and retention, $3 billion in funding for lead pipe replacement, a new round of student loan debt cancellation, a new “National Security Memorandum” on protecting critical infrastructure (available here), hosting a summit for “sustainable schools” , and more actions and funding for climate projects. Three items of interest for us:


  • 180 days after the President’s Executive Order on AI, they provided a progress update on where all federal agencies stand regarding the EO’s deadlines. It’s a good resource to identify every federal agency’s plans for AI. I’ve split out HHS’ newly issued plan below in the agency section below. You can find the progress report for the federal government’s goal of integrating AI talent into key federal jobs here (PDF).


  • In recognition of “Second Chance Month”, they published an update on the Administration’s actions to support individuals returning home from jails. One key point is their efforts to make it easier for folks to qualify for Medicaid, something that they are urging states to focus upon. It’s an important trend to monitor.


  • They finalized their rule to make it easier for DACA recipients to qualify for health care. The full rule will be linked below in the agency section, but as many residents and staff may have family members who qualify, it’s something they may appreciate hearing about from you.


CONGRESS:


Having ushered Congress through funding bill battles, including foreign aid, GOP Speaker Mike Johnson appears to have found new footing in his role. He was rewarded for his bipartisan work on foreign aid with Democrats announcing that they would support his role as Speaker ahead of an expected motion to vacate next week (the same procedural vote that cost former Speaker McCarthy the job). With several items still left on the to do list, including the FAA reauthorization and farm bills, expect the uneasy partnership between the Speaker and Democrats to continue, despite the ongoing conservative frustration. For now, with the next budget deadline not until the end of September, it’s going to be a lot of political posturing and noise coming out of DC. Elsewhere in the political world:



  • The House Energy & Commerce Subcommittee held a hearing on the Change Healthcare cyberattacks. The official committee recap can be found here. Fierce Healthcare also has a report.


  • The formal rules is yet to be released, but following reports that the Biden Administration will reclassify Marijuana as a schedule III drug, the Justice Department confirmed in a statement that they are in the final stages of the pre-rulemaking process. Once reclassified, there will be significant implications on marijuana legality and the murky relationship between federal and state policies regarding its oversight. The CRS issued an updated version of their report on what the legal consequences of reclassification will be. It’s available here (PDF).


  • As expected, NY State Senator Tim Kennedy won a special election for an open Congressional seat.


  • Six months out from election day, the path for the GOP to retake the Senate remains clear, they are wary of any predictions on that front, especially if they run into another candidate quality challenge.


  • 3 useful CRS reports from the last two weeks (all links to the PDF):


  • LSB11156 – a guide to the DOL’s new independent contractor rule
  • R48053 - a guide to how the federal government manages their Data
  • R48058 – An analysis of IDR claims under the No Surprises Act


AGENCIES:


HHS published their guide on how the agency will be using AI in the administration of public health benefits. You can download a copy here (PDF).


The FTC issued a final rule that will ban noncompete agreements. You can access copy of the rule here (PDF). The US Chamber of Commerce has already filed a lawsuit against the final rule.


The Department of Labor issued a final rule to expand overtime protections for salaried employees. They published a comprehensive guide to the rule and who is covered by the protections. The final rule, scheduled to go into effect on July 1st, 2024, can be found at the Federal Register. You can download a full copy here (PDF).


In addition to the minimum staffing rule, CMS also released a final rule on Medicaid adequacy. The fact sheet is here. Key dates and timelines can be found here (PDF). The final rule is scheduled to be published to the Federal Register on May 10th. In the meantime, if you’re in the mood for a little light bedside reading, the 1,004 page rule can be accessed here (PDF).


As the Medicare Drug Price Negotiation process continues, HHS released, via CMS, a new draft guidance and fact sheet on the program. It’s a good way to understand how changes to the program will impact those covered by the program.


CMS issued a new guide for individuals leaving prison on how to access healthcare upon reentry into the community. You can download a copy here (PDF).


HHS finalized their rule on protecting individuals with disabilities. Their guide to the rule can be found here. The final rule will be published to the Federal Register on May 9th. In the meantime, you can download a copy of the relatively svelte 436-page rule here(PDF).


HHS issued a press release on final rule on DACA recipients, mentioned above. The fact sheet is here. The final rule is scheduled to be published to the Federal Register on May 8th. In the meantime, you can download a copy of the prepublication rule here.


The OIG at HHS released an audit on compliance by SNF’s in Florida with federal background checks, finding that SNF’s were in compliance with federal requirements. The report in brief is here (PDF) while the full report is here (PDF).


FROM THE NOTEBOOK:


  • A good read from Stateline on which states are using their Medicaid programs to help individuals being released from prisons.


  • With litigation one key part of the strategy against the minimum staffing rule, a timely read on the constant back and forth between the administration and representatives of different industries on the many regulatory efforts undertaken by the Biden Administration.



  • With the Administration urging states to use their Medicaid programs for more than traditional uses, a look at how Oregon is using the program to fund climate initiatives, including air conditioners.


  • A Minnesota board, empowered by the legislature to establish standards for their SNF workers, voted to increase the state’s minimum wage to more than $23.


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SNF Digest #87

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