WHITE HOUSE:

The White House focused this week on their efforts to combat antisemitism, a new “Safer States” initiative on gun violence (full plan is available here as a PDF), and a public-private partnership to expand access to EV’s. Three items of interest for us:

• They released new data showing that investments in Home & Community Based Services (HCBS) totaled approximately $37 billion in 2022. The data brief is available here (PDF). More below in the CMS section. The announcement and data brief are good resources to get a sense of all the executive actions happening in the HCBS ecosystem.

• They highlighted the impact of the Inflation Reduction Act and the rebates that will be issued for 46 Medicare Part B drugs. More below in the HHS section on the information specifically related to the drug pricing negotiation. Overall, it’s a helpful tool to understand the entire spectrum of what the Administration is doing for pharmaceuticals.

• They released a new blog post outlining the Administration’s vision on using AI in healthcare. It’s an interesting insight into the Administration’s thinking and plans for AI.

CONGRESS:

The House wrapped up their business for the year and won’t return till January as Congress heads into the new year without a funding deal. The House’s final act for the year was to pass the annual defense bill, which has now passed 63 years in a row, and sending it to the President’s desk for signature. For our purposes, the passage of the NDAA came despite significant Conservative opposition, highlighting yet again the challenge that faces Speaker Mike Johnson as he attempts to navigate a path forward on funding. Meanwhile, the Senate will continue to work for the next few days on a bipartisan deal to address border security, Ukraine/Israel aid and immigration. A framework is slowly coming together, although final passage is far from certain. Ultimately, we’re in for a tight few weeks to avert a government funding shutdown when the House comes back in January. Elsewhere in the political world:

• As we get closer to the beginning of 2024 state legislative sessions, the National Conference of State Legislatures has several useful tools to prepare for state legislative sessions, including:

• 1) 2024 session calendars for all 50 states.
• 2) The political makeup of the legislatures.
• 3) A full forecast on trending legislative topics, including the need to find more healthcare workers.

• We’ve discussed, at length, the perceived problems with GOP candidate quality in the 2022 midterms. It’s a focus for Republican strategists as they rush to avoid a similar problem in 2024.

• It’s very early, but Congresswoman Diana DeGette, a Democrat from Colorado, is an early favorite to succeed retiring Congresswoman Anna Eshoo as a Democratic member of the House Energy & Commerce’s Committee on Health. It’s an important role that plays a heavy impact on the Congressional healthcare agenda.

• While things can change, with just under a month till the first Republican primary, former President Trump has a significant lead in the race to be the Republican nominee for President.

AGENCIES:

As part of the White House announcement on drug pricing, HHS & CMS released several new guidances and reports related to drug pricing provisions in the Inflation Reduction Act:

• 1) From CMS: Fact sheet (PDF) on the program.
• 2) From CMS: Revised guidance on how rebates for drugs included in the Medicare Part B (PDF) and Medicare Part D (PDF) inflation rebate program work.
• 3) From ASPE (Office of the Assistant Secretary for Planning and Evaluation): A new report (PDF) on rebates issued for 48 drugs (PDF) that are covered by Medicare Part B.

CMS also wrote a letter to PBM’s encouraging them to make sure to support pharmacies and plan D participants by continuing to make sure that cash flow to pharmacies continue, even after a new federal policy that lowers upfront federal payments to PBM’s kicks in on January 1^st. Axios has a good summary of the rule and letter.

As part of the White House announcement on HCBS services, CMS released new guidance for states on how to use available funding to develop direct support worker registries so that beneficiaries can better access caregivers. You can access a copy of the guidance here (PDF).

HHS updated the national plan to deal with Alzheimer’s disease. It’s available here (PDF).

HHS finalized the federal rule on ensuring full transparency on the usage of AI in health IT. They also issued a study in JAMA outlining the “guiding principles” to limit bias in healthcare algorithms.

HHS’ Office of the Chief Data Officer released a new “data strategy” outlining their priorities governing the usage and growth of data in healthcare policy for the federal government. The broad outline is here and the full strategy can be downloaded here (direct download PDF).

The OIG at HHS released a new toolkit designed to show MA plans the diagnostic codes that are at high-risk for being miscoded. You can access the toolkit here (PDF).

FROM THE NOTEBOOK:

• As the joint NY Times-Kaiser Health News series on “Dying Broke” comes to a close, they published a series of reader reactions to the long-term care system in the US.

• A look at the growth of Medicare Advantage among the employer still offering retiree health benefits.

• Axios looked at the latest class action lawsuit against Humana for the alleged usage of AI in systemically denying claims.

• A positive look at a collaboration between a local non-profit and SNF in creating a gift-giving experience for residents at a memory care facility.

• The Washington Post took a long, negative look at assisted living facilities, through the prism of elopements.

ECAP INTEL TOOL OF THE MONTH: Medicare Part B Reimbursements

z-INTEL has released detailed Medicare Part B therapy reimbursement for every SNF in the country. As Intel draws directly from distinct CMS datasets, SNFs can measure Part B reimbursement against rehab department expenses. This analysis is critical for therapy contract pricing, long-term Quality Measures, and ISNP financial performance. The information can be found under the Part B billing tab for each facility.

Questions? Email us at support@myzpax.com.

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• Group Invite Link: https://chat.whatsapp.com/EoNiPi8ezrOBV6SW1Gf7nD
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