WHITE HOUSE:

Over the last two weeks, the White House focused on a new effort to replace all lead water pipes, more on a climate change, their work on HIV, and their international collaboration with the Asia-Pacific region. Two items of interest for us:

• They announced a series of actions to protect the supply chain and protect against future shortages. One particularly relevant piece is that they’re looking into how to use the Defense Production Act to give HHS more authority and flexibility to invest in domestic manufacturing of medicines and other medical necessities.

• As part of Small Business Saturday, they announced an investment of more than $50 million to 20 states to support small businesses, with a special focus on businesses in minority communities. The full details of the awards can be found here. The funding will help states provide more support and investment to launch small businesses.

CONGRESS:

With the Thanksgiving recess in the rearview mirror, Congress returns to DC with several items on a packed agenda. Most of the legislation that need to be addressed, such as aid to Israel, federal surveillance authority and FAA authority, are unrelated to healthcare. For our readers, the next key deadline is January 19^th, when the first of the current funding bills expires. On that front, there seems to be little actual progress, and as highlighted by the struggles to find consensus on the must-pass Defense bill, the GOP is moving backwards. In fact, many of the same Conservative concerns are popping up again for the new Speaker and portend a contentious 6 weeks till the funding deadline. While 6 weeks seems a lot, it’s only 16 legislative days, and, as always in Washington, DC, it won’t be easy. Elsewhere in the political sphere:

• Senator Deb Fischer (R – NE) announced that she is going to introduce legislation that would bar CMS from implementing the minimum staffing rule and would create an advisory panel to identify real solutions to the workforce crisis. The legislation is expected to receive significant bipartisan support. While its passage is far from certain, it shows just how unpopular the staffing mandate is and the need to focus on incentivizing new workers, not trying to mandate them into existence.

• The House Energy & Commerce Health Subcommittee held a hearing on AI in healthcare. The focus was on the need for proper regulation and data privacy. As healthcare AI continues to evolve, the push to regulate is an important trend to monitor.

• Congress continues to face a series of retirements, including those with significant healthcare expertise. We’re now up to 36 members not seeking reelection, which can cause significant challenges for constituents. Former Speaker McCarthy has not decided yet if he’s going to run for reelection. Adding in the George Santos expulsion (here’s the process to replace him) and Senator Fetterman’s push to oust Senator Bob Menendez and 2024 is shaping up to be a tumultuous year for replacements.

• Several states pushed hard for expedited work permits for migrants. The early results, as seen through the eyes of New York, are not promising.

• One interesting CRS report, available here (PDF). It’s an overview of the current legal framework governing PBM’s.

AGENCIES:

Several weeks ago (November 15^th) HHS released the new set of standards for marketplace insurance plans. Included in the standards was a new proposed rule that would allow states to add dental benefits as an essential health benefit and be included in plans. Joining the call for more dental coverage was Senator Durbin.

As new rules governing Medicare Advantage roll out, the Biden Administration is enlisting the public’s help in cracking down on the many misleading ads for MA plans. Amid mounting criticism from providers, several post-acute care organizations, including AHCA and Leading Age, sent a letter (PDF) asking CMS to ensure plans comply with federal requirements.

On the heels of several high-profile cyberattacks at hospitals, HHS recommended an urgent fix (PDF).

The OIG at HHS did an audit of Managed Medicaid organizations and found that states made payments to MCO’s after enrollees had died. You can find the complete report here and the summary here (both PDF).

The IRS announced that they are delaying, yet again, new reporting thresholds for 1099 contract employees.

FROM THE NOTEBOOK:

• As the Medicaid unwinding continues to purge beneficiaries from Medicaid rolls (for example, 400,000 in New York), causing significant backups for call centers, states are using this as an opportunity to rethink how they connect with Medicaid beneficiaries.

• North Carolina’s Medicaid expansion is now in effect, covering an additional 600,000 beneficiaries.

• Yet another study, this time from Harvard (PDF), was released highlighting the increasing cost and unaffordability of long-term care. Continuing the theme of the cost of long term care was another article in the Dying Broke joint series from the Kaiser Family Foundation and the NY Times, featuring the failure of long-term care insurance.

• Another look at the lawsuit regarding MA denials and their usage of AI in medical care.

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.

z-INTEL WhatsApp info:

• Group Invite Link: https://chat.whatsapp.com/EoNiPi8ezrOBV6SW1Gf7nD
• Status Link: https://wa.me/message/WMSWZATTB5D6E1