STAFFING MANDATE:

That’s a wrap on comments season for CMS’ proposed minimum staffing mandate rule for long term care facilities. The final tally was over 46,000 submitted comments. CMS is obligated to read every one and take the feedback into account when formulating the final rule. There’s no official timeline for when the final rule needs to be issued. If you’re so inclined, you can find a more complete guide to the federal rulemaking process from the Federal Register (PDF) or from the Congressional Research Service (PDF).

Here's a selection of some of the more interesting comments and letters submitted on the proposed rule:

• AHCA: Overview & Letter (PDF)
• LeadingAge: Overview & Letter (PDF)
• American Hospital Association: Overview & Letter (PDF)
• A bipartisan group of 26 Senators (PDF)
• The US Small Business Administration’s (SBA) Office of Advocacy: Overview and Letter (PDF)

WHITE HOUSE:

The White House focused this week on continuing the Administration’s public support of Israel, announcing $16 billion in new funding for Amtrak’s Northeast Corridor, and new efforts to reduce wildfires. Two items of indirect interest for us:

• Ahead of Veteran’s Day, they announced a new program that covers all health care costs for World War II veterans, including for SNF care. They also announced fraud prevention effort aimed at protecting veterans from financial and other scams aimed at veterans and their families. For those of you who work with veterans, they may appreciate hearing about the efforts and attendant resources from you.

• With the two-year anniversary of the Bipartisan Infrastructure Law coming up next week, they published an updated report on the investments and efforts made as result of the Law. It’s a good summary of the many different projects that can be found across the country and is a useful guide to understand where federal investments are happening right now.

CONGRESS:

With only a week to go till a government shutdown at midnight this Friday, November 17^th, there’s not a lot of wiggle room for new Speaker Mike Johnson to find a path forward that has a chance of getting passed. Many of the same challenges that faced his predecessor still exist, although Speaker Johnson has more support from the more conservative members of Congress. For now, the most likely end game is a short-term continuing resolution (CR), with some nuances, as Conservatives seem inclined to give the new Speaker some room to navigate the difficult political math. With Democrats using GOP disarray in political messaging, it’s anyone’s guess as to what the next week looks like. Elsewhere from the political world:

• One huge item for 2024 was Senator Manchin of West Virginia’s announcement that he will not run for reelection, clearing the way for the seat to switch to the GOP. The switch heightens the chances for the GOP to retake the Senate in 2024, although the GOP will have to win a few competitive races to do so. Politico has an excellent behind-the-scenes look at the long game played by Senate GOP Leader McConnell.

• It was a strong showing for Democrats in the local elections held this past week, although takeaways for 2024 are unclear. It’s obvious that abortion remains a major energizing factor and the GOP continues to struggle with crafting the right response.

• The Senate Finance Committee unanimously passed several pieces of bipartisan legislation that cover Medicare Part D payments, PBM legislation and delays cuts to safety new hospitals. You can find the Committee’s summary of the legislation here (PDF). Practically, this increases pressure on the full Senate to properly move the legislation.

• Senator Manchin wasn’t the only retirement this week. Three House members announced their retirements, raising the total number of Congressional members not seeking reelection to 30.

• One interesting CRS report from the week: with Ohio becoming the 24^th state to legalize recreational marijuana, the CRS prepared a report for Congressional Members on economic development issues related to marijuana legalization. It’s available here (PDF).

AGENCIES:

CMS issued a proposed rule that increases oversight on Medicare Advantage plans. They also published a fact sheet on the changes. The Washington Post, USA Today, and Fierce Healthcare have summaries of the proposed rule. A prepublication PDF of the rule can be access here. The rule is scheduled for publication to the Federal Register on November 15^th, at which point a 60-day comment period will kick off.

The OIG at HHS performed an audit on Medicare claims data, urging CMS to use to better identify potential cases of abuse or neglect among Medicare beneficiaries. It’s something to monitor in case CMS increases the reporting requirements on providers as a result. You can download a copy of the report in brief and full summary (both PDF).

FROM THE NOTEBOOK:

• It’s always good to see innovative approaches to recruiting folks to the long-term care industry. A new proposed packages of rules was introduced in the Pennsylvania Senate that would look to modernize training and incentivize folks to join the direct care workforce. PHCA worked hard behind the scenes to get the ball rolling on these discussions.

• The Kaiser Family Foundation released a new "first look" at Medicare Advantage plans and enrollment for 2024. They also released a front-lines perspective on how the Medicaid unwinding is directly impacting beneficiaries.

• An important research study in JAMA highlighted the challenge that SNF’s in particular face with staffing, as job losses happen at triple the rate in SNF’s versus other healthcare providers. .An interview with the author is available here. McKnight’s has a good summary.

• The LA Times looked at the financial implications of California’s $25 minimum wage for healthcare workers, as well as what it means for the state and providers.

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