STAFFING MANDATE:

A reminder that the comment period for the minimum staffing rule ends today, Monday, November 6^th. If you’re a reader of the digest, it’s likely that you’re interested in the SNF world. It’s imperative that everyone submit comments to CMS on the unfunded and unfeasible nature of the minimum staffing mandate; a rule their own study says is impossible to implement. To that end, please submit comments to the rule at the Federal Register. If you need help or guidance, please reach out.

AHCA has created a simple tool to guide and assist in submitting comments here. They’ve also created an issue brief with talking points available here (PDF). Lastly, at the request of AHCA, Clifton Larson Allen did an analysis of the funding requirement for this rule, finding that it would cost $6.8 billion and would need 100,000 more workers than are currently in the field. The study can be found here (PDF).

A few sample comments from the more than 26,000 that have already been submitted:

· From a state legislator in New Hampshire.

· From a Director of Nursing in Pennsylvania.

· From a business office manager in Kentucky.

· From an assistant Director of Nursing at state VA home in South Dakota.

· From the Regional VP of a long-term care network in Tennessee.

· From a Managing Director at a commercial bank in Illinois.

Earlier this week, McKnight’s ran a summary of provider comments that can serve as a good template for other provider submissions.

If you’re not an operator, Direct Supply’s Senior Living Advocacy has created a portal specifically for vendors with guidance on submission of comments. They also hosted a live stream with the latest happening in DC.

WHITE HOUSE:

The White House focused this week on the third global gathering to fight ransomware, a $5 billion investment in rural communities, and a $1.3 billion investment in strengthening the nation’s energy grid. 2 items of interest for us:

• The President issued a new executive order to regulate the development and deployment of AI. Here’s a good summary of the overall EO, as well as a look at the primary aims. You can read the full EO here. Given the profound implications for AI growth and innovation, this is important to monitor.

• Building on their recent efforts on junk fees, the White House directed the Department of Labor to create a new rule that will minimize junk fees in retirement plans.

CONGRESS:

Welcome to the Speaker role, Mike Johnson. In his first full week as Speaker, the Congressman is already taking a much more conservative stance than his predecessors, beginning with a stand-alone financial aid package to Israel that is a non-starter with Democrats, the White House, and Senate GOP leader McConnell as the bill ignores Ukraine and gets funding by raiding money appropriated for the IRS.

In the bigger picture, there are only two weeks to go until the government shutdown deadline. With the Speaker taking such early hardline positions, the path forward remains unclear, especially as GOP infighting continues (although Democrats are also struggling on that front). As always, it’s a waiting game for DC to get their act together. Elsewhere from the political world:

• Ranking Member of the Senate Finance Committee Mike Crapo (R – ID), together with Congressman Jason Smith, Chairman of the House Ways & Means Committee and Congresswoman Cathy McMorris-Rodgers, Chairwoman of the Energy & Commerce Committee sent a letter to the Biden Administration asking them to withdraw the Minimum Staffing rule. You can download a copy of the letter here (PDF).

• 15 Republican governors sent a letter to the Biden Administration asking them to pull back on the minimum staffing rule. You can download a copy of the letter here (PDF).

• Next week marks two gubernatorial elections in deep red states that are seen as an early test of which way the 2024 presidential winds are blowing.

• Speaking of 2024, the Biden Campaign believes that it’s going to be very tight and are planning accordingly. Indeed, polls from last week have President Biden behind in a 2024 race against former President Trump. With that in mind, Axios examined the Democratic field behind the President.

• With the focus on AI this week, Politico explored the state of AI regulation for healthcare.

• The CRS updated their guide for older Americans on access to information related to benefits. You can download a copy of the report here (PDF).

AGENCIES:

CMS issued a whole slew of final rules this past week that impact our sector:

• The Home Health final rule: Here is the Fact Sheet, as well as the unpublished PDF of the final rule, scheduled for publication on November 13^th at the Federal Register. Home Health Care news has a summary.

• The Physician Fee final rule: Here are links to the press release and the fact sheet. They also created a specific guide to the Shared Savings Program (attached). You can download an unpublished PDF of the final rule, scheduled for publication to the Federal Register on November 16^th. The American Hospital Association has a summary.

• The Hospital payment system final rule: Here is the fact sheet for the overall rule. They also released a press release and fact sheet for the specific components related to hospital price transparency. The unpublished rule is available here (PDF) and is scheduled for publication to the Federal Register on November 22^nd. Fierce Healthcare has a summary.

• Included in the hospital final rule was a proposed fix to the 340B drug payment program that has been mired in litigation, with CMS proposing a lump sum payment to affected providers. You can find a summary here.

Building upon the CURES Act, HHS introduced a proposed rule that would establish “disincentives” for health care providers that commit information blocking. The rule is available for comment at the Federal Register through January 2^nd, 2024.

We’ve mentioned efforts by states to use their Medicaid programs to end homelessness and increase affordable housing. HHS, via the Administration for Community Living (ACL) and HUD, launched the “Housing and Services Partnership Accelerator” which is designed to give states support to expand these programs.

The VA launched a 120 day “Tech Sprint” with up to $1 million in grants to develop an AI solution that enables better dictation by clinicians during taking notes, allowing them to minimize their non-clinical work and hopefully reduce burnout.

The OIG at HHS released an audit on the HRSA’s Round 1 PRF payments and found that HHS generally got the funds to eligible recipients and established proper oversight. You can access a copy of the report in brief (PDF) and the full report (PDF).

We mentioned back in September that CMS issued a rule to streamline Medicaid applications. The Kaiser Family Foundation has a summary on what the rule means for beneficiaries.

FROM THE NOTEBOOK:

• The Kaiser Family Foundation reports that there are now more than 10 million Medicaid beneficiaries that have been disenrolled since the Unwinding began. They also published a story on crossing the threshold.

• Dr. Grabowski coauthored a piece in the New England Journal of Medicine on the Minimum Staffing rule and called for payment reform to make the minimum staffing rule actually sustainable (free registration required). McKnight’s has a summary.

• Another state effort to recruit staff is off to a strong start, highlighting a theme that focusing on finding and incentivizing new staff is a more practical way to address the staffing shortage.

• Yet another look at how MA plans are consistently denying claims, causing major financial pressure on rural hospital systems.

ECAP INTEL POST OF THE MONTH:

We often cover the different rules governing Medicare and Medicaid programs, including the budgetary decisions at the state and federal levels on funding levels for the program. Check out z-INTEL Co-Founder Marc Zimmet’s post on “Medicaid Rate Construction Reform”, a deep dive into the fundamentals that underlie how these programs are funded and why the entire way we fund long-term care needs to be rethought from the ground up to build a truly equitable and sustainable system.

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