STAFFING MANDATE:

A reminder that the comment period for the minimum staffing rule ends next week, 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 6,500 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.

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 earlier this week with the latest.

WHITE HOUSE:

The White House focused this week on their continuing support for Israel, reinforcing their alliance with Australia, and expanding contracting opportunities for minority-owned businesses. Three items of interest for us:

• With the new, more-remote work business world here, they are escalating a push to convert high-vacancy commercial buildings into residential apartments. This is the HUD specific guidance (PDF), but this effort encompasses many different federal agencies. Beyond the obvious real estate implications, there are potentially opportunities here for staffing (for example, new housing for staff).

• They announced the creation of 31 regional “tech hubs” that are meant to be centralized opportunities to spur the development of American technological innovation. If you’re located near the hubs, there may be a chance to tap into the programs they offer.

• As we near the colder months, they held two meetings focused on a new vaccination campaign; one for the public at large and one with a specific focus on the long-term care community.

CONGRESS:

Well, that came out of nowhere! After cycling through more well-known choices, the GOP settled on Mike Johnson, a fourth term Congressman from Louisiana, to be the new Speaker. As the least experienced Speaker in 140 years (!), the Congressman is a relative unknown in DC. His anonymity before the race was an asset, but now the tough task of actually governing begins. Here’s a comprehensive background on his political career, while his track record on health issues is mostly focused on conservative values. The House quickly got back to work, passing the first of the needed funding bills, but getting full Congressional approval on a path to funding the President will sign is going to be battle. Regardless, we (finally) have a functional Congress after 3 weeks. Elsewhere from the political world:

• The House Energy & Commerce Subcommittee on Health held a hearing this week on the minimum staffing mandate. Both Chair Cathy McMorris Rogers (R – WA) and Chair Brett Guthrie (R – KY) issued remarks arguing against the mandate, while the Democratic members supported the mandate. McKnight’s, Skilled Nursing News, and Modern Healthcare (registration required), covered the hearing. You can watch the entire Hearing here.

• Over 90 House members signed a bipartisan letter, available here (PDF), led by Congressman Greg Pence (R – IN), urging CMS to reconsider the minimum staffing rule.

• Both North Carolina and Georgia were ordered by courts to redraw Congressional districts before the 2024 elections, which can have an impact on the race to control the House. It’s also unclear just how much the GOP dysfunction over the last few weeks will impact the elections.

• With Mike Johnson’s elevation to Speaker, his former role of GOP Vice-Chair is now vacant. That race is also becoming crowded, although without the notoriety of the Speaker race.

• 538 took a deep dive into whether the infighting of the last few weeks is a sign of the new polarized normal in Congress and what that means for politics moving forward.

• Two interesting CRS reports this week (links are to the PDF):

• R47821: A guide to all the Medicaid provisions from the Appropriations Act passed in December 2022.

• LSB11061: This is very wonky but might be of interest to our legal readers. It’s an overview of the very important Supreme Court case this session regarding the Chevron deference, the legal theory underpinning federal agency authority.

AGENCIES:

CMS issued the final payment rule for ESRD providers. It’s scheduled for publication at the Federal Register on November 6^th. In the meantime, you can download the prepublication PDF here.

As part of their ongoing effort to improve the IDR process in the No Surprises Act, CMS released a new proposed rule. You can find a fact sheet on the proposed rule here, while a prepublication PDF is available here.

The Department of Homeland Security issued a proposed rule that will “modernize” the H1B application process. The proposed rule is available at the Federal Register, where comments can be submitted through December 22^nd.

HHS & CISA (the Cybersecurity and Infrastructure Security Agency) released a cyber toolkit to help healthcare providers better protect against cybersecurity attacks.

The OIG at HHS issued a new audit on how states are ensuring that Medicaid truly is a payer of last resort. The summary is here (PDF) and the full report is here (PDF).

The NLRB issued their final rule on joint employer status. The rule can be seen at the Federal Register.

FROM THE NOTEBOOK:

• Kaiser Family Foundation did an analysis of how states are using their Medicaid programs to solve their workforce shortages in home health programs. They also did a deep dive into the underlying payment rates.

• A fun program in Japan is connecting residents with toddlers to brighten up everyone's day!

• NPR looked at how Medicare Advantage plans are hurting rural hospitals.

• The state of Washington will be increasing their minimum wage, effective January 1^st, 2024.

• A look at the upcoming clash between the increased need for SNF services and the ongoing workforce shortage.

• Axios explored the growing luxury senior living market.

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.

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