STAFFING MANDATE:

A reminder that the comment period for the minimum staffing rule runs through 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 the President’s trip to Israel, his Oval Office address on the war with the accompanying ask to Congress for aid to Israel and Ukraine, and more climate change efforts, this time specifically focused on private homes. One item of interest for us:

• They introduced several new actions to support first time homeownership. As many of your staff may qualify for the various programs, they may appreciate hearing about it from you.

CONGRESS:

(This section is current as of Sunday October 22^nd, 1 PM EST)

The chaos continues in the House as the search for a new Speaker enters the 20^th day (as of this Monday, October 23^rd). After his third loss in the vote for Speakership, Congressman Jim Jordan of Ohio is out at the GOP speaker nominee. With frustrations mounting for the GOP, quite a few lesser-known Congressional members have thrown their hat into the ring. The GOP is trying to unify behind a candidate, but who that will be is anyone’s guess. In the meantime, Congressman Patrick McHenry of NC is the temporary Speaker, although the belief is that he has very little legal authority to conduct any real business. With aid to Israel now on the table (an issue that is very important to Republicans), and Democrats letting the GOP figure out their options, we’re in a waiting game. Elsewhere from the political world:

• Although the House is in chaos, the Senate continues to function normally. Senators Angus King and Kevin Cramer wrote a letter to CMS (available here as a PDF) asking them to hold off on enacting the minimum staffing rule and focus instead on finding new staff. This follows on Senator King’s earlier calling out of CMS Deputy Administrator for focusing on mandates as opposed to recruiting.

• The Senate Finance Committee held a hearing on deceptive marketing by MA plans. Fierce Healthcare has a good summary of the bipartisan anger with MA plans, while Politico reports that CMS nixed over 300 ads by MA companies.

• The House Energy & Commerce Committee held the first in a series of hearings on AI in healthcare, urging the need to create a framework for AI usage in healthcare settings.

• Last week, Republicans flipped the Governor’s seat in Louisiana when Jeff Landry won the race to succeed Democrat John Edwards. Rollcall examined the political implications of the race and whether it can help predict other 2024 races. Along the same lines, The Hill looked at the five Senate seats most likely to flip in 2024.

• With the final campaign finance reports in for 2023, Politico did a deep dive into the financial numbers to get a better sense of where we stand as we head into 2024.

• With 2024 election season about to heat up, we’re about to start getting inundated with polling. An interesting commentary piece on why polls, despite their uneven record, keep getting featured.

AGENCIES:

An important ruling from the Second Circuit Court of Appeals this week held that SNF’s are allowed to spend Medicare & Medicaid as needed with no directive to spend reimbursements in a specific way. McKnight’s has a good summary. Please share with your legal advisors.

CMS posted the final updated MDS item sets to their site today. Steven Littlehale of Zimmet posted a good primer on how to prepare for the next few months as payment systems adjust.

On October 1^st, CMS issued a new payment setting code that allows Medicaid services to be provided on the street for homeless individuals. This is a good summary of what it means and the impact it can have on the provision of care to Medicaid beneficiaries.

HHS created two new sets of HIPAA resources for providers and patients, specifically centered on telehealth. The guide for providers is here. The guide for patients is here. They created these resources as a result of a GAO inquiry back in September that recommended Medicare strengthen oversight on telehealth.

FROM THE NOTEBOOK:

• A good example of how government can target nursing shortages without resorting to mandates: Monroe County in New York is investing $11 million to build a strong pipeline of SNF workers and partner with facilities.

• A South Dakota legislative workgroup issued a whole slew of proposals to ensure the sustainability of the long-term care industry in the state. The full set of recommendations can be found here (PDF).

• The PA Senate passed legislation that would freeze rates to blunt the impact of the recent rebasing efforts and sent it to the Governor’s desk where it waits his signature. The full bill can be found here.

• We mentioned last week that MA star ratings were out. For the second year in a row, star ratings for the plans declined. Axios has a summary.

• The Washington Post has a summary of a new book for seniors, called “Honest Aging”, to help them understand what happens as they age. It may be a useful resource for your residents and families.

• Kaiser Health News has a report on clawbacks by the government on social security benefits, as well as a push by several Senators for answer.

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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