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.

WHITE HOUSE:

Over the last few weeks, the White House focused on condemning Hamas and assisting American citizens stranded in Israel (if you need assistance, fill out the form here), beginning the implementation of the National Strategy to Combat Antisemitism, launching their Invest in America tour, delivering new student loan debt relief, and hosting the first summit on “Climate Resilience”. Three items of interest for us:

• They announced that the manufacturers of the ten drugs selected for the initial Medicare drug price negotiation program have signed their agreements to come to the table for negotiations.

• Building on their earlier actions on junk fees, they announced a whole set of proposed rules to combat the fees, including by the FTC (requiring companies to disclose all fees), the Consumer Financial Protection Bureau (governing banks and credit unions), as well as issuing several reports on the effectiveness of their earlier actions. These actions can impact your residents and staff, as well as interactions with financial institutions and are worth monitoring.

• They developed several new programs to help families that are involved with fostering children. As many of your staff are potentially involved as foster caregivers, they may appreciate hearing about the programs from you.

CONGRESS:

It’s been quite a ride in Congress since our last update. While Congressman McCarthy was able to avert a government shutdown with a stopgap funding bill, it cost him the Speakership. In immediate practical terms, the short term funding bill keeps the government open through November 17^th. The bigger picture is the complete disarray the House GOP finds itself in as they seek a new Speaker. After cycling through several candidates, including Steve Scalise of Louisiana, the current prospective nominee is Representative Jim Jordan of Ohio. The challenge for Jordan is that over 50 House Republicans have come out against his candidacy and it’s going to be an uphill battle to win them over. For now, a vote is tentatively scheduled for this Tuesday. Meanwhile Democrats are exploring supporting Congressman Patrick McHenry of North Carolina (who’s currently serving in the role) as a compromise candidate in the hopes of keeping the Government functional. (For a quick rundown on why the Speaker matters and the current situation, here you go). Elsewhere from the political world:

• Despite the chaos in the House, there has been Congressional action on the minimum staffing rule. Senator Tester of Montana, who’s been an outspoken opponent of the rule, led a Senate letter expressing major concern with the rule. You can find a copy of the letter here (PDF). Several House Republicans have also introduced a bill barring CMS from enacting the rule. While the bill is unlikely to pass as is, it’s indicative of the pushback the rule is facing from members of Congress.

• The House Energy & Commerce Subcommittee will host a hearing this week on strengthening patient access to care in Medicare that will cover quite a few topics related to how Medicare provides care to seniors.

• Congressman Pallone and Senator Wyden opened an investigation into the leading MCO’s as part of an investigation into their prior authorization practices and the high rate of denials.

• MEDPAC, the Congressional advisory panel on Medicare, called out CMS for the minimum staffing rule, arguing that the “brute force” approach to staffing is not likely to accomplish its goals. McKnight’s has a summary of the meeting, while all documents and a transcript can be found here.

• A bipartisan group of Senators led a Congressional Delegation to Israel to reiterate the United States’ commitment in the fight against Hamas. The group experienced firsthand the terror in Israel as they had to shelter from a rocket barrage.

• We’ve talked in the past about Republican candidate quality challenges. Now Democrats are facing their own issues. Senator Bob Menendez of NJ, currently under federal indictment, is mulling a reelection campaign, much to the chagrin of Senate Democrats

AGENCIES:

With Medicare open enrollment period kicking off, CMS released the updated Part A & B premiums for Medicare beneficiaries, which reflect a 6 percent increase from last year.

They also released the 2024 star ratings for Medicare Advantage and Part D. The fact sheet can be found here while the underlying data can be found here.

CMS issued three relevant QSO’s and guidance (links are to the PDF):

1) QSO-23-01-NH: revisions to the SFF program

2) QSO-23-23-NHs: An updated guidance to the CMP program, with clarity on allowable and non-allowable uses. They also updated the main page for the CMP program as well as the current list of state contacts (PDF).

3) SMD 23-006: A State Medicaid Director guidance for states covering the rules governing Medicaid programs for non-emergency transport.

CMS released several updated reports for states participating in “Financial Alignment Initiative” models for dual eligible covering NY, OH and WA. The reports can be found at the central resource page here.

Two interesting reports from the OIG at HHS:

1) They found that Medicare could have saved significant cost savings by expanding transfers from hospitals to PAC centers. Here is the summary and the full report (both PDF).

2) They also called out New Jersey, finding that the state could have done a better job ensuring compliance by SNF’s with life safe and emergency preparedness rules. While this was on the state, it could lead to increased enforcement by the state on SNF’s. Here is the summary and the full report (both PDF).

The DEA announced that they are extending the telehealth flexibilities offered during Covid through December 2024. The full guidance was published to the Federal Register on October 10^th.

FROM THE NOTEBOOK:

• California passed a $25 a hour minimum wage bill for healthcare employees. The timeline for phase-in will be different for different healthcare sectors and employers, but ultimately will cover all healthcare employers in the state.

• California also passed a law that begins the process of identifying a path of implementing a unified single-payer system within the state that can be submitted for federal approval by 2026.

• North Carolina received federal approval to expand their Medicaid program on December 1^st.

• The AP took a look at which states are expanding their Medicaid programs to cover dental care.

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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