In observance of Sukkot, our next digest will be posted on Monday, October 16^th.

STAFFING MANDATE:

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 2,000 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.

WHITE HOUSE:

The White House focused this week on the establishment of a new “White House Office of Gun Violence Prevention”, a new agreement between several federal agencies and nine states to drive wind energy adoption (the MOU can be found here – PDF) and the launch of the “American Climate Corps”, a new initiative aimed at getting young people involved in climate related projects. One item of indirect interest for us:

• They announced that the Consumer Protection Financial Bureau will begin a rulemaking process to remove medical debt from credit reports. The full list of proposals under consideration can be found here. The central CPFB resource page is here. As this may play a role in billing and collections processes, it’s something to monitor.

CONGRESS

(The section on the government shutdown is current as of Friday, September 22^nd, 2023)

The odds of avoiding a government shutdown continue to deteriorate In Washington DC as the House headed home for the weekend with no end game in sight. With the House GOP locked in intraconference battles, the Senate is again trying to create a path forward while centrist Democrats in the House are working behind the scenes to find a compromise. In addition to the real-word practical implications of a government shutdown, politically the GOP is usually seen as the cause of the shutdown and tend to bear the brunt of the public’s frustration. While a longer-term legislative solution to prevent government shutdowns is gathering steam, at this point, Washington is getting ready for a shutdown. Elsewhere on the political front:

• Axios has a good summary of which healthcare programs will be most impacted by a government shutdown.

• There’s a new bipartisan effort to introduce a less heavily regulated approach to AI. This legislation, led by Senators Thune (R – SD) and Klobuchar (D – MN), stands in distinction to Senator Schumer’s efforts as well as a new set of principles issued by the United Kingdom’s AI regulatory agency.

• Following up on several Democratic governors pushing for easier paths to work permits for immigrants, the Biden Administration expanded protections for Venezuelan immigrants.

• With Florida Governor DeSantis’ presidential campaign floundering, Politico explored what it means for his influence in Tallahassee.

• Exploring the new norm of increased polarization in politics through the prism of Wisconsin.

• 538 looked at the impressive record for Democrats in the nearly 50 special elections held in 2023 and what it can mean for 2024.

AGENCIES:

As expected, the Medicaid unwinding has caused significant disenrollment spikes. CMS announced this week that 30 states are required to pause the unwinding until they can assure CMS that folks won’t get kicked off for “procedural reasons”. Unclear what the timing looks like, but something to keep an eye on. The 30 are: Alaska, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Vermont, Virginia, West Virginia, Wisconsin, Wyoming and the District of Columbia. You can access the notice here (PDF). Despite NOT being on the list, Florida is currently being sued for the disenrollment process.

CMS issued a new QSO with updates to care compare and staffing/quality measures. You can download a copy here (PDF).

CMS released the final rule for streamlining enrollment practices for those eligible for Medicare Savings Programs, affecting an estimated 860,000 potential beneficiaries.

HHS awarded $600 million to restart a program to provide free Covid tests to the public.

The OIG at HHS called out New York for not having proper oversight in place to ensure MCO’s properly complied with requirements for prior authorization denials. The summary is available here (PDF). The full report is available here (PDF).

While more retrospective in nature, the OIG did a review of state Medicaid enrollment strategies during the PHE. In theory, it could be helpful to understand state procedures moving forward.

We often highlight new or innovative payment models that CMS is exploring. To better understand the process, the CMS Innovation Center created a central page outlining how these models are planned out, tested, and implemented.

Following up on their announcement last week regarding enforcement on high-income compliance, the IRS announced the creation of a new division focused specifically on “pass-through” entities.

The Equal Employment Opportunity Commission (EEOC) signed a MOU with the Department of Labor to develop greater collaboration between the agencies to develop enhanced enforcement of wage and labor violations. It’s not specific to SNF’s, but something to keep in mind.

FROM THE NOTEBOOK:

• The Kaiser Family Foundation found that less than 1 in 5 facilities would currently meet the new staffing requirements envisioned by the proposed rule, highlighting yet again how impractical and unfeasible the rule is.

• As part of their September 2023 meeting, MACPAC took aim at the lack of consistent oversight on MCO plans. You can access the presentation here (PDF). McKnight’s has a good summary.

• NPR did a deep dive into the bureaucratic and administrative mess for dually-eligibles.

• A good summary of the federal government’s effort to reclassify Marijuana as a stage III drug.

z-INTEL Tool of the Month: Medicare Advantage Debt Clock

Over the last few months, the Digest has focused on the growth and challenges of Medicare Advantage. Historically, Medicare Advantage's growth was more than offset by an increase in traditional, Fee-for-Service (FFS) enrollment. Starting in 2019, the absolute number of FFS beneficiaries started to decline as beneficiaries shifted to MA plans. This Medicare Attrition Rate has reached alarming proportions across the country, topped by West Virginia's reality wherein for every 100 additional MA enrollees, FFS drops by 91 (!) potential SNF admissions.

If you want to truly understand the impact that MA is having on the SNF world, check out Ecap Intel’s "Medicare Advantage debt Clock" as we creep toward $9B lost in 2023.

Questions? Email us at support@myzpax.com.

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