In observance of Yom Kippur, next week’s digest will be on Tuesday September 26^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).

WHITE HOUSE:

The White House focused this week on the G20 Summit, improved relationships with Bahrain & Vietnam, and the start of the Vice-President’s “Fight for our Freedoms” college tour aimed at getting more young voters involved. Three items of interest for us:

• As part of the Cancer Moonshot program, they announced the creation of a “Biomedical Data Fabric Toolbox” under ARPA-H. While specifically focused on cancer data, the explicit goal is to rethink how data is shared across the medical field, which may have implications for those of you involved with data providers.

• As part of their Invest in America initiative, they created a new technical assistance guide to help applicants tap into the many funding opportunities available. The full guide is available here (PDF).

• As part of the White House’s efforts on AI, they secured voluntary commitments from seven more companies to participate in efforts to ensure safe deployment of AI. You can access a copy of the guide to the commitments here (PDF). While voluntary, it’s a good insight into where regulation on AI may go.

CONGRESS:

As the clock ticks closer to a government shutdown, we appear to be moving backward. GOP House Leader McCarthy faces growing discontent among House members as frustrations mount. In the meantime, the Senate, which had hoped to start the process, went home without any progress as Senate conservatives stalled the effort. At this point, recognizing the logistical reality of a tight time-frame, the House is looking to pass a temporary funding bill, which has little chance of getting through the Senate. All in all, the odds of a government shutdown grow every day. Elsewhere on the political front:

• A bipartisan group of lawmakers, led by Congresswoman Cathy McMorris Rodgers introduced new legislation titled the “Lower Costs, More Transparency Act” which includes pieces of the different PBM bills that we’ve discussed over the last few months. You can find a copy of the bill text here.

• An updated look at Congressional efforts to tackle private equity investment in healthcare.

• More than 100 House Democrats called on the Biden Administration to open up immigration protocol to help immigrant get their work permits faster at the same time that advocates called out the Administration for dragging their feet on immigration.

• Senator Mitt Romney, one of the last moderates, announced that he would not seek reelection in 2024. While the candidates to replace him comprise a wide range of political beliefs, the bigger picture is that the centrists in the Senate are becoming an endangered species.

• The Senate HELP committee made bipartisan progress on the reauthorization of several must-pass healthcare programs, although the legislation will likely be caught in the greater funding fight.

• Following Senator Schumer’s forum on AI, it’s clear that there’s a broad consensus that Congress needs to regulate, although what that regulation would look like remains a major work in progress.

• New legislation was introduced that would revamp and raise the asset limits for those who qualify for SSI.

• 2 useful CRS reports this week:

• IN12240 – A guide to HHS’ recent recommendation to reclassify Marijuana.

• R47693 – A guide to what happens to federal agencies during a government shutdown.

AGENCIES:

The IRS announced that they are freezing applications for the ERC program as they beef up oversight to protect against fraud and abuse. They specifically note that any applications already sent in will be processed (pending eligibility review), but they will take longer to process.

CMS held a national stakeholder call on Thursday to discuss the minimum staffing rule. McKnight’s has a good summary.

CMS announced a list of 34 drugs that Part B beneficiaries will be eligible to receive a discount upon from October 1 to December 31. The fact sheet is available here (PDF).

The OIG at HHS released an analysis of discharge by hospitals, finding that hospitals did not fully comply with transfer policy, often charging Medicare the higher rate for discharge to home, as opposed to transfer to a SNF. The summary is available here (PDF). The full report is available here (PDF).

FROM THE NOTEBOOK:

• A new Gallup poll released this week highlights the uphill battle long-term care providers are facing in changing the narrative.

• The Kaiser Family Foundation tracked the growth of Medicare Advantage in rural areas and how it compares to metropolitan areas.

• We covered the FDA rule that allowed for the purchase and sale of hearing aids over the counter. One year later, a survey suggests that folks are still not using them. You can download the survey here (PDF).

• Modern Healthcare explored how rural hospitals are dealing with Medicare Advantage growth (registration required).

• Marketplace looked at the growth of nurses from the Philippines and their critical role in helping navigate the staffing crisis.

• Axios reported on the domino effect the unwinding is having in Iowa.

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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