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.

WHITE HOUSE:

The White House focused this week on new initiatives to strengthen aviation safety, environmental actions in the Arctic regions, and the US-Southeast Asian Nations summit. One item of indirect interest to us:

• * This is more of a political item, but the Vice President is embarking on a “Fight for our Freedoms” college tour to encourage the student to register to vote and get involved in elections. As the student demographic can be a potent and vocal force in elections, it’s important to recognize the potential impact they can have on elections in those areas.

CONGRESS:

As expected, Congress made little progress in finding a path forward on spending talks in their first few days back. Although government finding discussions usually start in the House, this time the Senate is taking the lead on funding efforts in the hope that bipartisan unity will make it easier for the House to find common ground. It’s not going well as House Conservatives continue to push back on GOP Leader McCarthy and flirt with a government shutdown. A government shutdown has broad implications for the country, especially as it relates to health care. For now, the posturing continues. Elsewhere in the political world:

• * Congressman Jason Smith (R – MO), Chairman of the House Ways & Means Committee, is asking for public input on access to healthcare, particularly in rural communities. You can access his open letter here (PDF). This represents an additional opportunity to weigh in with Congress on realistic paths forward to help resolve the staffing shortage.

• * Senators Hawley (R – MO) and Blumenthal (D – CT) are set to introduce a bipartisan framework for the regulation of AI with specific regulatory proposals, including new oversight, licensing and liability determinations. This is notable as the first set of specific regulatory guidelines for AI suggested by Congressional members. They plan to release the details at a hearing next week, one of three that Congress will be holding on AI.

• * With Senator McConnell’s health and future the focus of DC, he announced that he has no plans to retire before the end of his term in 2026.

• * With the age of elected officials a consistent focus of the Presidential and Congressional races, 538 explored the trend and whether it’s here to stay.

• * A few weeks ago we mentioned NY Governor Hochul’s push to expand work permits for migrants and highlighted the Administration’s response last week. Illinois Governor Pritzker joined the fray, calling on the Administration to streamline applications for work permits in industries with severe workforce shortages, like healthcare.

• * One CRS report this week: We’ve been tracking the court cases filed against the Medicare Drug Pricing program. The CRS issued a guide for Congressional members on all the Constitutional issues at hand underpinning the lawsuits. You can access a copy here (PDF).

AGENCIES:

For anyone who regularly uses the CMS website, they updated the design over last week’s Holiday weekend. As part of the redesign, they created a new central hub for SNF resources, available here.

HHS issued a new proposed rule that strengthens the protections against discrimination against individuals with disabilities. The fact sheet breakdown of the new rule is here. The 60-day comment period will begin upon formal publication to the Federal Register on September 14^th. For now, you can download a copy of the proposed rule here (PDF).

CMS announced a new effort to get states to explore a more comprehensive approach to health care delivery, called the “Advancing All-Payer Health Equity Approaches” (AHEAD) model. The new concept, modelled on similar programs already extant in Maryland, Pennsylvania and Vermont, is a “Total Cost of Care” effort, which shares savings with the state and aims to control spending. This is an entirely voluntary model that will be worked through with the states. You can find more details here.

CMS issued a new fact sheet outlining the process and timeline for the first round of negotiations in the Medicare Drug Price Negotiation Program. You can download a copy here (PDF).

The OIG at HHS released three relevant reports this week:

• * An analysis of SNF preparedness for public health emergencies and natural disasters. You can download the full report here (PDF).

• * Specific to Georgia, they said that the state could do a better job ensuring the state’s SNF’s comply with federal life safety regulations. You access copies of the overview and the full report (both PDF).

• * They called out Home Health Agencies for not reporting falls and hospitalizations among their Medicare patients. The report is here (PDF).

The IRS announced a major initiative focused on high-income individuals and partnerships. They plan on using AI and new technologies to support the effort. Please consult with your tax advisors.

The DOJ issued a blistering report against New Jersey for the state’s handling of two veterans’ homes during Covid. The report was covered by Politico and the NY Times, among many other news outlets. You can access a copy here (direct download PDF).

FROM THE NOTEBOOK:

• * HealthAffairs explored the growth of MA, finding that a major source is folks switching from traditional FFS to MA plans, a trend that Ecap Intel Co-Founder Marc Zimmet has highlighted with our Medicare Advantage Debt Clock (see below). FierceHealthcare has a good summary of the study.

• * Way back in 2020, CMS created the Medicare Advance payment program, a program that many healthcare providers participated in. RollCall looks back at the program and the impact that repayment has had on those providers.

• * The NY Times did a deep dive into recent data that show spending per Medicare Beneficiary is down over the last few years, although no one is quite sure why.

• * Always nice to see SNF’s in the news for good reasons!

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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