WHITE HOUSE:

The White House focused this week on a "trilateral summit" with the leaders of Japan & Korea, continuing the federal response to the Maui fires, and a new ARPA-H initiative related to curing cancer. One item of indirect interest for us:

• They announced a new type of student loan repayment plan called SAVE. This promises to be one of the most affordable student loan repayment plans ever, with significant costs savings for those who qualify. As many of your staff would likely qualify, they may appreciate hearing about it from you. Additionally, as helping with student loan payments is an invaluable recruiting tool, please consult with your financial teams to see if there’s a way to tap into it. The sign-up site for individuals is here.

CONGRESS:

Welp. We have our first victim of the ongoing budget funding impasse in DC with the formal acknowledgment by Senate Minority Leader McConnell that the farm bill will not pass before its scheduled September 30^th expiration. The farm bill, which needs to be reauthorized every five years, is considered one of the ‘must-pass’ pieces of legislation. Beyond the direct impact on SNAP benefits, which many of our families and residents benefit from, the political implications for the broader budget discussions are sobering. If you want to read more about the farm bill, the Congressional Research Service issued a full report on the Congressional implications here (PDF). With the House Freedom Caucus playing hardball in opposing DC’s usual tools to avoid a shutdown, the Senate is exploring a different path forward. This just highlights the challenges for House GOP leader McCarthy as he navigates the political minefield that is the federal budget. Elsewhere on the political front:

• The GOP, recognizing their weak slate of candidates in 2022, have had early success in recruiting their preferred candidates to run in 2024. Meanwhile, the Democrats picked up a desired candidate of their own in a perceived winnable Senate race in Florida.

• A new study appeared to confirm that there is a liberal political bias extant in AI tools, like Chat GPT, although the paper’s conclusions are being challenged.

• Following up on a point about the getting younger voters involved, Politico explored the conflict behind the most effective tool at engaging young voters (TikTok) and legal efforts to regulate them.

• Axios scooped the broad details on what immigration policy would look like should Trump win in 2024.

• New York Governor Kathy Hochul became the most prominent Democrat publicly urging the Biden Administration to change immigration policy to expedite work permit for migrants.

• The CRS issued an updated guide to Congress on using Medicaid for incarcerated individuals, an interesting read, especially with the recent efforts we’ve tracked to expand Medicaid for soon to be released individuals. It’s available here (PDF).

AGENCIES:

CMS announced details of the “Medicare Prescription Payment Plan”, a new program created by the Inflation Reduction Act that will allow Medicare Part D beneficiaries to pay their pharmacy bills in capped monthly payments as opposed to a single lump payment. This announcement, which comprises a fact sheet, timeline, and draft guidance (all links are to a PDF), serves as Part 1. They plan on announcing the rest of the details in “early 2024”. They’re seeking comments on the draft guidance for the next 30 days. Comments can be submitted via email through September 20^th.

CMS released a blog post focused on their efforts to increase the integrity of the hospice program, letting drop that they are considering “administrative action” for nearly 400 hospices. The blog post summarizes many of their recent actions related to hospices.

We’ve been tracking the “unwinding”, the process by which states are now allowed to disenroll beneficiaries from their Medicaid rolls. A new lawsuit was filed this week against the state of Florida on behalf of two beneficiaries who were kicked off Medicaid. If successful, this can have repercussions throughout the country.

HHS, via the Administration for Strategic Preparedness and Response (ASPR), announced the award of $1.4 billion to support Project NextGen, the federal project to provide ongoing protection against Covid. More details are available here.

The White House is expected to release the list of the first 10 drugs chosen for the Medicare Price negotiation early, with a formal announcement set for Tuesday afternoon.

Following up on an item from last week regarding the availability of vaccinees for uninsured folk, the Administration announced that there are attempting to “accelerate the timeline” and finalize the requisite contracts.

The US Treasury Department and the IRS announced new rules governing the sale of cryptocurrencies, regulations that will have significant tax implications for those of you dealing with crypto. The proposed guidance will be published to the Federal Register on August 29^th, where comments will be accepted through October 30^th. You can access a copy of pre-publication regulations here (PDF).

FROM THE NOTEBOOK:

• The Wall Street Journal took a long look at the epidemic of closing nursing homes and the strain that places on the rest of the healthcare system. The article comes on the heels of AHCA’s August 2023 Access to Care report (PDF) about the growing inability to access care at SNF’s.

• HealthAffairs published an article looking at the recent trend of Medicaid being used to facilitate affordable housing.

• Modern Healthcare explored the rise in SNF bankruptcies (registration required).

• Following up on a misleading NY Times article about for-profit SNF’s, Dr. Grabowski clarified to McKnight’s that his point wasn’t to cast blame on SNF’s but rather to highlight the policy shortcomings in the greater healthcare system.

• ProPublica did a deep dive into the fees that insurers are charging healthcare providers for the benefit of being paid electronically.

• After United Healthcare eliminated a percentage of prior authorization requirements, Cigna followed suit this week. The public pressure on insurers continues to mount.

• Another week, another health care system thinking about their Medicare Advantage contracts, this time in Ohio.

• Rollcall looked at different state efforts to use their Medicaid programs to pay caregivers.

z-INTEL Tool of the Month: Wage Index Adjustment

Much was made of CMS’ proposed annual payment rule for SNFs that resulted in a net 3.7% Medicare rate increase effective October 1, 2023. It’s important to realize that the 3.7% increase is for all SNF’s in the aggregate, not for each facility. One key factor is the annual change to the wage adjustment index, which will impact every facility differently. At the extremes, operators in Sante Fe, New Mexico are going to wake up on October 1, 2023, with a $150/day Medicare rate increase, while it will be overcast skies in Ithaca, NY as rates begin their decent to a $60/day phased-in cut. z-INTEL has a dynamic PDPM rate modeler here, and provides a detailed two-year trending report for the area wage index for every county in the nation here.

Questions? Email us at support@myzpax.com.

z-INTEL WhatsApp info:

• Group Invite Link: https://chat.whatsapp.com/EoNiPi8ezrOBV6SW1Gf7nD
• Status Link: https://wa.me/message/WMSWZATTB5D6E1