WHITE HOUSE:

As the August DC lull continues, it was another quiet week for the President. The focus was on responding to the wildfires in Maui, exploring new data collection rules for “data brokers” (via the Consumer Financial Protection Bureau), and starting student loan cancellations for those who qualify. One item of interest for us:

• This week marked the one-year anniversary of the signing of the Inflation Reduction Act, which has had significant impact on every walk of life. Both HHS and CMS issued fact sheets with very useful summaries of the healthcare specific impact the Act has had. HHS, via ASPE, also issued a report on the Medicare drug pricing provisions from the Act. It’s available here (PDF).

CONGRESS:

While Congress remains out for August, the impending September 30^th deadline for a government funding is looming large. GOP House Leader McCarthy, recognizing the very tight legislative calendar in September, suggested that Congress will utilize a budget tool called a Continuing Resolution (CR) as a short-term way to fund the government through the beginning of December. While Democrats are fine with buying a few months with a CR, strong conservative opposition is expected and we’re in for a rough few weeks. Elsewhere in the political world:

• Congress is looking at different ways of tackling high health insurance costs, with a specific focus on HSA plans.

• Dr. Mark Green, a Republican Congressman from Tennessee, reintroduced a bill to tackle prior authorization requirements. While unlikely to pass as is, these bills are important in keeping the pressure up on insurance companies.

• North Carolina’s effort to expand Medicaid remains in flux.

• The National Conference of State Legislatures (NCSL) updated their overview of the different approaches to regulating AI. With multiple countries also in the mix on how to regulate AI, it’s a useful resource to keep an eye on the changing regulatory landscape.

• Axios explored the voting map for felons who have served their sentence and how impacts the 2024 elections.

• One interesting CRS report this week: a complete summary of the “PREVENT Pandemics Act”, which was enacted at the end of last year. It’s a useful overview of how the US will plan for the next pandemic. You can access a copy here (PDF).

AGENCIES:

ARPA-H, the new federal agency designed to spur investment and innovation specifically related to health projects, announced a new initiative, called Digiheals, aimed at transforming digital cybersecurity for healthcare providers.

HHS issued a new guidance, specifically meant for state Medicaid directors, on the claiming methodologies states must use when claiming federal reimbursement on spending on Medicaid managed care. It’s super wonky and technical but may be helpful in understanding how dollars flow through managed care plans. You can access a copy here (PDF).

We’ve mentioned the legal efforts by pharmaceutical companies to block the Medicare drug pricing provisions of the Inflation Reduction Act. The DOJ filed their response this week. For now, the plan remains for CMS to announce the first 10 drugs subject to negotiation on September 1^st.

New data released by the US Bureau of Labor Statistics showed that SNF and adult day care costs rose by 2.4%, the largest single month jump in more than 20 years.

The CDC announced this week that they have not yet finished negotiations with pharmacies under their Bridge Access Program to make next generation of covid vaccines available to the public. For now, details on how the program will look remain unclear.

FROM THE NOTEBOOK:

• New Hampshire passed a law that would impose significant regulatory requirements on staffing agencies, including preventing double-booking. The full text is available here (PDF). It goes into effect on October 1.

• With state legislative cycles wrapped up, Sellers Dorsey, an advisory firm for state Medicaid agencies, released a very good summary of enacted state budgets, with a specific look at Medicaid spending. This is a very useful resource to get a quick overview of state budget spending. You can access a copy here (free registration required). It’s a good reminder that every state has a different landscape with different opportunities and challenges.

• In an effort to increase CNA applications, Massachusetts will be offering the test in more languages next year, including Spanish & Chinese.

• Kaiser Health News explored the details of a new federal proposal to explore oversight of provider taxes for hospitals.

• A new federal survey found that the fastest growing demographic for cannabis use are seniors over 65.

• We mentioned CMS new model to train caregivers a few weeks ago. Kaiser Health News did a full breakdown of the proposal.

• A good reminder about the need to have solid billing practices in place.

• An inside look at Idaho’s troubled SNF survey department. They’re down to 8 surveyors (!) for the state.

• A new study from Miami University of Ohio found a strong link between leadership turnover and increased complaint surveys. McKnight’s has a good summary of the study.

• Yet another health care system, this time in Oregon, is “evaluating” their MA agreements. As mentioned in the special section on Medicare Advantage last week, and highlighted in McKnight’s, eCap Intel Co-Founder Marc Zimmet created a debt clock so you can see the impact managed care is having.

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.

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