WHITE HOUSE:

The White House focused this week on updating the definition of “prevailing wages” for the construction industry (by a soon to be issued rule from the Department of Labor), launching a new cybersecurity effort for K-12 schools and signing an executive order to limit investment in Chinese companies & technology (like AI) that might impact national security (via the Treasury Department). Two items of indirect interest for us:

• On the one-year anniversary of the PACTS Act, they highlighted the many different investments that have been made into veterans’ healthcare. Especially for those of you who work with the VA, it’s a useful resource to understand the many benefits that veterans are deservedly entitled to.

• They announced a new AI cyber challenge, via DARPA, to develop tools to better secure AI systems. It’s designed for both large and small businesses. For those of you who deal with AI technology, there may be an opportunity here. For more details, the competition site is here.

CONGRESS:

With the August Congressional recess continuing, the GOP is starting to think about how to navigate the upcoming fiscal conversations that will dominate September. With tight margins to navigate in a fractured conference, bipartisan support may be needed to avoid a government shutdown. In the legislative void, DC remains filled with campaign talk and party retrospectives. Elsewhere in the political world:

• Representative Joe Courtney (D – CT) reintroduced a bipartisan bill to eliminate the 3-day stay waiver.

• In a closely watched election in Ohio, voters turned out in droves to defeat a perceived anti-abortion measure, yet again highlighting how abortion continues to be a mobilizing factor for Democrats.

• We mentioned last week about the usage of AI in election campaigns. The FEC voted this week to open public debate on how to regulate AI’s usage in campaigns.

• A new PAC has been formed to encourage more young people to get involved in politics and elections.

• With the minimum staffing mandate still under review at OMB, the Hill did a deep dive into the current status.

AGENCIES:

HHS announced the award of more than $100 million to develop the nursing workforce. A full list of awardees, and the different programs they belong to, can be found here.

HHS also announced the award of $88 million for youth mental health services and expanded access to substance abuse centers.

With the impact of Medicaid unwinding becoming clear, CMS published the letters that they sent to every state Medicaid office warning them of potential violations of federal law as they continue to process Medicaid application renewals. The Kaiser Family Foundation analyzed whether states are actually targeting folks that were likely ineligible, thereby leading to early accelerated rates of disenrollment, which may be helpful for forecasting enrollment numbers.

CMS announced yet another delay in the implementation of the federal arbitration process related to the No Surprises Act, the result of another court decision against the agency.

The Consumer Financial Protection Bureau published an analysis of older Americans medical debt. The full report is available here.

MEDICARE ADVANTAGE:

The penetration of Medicare Advantage, and the challenges it creates for SNF’s, is something we’ve been tracking in these updates. At this past week’s Zimmet Conference in Mohegan Sun, eCap Intel Co-Founder Marc Zimmet focused on it during his keynote address. If you want to see the real-time impact of Medicare Advantage on SNF’s, check out this new tool: Medicare Advantage Loss Counter (z-pax.com).

Some other notes from the MA world:

• Brookings Health System, a non-profit, city-owned health system in South Dakota, announced that they are no longer accepting MA plans.

• Scripps in San Diego, another major health system, also appears to be cutting ties with MA.

• A major study released this week found that many of the enrollees in MA plans don’t actually understand the plans.

• The Kaiser Family Foundation broke down the state of Medicare Advantage in 2023 and explored updated enrollment numbers and trends for MA.

• Following up on New York City’s effort to switch retirees to a MA plan: a city judge barred the city from switching enrollees onto the MA plan, although the city is planning to appeal.

FROM THE NOTEBOOK:

• JAMA published a study highlighting just how challenging the staffing shortages during Covid were for SNF Administrators.

• Labor unions are gearing up for a $50 million ad campaign leading up to the 2024 elections focused on putting senior care legislation back on the agenda.

• We've highlighted the effort to regulate private equity in healthcare. The Wall Street Journal explored the current state of Congressional and regulatory action.

• Skilled Nursing News did a deep dive into the survey challenges that operators are facing.

• Health Affairs continues to explore new pathways to building smrter care for dual-eligible beneficiaries.

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