WHITE HOUSE:

The White House focused this week on new efforts to increase access to affordable housing by rethinking zoning regulations in high-need areas (via a HUD funding grant), creating new renter protections, and issuing two new executive orders related to incentivizing manufacturing in the US and military justice reform. 3 items of interest for us:

• They directed multiple agencies (including the Department of Labor, HHS & Treasury) to issue proposed rules to make sure that everyone has access to mental health services. I’ll reference specific agency links below, but especially for those who self-insure, it’s something to monitor.

• With extreme heat gripping the country, the President asked the DOL to issue a “Hazard Alert” outlining worker protections for heat. In addition, OSHA will be stepping up enforcement of heat related protections.

• On the 33^rd anniversary of the American with Disabilities Act (ADA), they directed the DOJ to issue a new rule to make it easier for individuals with disabilities to access online services, which can be helpful to your residents and families.

CONGRESS:

Welp. As was fairly predictable, the House is leaving for the August recess with only one of the 12 annual spending bills passed. Meanwhile the Senate passed their version of the annual defense bill with none of the conservative amendments that were added to the House version. Practically, this means yet another hurdle to clear for Congress when they get back from the recess as they’re going to have to find a compromise that works for both parties. Ultimately, there’s going to be a very tight window in September to avoid a government funding shutdown at the end of the month. Elsewhere on the political front:

• On behalf of the Senate Committee on Aging, Senator Casey issued another call to CMS to increase oversight on SNF’s. You can access a copy of the letter here (PDF).

• Another week, another Congressional effort to lower drug prices, this time with a new bill to expand the ability of CMS to negotiate drug prices with private insurance plans.

• In light of Senator McConnell’s health scare this week, speculation is rampant about his future, as well as the elderly nature of many Senators. One important note: the likeliest candidate to succeed as Republican Leader is Senator John Thune of South Dakota.

• With Governor Desantis’ presidential campaign floundering, and former President Trump ahead in current polls, Politico explores if we’re really locked into a 2020 rematch in the 2024 presidential election.

• AHCA wrote a second letter to the President this week outlining proactive steps that can be taken to help with the staffing crisis instead of the staffing mandate. You can access a copy here (PDF).

• The President signed into law a bill that your humble author greatly appreciates: the “Providing Accountability through Transparency Act” which requires all government agencies to make available a plain language, 100 words or fewer summary of any proposed rule.

• As access to the ability to vote is very important to residents, and something that CMS monitors, a worthwhile update from 538 on the latest on voting right bills over the last few years.

• A bit wonky, but here’s the CRS’ explainer of the Congressional budget timeline and process. It’s helpful to get a good grasp of the process. You can access a copy here (PDF).

AGENCIES:

CMS created a central site for data reporting related to the Medicaid unwinding. They’ve also issued a summary of how every state has approached the unwinding and what, if any, strategies the state is using to mitigate and lessen disenrollments. You can access a copy here (PDF).

CMS released the formal announcement of the expiration of QSO-23-02 which mandated staff vaccination.

We mentioned the White House’s plan to ensure access to mental health treatment. HHS issued their own announcement, which includes a prepublication version of the proposed rules. You can download a copy here (PDF).

On Friday, CMS released their 2024 hospice payment final rule. You can access a prepublication version of the final rule (PDF), which will be published to the Federal Register on August 2^nd.

CMS issued a notice today that there was a data breach at Maximus involving Medicare benificiaries information. As your residents may have been impacted, please make sure your cybsersecurity teams are aware of the breach.

CMS released several data briefs focused on Medicaid demographics, which may help with forecasting need and utilization.

HHS secretary Becerra published a piece in the New England Journal of Medicine outlining Project Next Gen and the government’s plan to tackle another pandemic.

FROM THE NOTEBOOK:

• JAMA published a study that showed SNF used their PPP loans to increase staff pay and hours, echoing yet again the argument that if it’s funded, SNF’s will pass the dollars along.

• Cigna got hit with a lawsuit (that’s seeking class action status) regarding the use of an algorithm that is leading to massive prior authorization denials.

• In a surprise to no one, another report found that hospitals are struggling to discharge patients to SNF’s amid staffing shortages. You can download the report here (PDF).

• Three interesting Kaiser Family Foundation reports were issued this week:

1. A look at the OIG’s investigation on MCO’s prior authorization’s denial patterns that we mentioned last week.
2. A map of the current state of Medicaid expansion across the country.
3. A deep dive into Medicare part D and drug pricing.

• It’s purest rumor at this point, but a report is out that the Justice Department is opening a monopoly invesetigation into the managed care industry.

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 as well as a detailed two-year trending report for the area wage index for every county in the nation here.

ZIMMET CONFERENCE:

Registration for the 2023 Zimmet Conference at Mohegan Sun from August 9^th – 10^th is still open! The topic this year is “Roaring Reimbursement”. You can find more information and register at the conference site.

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