WHITE HOUSE:

The White House focused this week on highlighting “Infrastructure Week” with a new dashboard outlining federal awards across the country (a very useful tool to find specific projects), the next step in electrifying ports, with an EPA request for information, and celebrating the one year anniversary of the launch of the Global Health Worker Initiative (GHWI). Two items of interest for us:

• They issued a guide on federal action as we transition out of the PHE. While the primary focus is on vaccination and testing, there is also an effort to improve air quality and HVAC systems to protect against the spread of respiratory illnesses, which can potentially be an opportunity for older facilities. It’s something to keep an eye on.

• They also announced a series of HUD agency action items designed to increase energy efficiency & lower heating costs, including the availability of more than $837 million for the Green & Resilient Retrofit Program (GRRP). While the focus of this release is multifamily properties, there may be future options for senior housing.

CONGRESS:

As expected, the debt limit conversations slowly meander forward, with a planned sit-down scheduled for Friday pushed back to this week. On the bright side, in DC, delays like this are generally a positive sign as it means that staff are working through some of the broader items. The latest Congressional Budget Office (CBO) report (available here) gives some wiggle room on a potential default date which remains a moving target. Both practical and arcane approaches to avoid a default are being proposed, but in the meantime, as we’ve said before, Congress likely won’t do something till they have to.

Elsewhere from the world of politics:

• The Senate HELP Committee moved a PBM bill this week. A full list of bills with markup is available at the Committee website, with S.1339: “Pharmacy Benefit Manager Reform Act” (PDF) the most directly impactful. Practically, the legislation is unlikely to pass is, but pieces are likely to find their way into a healthcare package that the Senate would like to bring to the floor in the coming months.

• Senator Feinstein returned to DC this week, after several months away, restoring the Democrats 51-49 lead in the Senate.

• A long look at Governor DeSantis political strategy related to 2024, as well as a look into his record on Covid.

• An updated report on the impact that the visa freeze is having on the international nursing workforce.

AGENCIES:

With the PHE ending yesterday, HHS & CMS created a series of resources to help providers, elected officials, and the public with the transition. Where applicable, I’ve noted the day it was most recently updated:

• CMS FAQ post-PHE (PDF – last update 5/12/23)

• CMS FAQ for SNF specific items (PDF – last update 5/10/23)

• CMS FAQ for State Medicaid agencies on practical issues related to unwinding. This is useful to understand the practical implications of Medicaid renewals & redeterminations for residents (PDF – last update 5/12/23).

• CMS Informational Bulletin to states on their obligations in a post-PHE world (PDF 5/8/23).

• Central Resource Page: This has most of the FAQ’s, Fact Sheets and other guidance available for a post-PHE world.

• Letter to Governors

• End of PHE Fact Sheet

• Telehealth Specific Fact Sheet

The CDC updated their guide to infection prevention & control procedures in healthcare settings.

As mentioned last week, in the wake of significant public comments, the DEA is officially extending provider-flexibility in prescribing controlled substances via telehealth for at least six months. You can access a copy of the temporary rule here (PDF).

LEGAL:

Two interesting developments on the legal front to keep an eye on:

• The Supreme Court will hear a case on the “Chevron deference”, which has been at the core of federal agency action over the years and has implications for every federal agency, including HHS & CMS.

• There is a case in front of the court now that would have major repercussions on elections at the state and federal levels. New arguments were filed this week that argue the Court should not decide the case.

END OF PHE ROUNDUP:

With the PHE ending, there were quite a bit of news on the impact as we move forward. Here are a few of the more useful ones:

• Politico on "what goes away".

• Axios on Covid reporting data.

• McKnight’s explored the SNF specific impact.

• Forbes looked at the 3-day stay rule.

• The NY Times reported on the transition to a “peacetime” response to Covid.

• KFF is tracking pricing on Covid testing and vaccines, now that the federal government is no longer requiring private insurers to cover it.

• Pew highlighted challenges that states will face as they move away from federal pandemic aid.

• Finally, Mark Parkinson of AHCA conducted a wide-ranging interview with Skilled Nursing News where he touched upon the major areas of concern as we move forward and urged providers to get ready for the staffing mandate topic.

FROM THE NOTEBOOK:

• With the staffing mandate looming, both the Washington Post & Axios did deep dives into the political and practical realities of a mandate.

• Strengthen the arguments about the realities of the staffing challenges are official state reports from Connecticut and Pennsylvania (PDF) recognizing the costs in implementing a staffing mandate.

• Kaiser Health News explored the Senate’s efforts to tackle PBM legislation.

• A look at how the mental health crisis is impacting counties around the country.

• Blue states are hesitant of implementing healthcare coverage for undocumented immigrants in light of escalating healthcare costs.

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