WHITE HOUSE:

The White House focused this week on the US-South Korea relationship, recognizing the 75^th anniversary of the State of Israel, and a new Executive Order focused on drug trafficking. Two indirect notes for us:

• They released a new plan, called the “Alternatives, Rehabilitation, and Reentry Strategic Plan”, aimed at facilitating reentry into society for individuals with criminal records, including advocating for state Medicaid programs to provide coverage for soon-to-be-released individuals (as outlined here (PDF) in a guidance letter from CMS to state Medicaid directors) as well as expanded HUD guidelines related to affordable housing. You can download a copy of the full plan here (PDF).

• They celebrated the 60^th anniversary of “Older Americans Month” (OAM). While this has no regulatory impact, it’s a good central resource to understand the Administrations priorities as it relates to seniors. OAM is celebrated every May. If you’d like to recognize it in your facilities, the Administration for Community Living (ACL), has a central page with resources for your marketing folks.

CONGRESS:

As mentioned last week, the House GOP finally made progress on their version of a debt ceiling bill, which Speaker McCarthy successfully pushed through in a party-line vote. Although the bill as passed is DOA in the Democrat-led Senate, it sets the stage for further negotiation. While both Democrats and Republicans navigate the PR wars in support of their respective positions on the debt limit, the passage of the bill provides insight into how the GOP will work under Speaker McCarthy’s tight majority.

It’s important to remember that the debt ceiling fight can significantly impact the federal government’s ability to pay its bills, including to healthcare providers. Regardless, for now, the conversation continues in DC. Elsewhere on the political front:

• The Congressional Research Service (CRS) released an important guide to immigration options for foreign healthcare workers. The CRS provides background knowledge on a wide variety of topics to Congressional offices. You can download a copy here (PDF).

• With the President’s formal announcement of his reelection campaign, a look back at his promises from his original campaign and how he did on them. Despite a noticeable lack of enthusiasm for a second term, and other substantive concerns, early signs suggest we’re heading for another Trump-Biden race, which would shatter age records for a presidential election.

• With age taking center stage in elections, an updated look at the politics of the situation in California with Senator Feinstein.

• Republicans got their man in West Virginia, as popular Governor Jim Justice announced a Senate race against Senator Joe Manchin. This is an important first step in Senator McConnell’s plans for the GOP to retake the Senate.

• While the overall debt ceiling discussions are the main attraction, both the House & Senate are working on healthcare packages (which will be incorporated into a budget later this year).

• The Senate is continuing its focus on PBM’s and drug prices.

• A more complete analysis of the earmarks requests that have been made this year by Congressional members.

AGENCIES:

CMS issued a new FAQ with guidance for the end of the PHE, including directions on how to handle the end of the 3-day stay waiver. You can download a copy here (PDF).

CMS released two proposed rules this week, designed to ensure “adequate” spending by states on their Medicaid programs, both via traditional Medicaid and MCO’s. While the focus is on HCBS and primary care services (as opposed to SNF services) there are several items of import to us, including more transparency by states on Medicaid rates to providers. A good summary of the rules is here. As there are several different rules, here are direct links to make it easier to review:

• General Medicaid access fact sheet. The proposed rule (PDF) will be published to the Federal Register on 5/3/23.

• Managed care fact sheet. The proposed rule (PDF) will be published to the Federal Register on 5/3/23.

• HCBS fact sheet.

CMS announced new enforcement measures for their hospital price transparency efforts.

HHS released the formal proposal governing health insurance coverage for dreamers. CMS issued the press release and fact sheet. The proposed rule (PDF) is available at the Federal Register, where comments can be submitted through 6/23/23.

The OIG at HHS released a new audit on duplicate payments made by the VA & CMS for veterans eligible for both programs. This is NOT aimed at providers, but for those who provide services to veterans it’s an important issue to monitor. You can download a copy of the full report and the report in brief (both PDF).

The State Department announced it was freezing EB-3 visas, a major concern for healthcare providers.

FROM THE NOTEBOOK:

• With the Medicaid unwinding in full swing, the Kaiser Family Foundation (KFF) looked at the latest numbers from the unwinding. In addition, they identified which states have policies in place to deal with the unwinding, something that can be helpful in identifying which states are most likely to have high number of issues with Medicaid redeterminations.

• KFF also created a helpful cheat sheet on the timelines of different federal programs impacted by the end of the PHE.

• An important op-ed from the Hill pointing out how immigration can help with the nursing shortage.

• JAMA published a new study that looked at the utilization and impact of the 3-day stay waiver during the PHE.

• The state of Washington passed a law increasing privacy protections for apps and consumer health data, an important trend to monitor for other apps and states.

• The “Covid Crisis Group”, created in 2021 to analyze the response to the Covid pandemic, released their report in book form this week. As expected, the lack of coordination by government agencies is a central feature of the report.

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