WHITE HOUSE:

Over the last two weeks, the White House issued a new executive order modernizing the federal regulatory review process, new clean energy projects, a more comprehensive approach to drug trafficking, new pollution standards (Politico has a good summary) and more infrastructure investments. Two items of interest:

• They announced a plan expand health care coverage for DACA recipients. More specifics below in the agencies section, but essentially, this rule, if successfully enacted, would allow “Dreamers” (I.e. children of undocumented immigrants) to qualify for federal healthcare programs.

• While issued within the context of reproductive health, they announced strengthened rules regarding HIPAA. More information below in the agency section, but as always with HIPAA changes, it’s important to be aware of potential unintended consequences and how it ripples across all healthcare providers.

CONGRESS:

With Congress out of office for the past two weeks, most of the noise out of DC has been political posturing. Set to miss the budget “deadline” for the 20^th year in a row (a deadline that has no real world implications, other than publicity), there’s been no legitimate movement on the debt ceiling negotiations. In the meantime, individual Democrats and Republicans (PDF) are publishing thought pieces on how to tackle the debt limit, AND the GOP as a whole is struggling to find common ground on an approach. Regardless, as is often the case in DC, a deal isn’t likely until the US actually hits the debt ceiling. Elsewhere in the political sphere:

• In 2017, as part of the Trump Administration tax cuts bill, Congress passed a $10,000 cap on state and local tax deductions (SALT) (which disproportionately impacts homeowners in CA, IL, NY, NJ, and other blue states) that will sunset in 2025. While it won’t pass as a stand-alone legislation, there appears to be enough bipartisan support that it will be very difficult to renew the cap.

• Senator Feinstein (D – CA) hasn’t been in DC for nearly two months as she recuperates from shingles, leading to calls for her resignation from her own party. Procedurally, it’s causing headaches for Democrats who hold a 51-49 majority in the Senate, while setting up an intriguing political situation for potential replacements.

• Senator Tim Scott announced an exploratory committee for the Presidential election of 2024.

• A look back at the first 100 days of the House under the GOP.

• A new effort to “make elections boring again” was launched.

• Finally, takeaways from the state elections in Wisconsin last week.

2024 SNF Payment Rule:

The big item over the last few weeks was, of course, CMS’ release of the 2024 SNF payment rule. Two key points from the rule:

• CMS removed the minimum staffing rule from the payment rule, an acknowledgement of the complexity of the situation and the fact that they can’t simply regulate their way out of a legitimate staffing crisis. They are still planning on issuing a staffing rule “later this spring”.

• Practically, the net result is a 3.7% increase for SNF’s, an anticipated increase (in the aggregate) of nearly $1.2 billion.

As always there are significant complexities to the rule and how it impacts individual SNF’s, especially as it relates to the wage index (available here) and to the VBP components. You can find eCap Intel co-founder Marc Zimmet’s thoughts on just how much the wage index matters here. Comments on the rule can be submitted at the Federal Register through June 5^th.

AGENCY ROUNDUP:

Quite a few other items on the agency front:

• With the PHE coming to an end on 5/11, HHS announced several changes to the Prep Act, covering administration of Covid vaccines.

• They also announced that they will be ending several waivers related to telehealth provision when the PHE ends. You can access a copy of the notice here (PDF).

• As mentioned above, HHS issued proposed new rules related to HIPAA compliance, available here.

• CMS issued the final MA rule. A fact sheet is here.

• They also issued a proposed rule related to the 21^st Century Cures Act, which covers EHR software. The proposed rule can be found here. While not directly on providers, if you’re involved with software in the Health IT space, it’s worth reviewing.

• With the “unwinding” underway, HHS’ Office of Civil Rights reminded states of their legal obligations regarding Medicaid. A copy of the letter is available here (PDF).

• The OIG at HHS released a new report that found CMS’ Care Compare site underreported deficiencies from SNF surveys. You can download copies of the report in brief and the full report (both PDF).

• The IRS released a “10-year strategy plan” outlining their goals with all the new funding they received from Congress. You can download the full plan here (PDF).

• The National Institute of Aging wants to build a comprehensive, national database to assist in research on Alzheimer’s disease and related dementias. They are planning on issuing a $300 million, six-year grant to one organization to build the platform.

• HHS launched a new $5 billion effort, called “Project NextGen”, to accelerate development of the next generation of Covid vaccines.

• Finally, CMS held an open-door forum for SNF’s on Thursday. Both Skilled Nursing News and McKnight’s had summaries of the call, which covered technical details related to the MDS transition. CMS created a “what to expect” site along with a guide to the transition (PDF).

From the notebook:

• Politico highlighted the staffing challenges healthcare is facing right now and the need for innovative solutions, including immigration.

• This is more geared for states and MCO’s, but the Kaiser Family Foundation looked at potential strategies to manage the risk associated with unwinding. The data may be useful in understanding market dynamics as the impact of the unwinding becomes clearer.

• A look at several states’ efforts to limit telehealth bills.

• USA Today explored the lack of federal oversight on Medicaid’s “Directed Payments” program that provides payments to MCO programs.

• Dr. Grabowski wrote a piece (free with registration) for the New England Journal of Medicine suggesting a more integrated approach for dual-eligibles.

• HealthAffairs did a deep dive into the Green House model of SNF’s and what it would take for the federal government to incentivize more similar programs.

• With all the news around HIPAA, a good summary of what HIPAA does, and perhaps more importantly, doesn’t do.

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