In observance of Passover, there will be no Digest next week. We will return Monday, April 17.

WHITE HOUSE:

The White House focused this week on a new executive order related to government usage of spyware, a new 10-year plan outlining the US strategy for promoting international stability, and an update on their efforts related to electric vehicles and wind energy. One indirect item of note:

• They announced a new set of initiatives to support women-owned small businesses. As many of your staff, and some of your vendors, may benefit from these rules, they may appreciate hearing about it from you.

CONGRESS:

Congress, with bipartisan support, passed a resolution that would end the Covid National Health Emergency (NHE). The President said he won’t veto the bill, despite strong Democrat objection. For our purposes, it’s important to note that the NHE is different than the Public Health Emergency (PHE). There’s a good summary here and here on the difference between the two and the impact on the healthcare system. For SNF’s, the primary impact of ending the NHE is related to utilization of waivers for TNA that are still in effect in several states and for specific facilities, which will end whenever the President signs the bill. See below for CMS’ official clarification on what ending the NHE means for SNF’s. Elsewhere from the political world:

• The posturing on the debt limit discussions continue with no clear end in sight. It’s important to note that the technical details in these discussions matter as unclear language can even tie up funds that were already appropriated.

• Complicating the conversation was the 2023 Social Security & Medicare Trustees report, issued today by the Treasury. The overall fact sheet is available here (PDF); the Medicare report is available here (PDF), and the central resource page for the Social Security report is here. Bottom line: while the precise date when the programs run out of funds is a fluctuating target, Congress needs to act to keep the programs funded. This is also having ripple effects for the Congressional discussion over Medicare Advantage plans.

• As always when discussing Medicare & Social Security, it’s important to remember that they remain incredibly popular. Practically, this is a good summary of the latest political positions in DC related to the programs.

• An interesting profile of Speaker McCarthy’s new Congressional “wingman”.

• Written early in the week, but an interesting look at who Democrats would prefer as the 2024 GOP nominee.

• While we often focus on the national elections, one downstream race to keep an eye on: the Wisconsin race for a state Supreme Court seat, scheduled for this Tuesday.

AGENCIES:

As mentioned above, this is official confirmation from CMS that the end of the NHE doesn’t affect the 1135 waivers that are tied to the PHE.

As is their way, late Friday CMS announced the final MA rate rule for 2024. The fact sheet is here. The formal rate announcement can be found here (PDF). This had been the subject of intense lobbying on the part of insurers.

CMS released a new QSO related to infection control enforcement. You can access a copy here (PDF). They also let expire a whole bunch of Covid era QSO’s related to visitation and other policies. The full list can be found at CMS’ QSO site.

CMS also issued their proposed 2024 hospice payment rule, for those involved with hospices. A copy of the rule can be accessed at the Federal Register, where it is scheduled to be published on April 4^th, at which point comments can be submitted till May 30^th.

USCIS announced that they ended several Covid-related waivers on March 23^rd. At the same time, they also announced that they are creating a new virtual center to expedite humanitarian relief applications and relieve some of the backlog.

It’s unclear the impact on the health care system, but a federal judge in Texas struck down the preventative services requirement of the ACA on Thursday, and the ruling has already been appealed by the Justice Department.

For your legal teams, a decision in California that allowed a lawsuit against a SNF go forward in state courts, despite the state regulatory agency’s involvement.

We mentioned in the past that ARPA-H was launched by the Biden Administration to fund new research into future possibilities for healthcare. They put out an open call for proposals this week.

FROM THE NOTEBOOK:

• An updated look at state public option plans and the political challenges they keep hitting.

• A new study showed how impactful telehealth was in lowering fatal opioid overdoses during the pandemic.

• The Washington Post takes a deep dive into the Medicaid unwinding that began on April 1^st.

• A look at how Medicare Advantage plans penetration is shaking up the healthcare market.

• Following up on an item from last year, Congress is looking at how to make the price transparency rule more impactful.

• A look at Cigna’s process in rejecting claims without actually reading them.

• Always nice when a SNF is in popular culture for a good note. Rihanna appreciated a SNF’s rendition of one of her songs.

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