WHITE HOUSE:

The White House focused on the President’s first veto, nearly $200 million in funding to help with wildfires this coming summer, and more conservation efforts related to national monuments and waters. Two items of indirect interest for us:

• They created a new “challenge” to encourage a public-private partnership to end hunger and help develop healthier communities. While not directly geared to SNF’s, healthcare providers that target healthy nutrition may be eligible to participate. The central resource site is here.

• This isn’t actionable per se, but we’ve discussed the different budgetary approaches between the White House and the GOP as the US approaches the debt ceiling. The White House released a state-by-state series of fact sheets highlighting the impact that the House Freedom Caucus budget would have on Medicaid should it pass. Practically, that budget won’t pass as is (like we discussed with the President’s budget), but it’s important to understand the different approaches in DC.

CONGRESS:

Although the divided Congress has made it difficult to pass legislation, there are still some bipartisan pieces of legislation that have made it through. The President signed into law the "COVID-19 Origin Act of 2023", which requires the publication and declassification of all information related to the origins of Covid. While a pure information bill, given the intersection between long-term care and Covid, it’s possible that as more information is released, there may be unintended consequences related to litigation, legislation, and regulation. It’s something to keep an eye on. Elsewhere from the political world:

• We’ve looked at different ways state legislatures step up to the plate when a legislative path through Congress is tough. The latest state push? Immigration.

• The Senate Committee on Homeland Security & Government Affairs (HSGAC) held a hearing this week on pharmaceutical supply and shortages. The full report is available here (PDF).

• The latest on the debt ceiling discussions comes with an interesting wrinkle: a letter from the Congressional Budget Office (CBO) offering an analysis as to the accuracy of their projections related to federal healthcare spending. There are some interesting data points in there related to US healthcare spending, including on long-term care. You can access a copy here (PDF). Overall, the progress is slow.

• We’ve discussed a lot about the effect of divided government and passing legislation. The data is backing up that trend in the Senate, although, counter-intuitively, the House has had more agreement than in the past.

• One area that came up often in the run-up to the 2022 Midterms was the weak slate of GOP candidates. The GOP hopes to solve the problem with their latest candidate in the race against Senator Joe Manchin: popular Governor Jim Justice. The GOP is taking the issue seriously as they prepare for the 2024 elections.

• Finally, on the Presidential side, an up-to-date look at the GOP presidential candidate field in 2024.

AGENCIES:

CMS gave their first approval of a VR device as a DME, opening the door to reimbursement by Medicare. As many of our readers are involved in innovative technologies assisting seniors, this can be helpful in guiding the process elsewhere. You can access a copy of the NCD (National Coverage Determination) here (PDF). On a related front, a bipartisan group of Congressional members introduced new legislation to limit the time between FDA approval and CMS approval for Medicare.

HHS & CMS celebrated the 13^th year anniversary of the passage of the Affordable Care Act this week with a new report (available here as a PDF) highlighting data related to enrollment and growth of the program. The program is enormously popular, and continues to expand, even in red states. Only ten states haven’t yet chosen to participate in the expansion.

March 17^th was an important date for transition to compliance for states related to their HCBS programs. CMS issued a joint statement with the Administration for Community Living (ACL) to mark the occasion. You can access a copy here (PDF). More information is available at the Medicaid’s central resource page for HCBS.

HHS, via HRSA, announced a new modernization effort aimed at update the regulations surrounding organ donation and transport. The central resource page is here.

For those of you involved with dialysis, CMS updated their QSO governing on-site provision in a SNF. You can access a copy here (PDF).

For those involved with Certified Community Behavioral Health Clinics, HHS announced the availability of more than $120 million in funding opportunities.

The National Labor Relations Board issued a new guidance memo governing severance agreements. As this may impact your agreements, please share with your legal teams for guidance. It’s available here (PDF direct download).

The HHS at OIG did an investigation into Georgia’s adult day care program, finding non-compliance at all 20 facilities they looked at. While not a direct investigation of the facilities, the result is that Georgia promised to conduct more in-depth audit at adult day care facilities in the state. You can access PDF copies of the summary and complete report.

FROM THE NOTEBOOK:

• North Carolina finalized their Medicaid expansion. Slipped into the bill is a provision loosening the requirements around CON’s.

• Michigan passed a bill that repealed the right-to-work legislation in the state, potentially strengthening the union there. 538 looked at the national implications of the bill.

• We’ve been tracking the MA fight going on in Capitol Hill. The NY Times did a deep dive into the fight.

• An updated look at the impact that ending the PHE will have on healthcare providers. First item on the list? The tougher rules governing training of SNF staff.
• Kaiser Health News took a look at the workforce retention challenges that accompany low Medicaid rates.

• Finally, an in-depth exploration at how telehealth has been utilized in rural SNF’s to help with mental health challenges among residents.

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