WHITE HOUSE:

The White House focused this week on the President’s secret trip to Ukraine, followed up with new sanctions on Russia, the surprise nomination of Ajay Banga to lead the World Bank and more efforts to expand offshore wind energy production. One item of indirect interest:

• Through HUD, via the Federal Housing Administration, they announced that they are lowering mortgage premiums for new homebuyers who qualify for the program. The formal letter is available here (PDF). As many of your staff may be eligible for the benefit, they may appreciate hearing about it from you.

CONGRESS:

With President’s Day last Monday, Congress was out of town for the week. Many Members took the opportunity to participate in Congressional Delegations (known as CODEL’s) to foreign countries. In the meantime, keeping up the pressure on the debt limit discussion was a new report from the Bipartisan Policy Center that the actual date when the US will hit the debt limit is dependent on tax revenue over the next few months. Regardless, for now, little progress has been made in negotiations. Elsewhere on the Congressional front:

• Congress being out didn’t stop Senators Casey & Wyden from issuing a report on how the Texas blackouts impacted long term care. Here are the links to the summary & the full report (both PDF).

• We have our first Democratic challenger to the President, albeit quite a longshot to actually win. This was on the heels of more murmurs regarding whether President Biden will actually run again. In the meantime, potential GOP candidates remain wary of publicly challenging former President Trump, despite some favorable polls for challengers.

• Continuing their (somewhat unpopular) oversight theme, the House GOP is starting to look at regulations on small businesses.

• Senate Democrats received a boost when Senator Tester of Montana decided to run for reelection in a likely tough race. Meanwhile, the race to replace Senator Feinstein of CA continues to attract challengers.

• Always good to have a reminder that social security and Medicare remain popular, making it politically difficult for Congress to enact cuts to the programs. Along similar lines, Republicans are attacking the Biden Administration for their recent efforts on MA plans, framing the regulation as cuts to the politically popular programs.

• Highlighting a theme from the Midterms, Republicans are struggling to identify how to better appeal to women voters.

• Finally, following up on a disappointing showing in New York in the Midterms, the Democrat Leadership PAC announced a planned $45 million investment in the state leading up to 2024.

One interesting CRS report this week, covering AI & copyright law. While somewhat far afield, several of you are involved in AI software. You can download a copy here (PDF). There was also an in-depth review on potential legal issues related to using AI.

AGENCIES:

It was a quiet week for the agencies. The big item was a national stakeholder call with CMS where they confirmed that the PHE waivers would be ending on May 11^th. Following the call, they released updated guidance on the waivers. You can download a copy here (PDF). One important note from the call is that the 3-day stay waiver is a statutory requirement from section 1861(i) of the Social Security Act. A permanent change would require Congressional action.

CMS also issued a notice that they are suspending, for now, IDR hearings related to the No Surprises Act.

We’ve highlighted different states utilizing Medicaid waivers for innovative programs, like hunger. Axios reviewed how the programs are playing out several months in.

One legal note: There’s a very impactful case at the Supreme Court right now related to liability for social media companies for posts to their platforms. This can have broad implications for marketing, litigation, and many other areas related to all areas of the internet, including online reviews. For now, the Court appears unlikely to make massive changes to existing law, but it’s something to monitor.

FROM THE NOTEBOOK:

On the non-agency front:

• An important study from Dr. Grabowski, among others, shows what we all know intuitively: increased immigration is tied to more staff and, ultimately, better patient outcomes. You can download a copy of the full working paper here (PDF).

• With the unwinding of Medicaid rolls starting anew on April 1^st, the Kaiser Family Foundation updated their useful guide on the upcoming unwinding. Here’s an example of how the unwinding process will work through the eyes of CT.

• They also published a guide on CMS’ proposed rule related to prior authorization and MA plans.

• An interesting piece of legislation was introduced in Montana that would tie future Medicaid rates to inflation and other metrics to more accurately reflect the cost of providing care. Similarly, as highlighted by eCap Intel’s own Ari Stawis, South Dakota’s House passed legislation that would adjust, on a yearly basis, the state’s funding for Medicaid recipients to 100% of the costs. These haven’t yet been signed into law, but are two examples of legislation that could, in theory, be a model for other states to explore.

• A look at the patchwork way long term care is funded through the eyes of the US and globally.

• In 2019, Oklahoma passed a law tying funding increases to quality metrics. Four years later, the data is showing positive outcomes for residents. As mentioned in a panel at ECAP, these types of quality metrics are likely to become more common.

• This is particularly meaningful if you’re in a UPL state, but a JAMA study showed that tight integration between a hospital and SNF generally resulted in better outcomes.

• Finally, California is adding Medicaid incentives to facilities who hire more staff.

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