At ECAP this past week, our very own eCap Intel co-founder Marc Zimmet was featured on a panel related to the New Medicaid and what Medicaid programs are looking to include as they craft rate structures moving forward. Skilled Nursing News covered the panel.

WHITE HOUSE:

With the State of the Union this past week, the White House primarily focused on messaging centered around the President’s accomplishments, including his efforts on Medicare, the infrastructure plan (with a useful state-by-state breakdown that can be a guide to available programs in each state) and criminal justice reform. One note:

• Unlike last year, the President mostly avoided focusing on the long-term care industry and kept his remarks on his reforms to a minimum. Of course, it’s unclear what the State of the Union means for legislation and policy.

CONGRESS:

On the heels of the State of the Union, the big discussion this week was the back & forth with the GOP regarding their plans for Medicare and social security. Senator Scott continued his push to have all federal programs, including entitlement programs, end after five years. With heavy pushback from the rest of the GOP, including Senator McConnell, the entire discussion remains much ado about nothing. A few other notes:

• As we’ve discussed over the last few months, the likeliest immediate path for conversations around rates will be taking place at the state level related to Medicaid programs. To that end, the NGA has created a central hub where you can find every Governor’s state of the state address. Along the same lines, while not specific to SNF’s, a look at how states are stepping up to the plate to help families when Congress won’t, which can be a playbook for other priorities.

• With the debt ceilings conversation ongoing, a look at some of the new conservative Congressional members on the Appropriations committee. One important nuance is that, at least politically, Republicans often come out on the wrong side of the public opinion in debt ceiling negotiations.

• Highlighting the ongoing cost of political activity, an interesting report on the fundraising activity necessary for Congressional members interested in committee chair spots. You can download the report here (PDF). In a similar vein, Speaker McCarthy’s first event as Speaker raised over $12 million.

• Politico hosted an event with six governors from across the political spectrum this past week. It’s an intriguing look at how politics looks different at the state level.

• Finally, as mentioned last week, conservatives are looking for alternatives to former President Trump as the GOP nominee. Here’s a deep dive into the divides within the party.

AGENCIES:

On the heels of the announcement of the end of the PHE, HHS sent out a letter to governors and created a roadmap to help states acclimate to the new reality. In response, the American Hospital Association sent an open letter to HHS Secretary Becerra with their requested priorities (available here as a PDF), which includes a piece of easing transition of patients to post-acute providers.

CMS released preliminary guidance on how drug companies will be required to issue rebates when their prices outpace inflation, a requirement of the Inflation Reduction Act. They issued three sets of guidance, all of which are linked below (direct to the PDF). I should note that these are highly technical, but they are looking for public input on their implementation of these rules:

• Fact Sheet

• Part B Guidance

• Part D Guidance

CMS also released a new blog post describing their administrative actions over the last few weeks. It’s a useful one stop shop on the latest at CMS.

Two interesting Congressional Research Services (CRS) reports to Congress this week, linked below (direct to the PDF). As a reminder, CRS reports are (in theory) the information and guidance that Congressional members rely upon for education in different policy areas:

• Medicaid: An Overview.

• US Health Care Coverage & Spending.

HUD issued new guidance on their section 202 programs regarding housing for low-income seniors. You can download a copy here (PDF).

Two legal notes, although I’m not sure of the immediate impact on SNF’s:

• A DC court threw out a lawsuit by the pharmaceutical industry that challenged the FDA’s authority to allow states to import cheaper medications from Canada.

• A Texas court ruled in favor of providers related to arbitration provisions in the surprise billing act.

RESEARCH STUDIES:

It was a heavy week for academic studies related to the SNF industry so I’ve given them their own section:

• HealthAffairs on the differences in vaccination rates among different shifts in SNF’s.

• HealthAffairs on the growth of Medicare Advantage plans.

• HealthAffairs on the correlation between SNF spending and staffing rates.

• JAMA on whether patients with dementia are more likely to be discharged to SNF’s with a lower star rating.

• ACP on the lower rate of admission of folks with opioid use disorder into SNF’s.

• Finally, Oxford Academic released their first Public Policy & Aging Report of 2023, which focused on the NASM SNF report from last year.

On the non-agency front:

• The Kaiser Family Foundation did an analysis of prior authorization requests and which insurers were most likely to deny them. This can potentially be helpful for forecasting your own claims.

• The Washington Post ran an op-ed calling on Congress to invest in more nursing instructors to help solve the nursing shortage.

• Several consumer advocate organizations wrote a letter to CMS in support of the staffing mandate, although they don’t mention any actual specific number. You can download a copy here (PDF).

• Premier Inc., a publicly traded GPO aimed at healthcare systems, released an analysis that found nearly 70% of surveyed providers are still using CMS’ pandemic-era waivers that are slated to end on May 11^th with the end of the PHE.

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