WHITE HOUSE:

Over the last two weeks, the White House released a new plan to replace lead pipes, a new Presidential memorandum on abortion medication, more funding for community schools and new gun control measures. Two items of interest:

• Ron Klain, who’s functioned as Chief of Staff to the President since the inauguration, will be stepping down this week. He will be replaced by Jeff Zients, who served as the leader of the White House’s Covid response taskforce.

• This doesn’t directly impact SNF’s, but for those of you involved in other real estate transactions, the White House released a new blueprint for a “renters bill of rights”. For now, the directive is primarily about gathering information, but over time it can lead to more directives centered on rent regulation and tenant protections.

CONGRESS:

As we move into the new Congress, House Committee assignments have been doled out. These include the 21 conservative GOP holdouts that led the fight against Speaker McCarthy as well as the removal of several Democrats from key committees. While conservatives have definitely gained more clout, the fundamental reality is that it’s unlikely to turn into real legislative action. With the House rounding into shape, two things are becoming clear:

• The GOP-led House will be the focal point for the fight over the debt ceiling. An early plan is starting to come into shape, but this debate will loom over all Congressional business through the summer. For those so inclined, this is a good explainer of what the debt ceiling actually is and how we got here.

• With most GOP legislation unlikely to move in the Democrat controlled Senate and signed by a Democratic Administration, most of the GOP power will be reflected in oversight investigations, including a new look at Covid in SNF’s (although likely to look at state government response by Democratic Governors, not private ownership).

A few other items of note from Congress:

• Senator Jon Tester led a bipartisan letter pushing the Biden Administration to oppose a blanket staffing mandate and recognize the staffing challenges that exist, particularly in rural areas. You can access a copy of the letter here (PDF).

• The NY Times did an in-depth look at the omnibus bill that passed at the end of last year and how many of the provisions directly impact healthcare policies.

• Several Congressional Members want to take a long look at PBM’s and their impact on drug pricing.

• With so much focus on the House, the Senate is slowly easing back into the new session. Despite the political challenges in the House, a group of Senators continue to try to find a path on immigration.

• An early look at the Senate seats most in play in 2024. Races are already starting to come into focus in Arizona, California & Indiana where several folks have publicly announced their campaigns for Senate seats.

• With so much talk centered on the aging Democratic leadership, Politico explored the future for Democratic candidates.

• While mainly an “off-year“ for federal elections, 538 looked at the important state-level elections taking place this year.

AGENCIES:

Several items out of HHS & CMS over the last two weeks:

• HHS approved a new request from California that will allow Medicaid beneficiaries to access certain benefits prior to release from prison. This can become a model for other states around the country. They also released a report looking at how Medicaid can be utilized for folks transitioning back into the community. You can access a copy of the full report here (PDF). The Washington Post has a summary of the waiver.

• HHS also released a new report on what the new $35 monthly cap on insulin will mean for Medicare beneficiaries. You can access a copy of the public study here (PDF).

• CMS released a new QSO with two distinct components. You can access a copy here (PDF):

• They’re going to start to audit antipsychotic usage in facilities.
• They will also post citations that are currently under dispute.

• CMS also released a guide to new videos they’ve created to help identify common challenges in SNF’s. You can access a copy of the QSO with links to the videos here (PDF).

• In light of their several administrative actions over the last month, CMS posted a roundup of their different initiatives.

The OIG at HHS released a new look on infection control in SNF’s in the first year of Covid. You can access the full report here (PDF).

Two items from the FDA:

• They are trying to simplify the recommended timeline for Covid booster shots moving forward, although there is still internal disagreement on how to best structure it.

• They announced that they are going to seek approval from Congress to regulate CBD products, as they believe the existing regulatory tools are insufficient to properly oversee the exploding market for CBD.

Clearing out the notebook from the last two weeks:

• Continuing their analysis of MA plans overcharging the government, KHN released a spreadsheet breaking down each plan’s overcharging.

• Skilled Nursing News explored the challenging survey environment through the prism of Wisconsin.

• An interesting opinion piece on how to engage with nurses in discussing staffing ratios.

• Kaiser Health News looked at the wave of rural health care closures that are coming from the staffing crisis.

• HealthAffairs published a study on the how REIT’s are impacting SNF staffing. As the study is behind a paywall, you can find an analysis here.

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