WHITE HOUSE:

With the President recuperating from Covid, it’s been a quiet week out of the White House. The focus was on efforts to explore “Eviction Prevention Reform”, releasing more details about the Safer America Plan we mentioned last week and a new energy efficiency initiative for federal buildings. One item that may impact the industry:

• As part of the Administration’s efforts on reproductive rights following Roe v. Wade, the President signed an Executive Order that may impact other healthcare providers, especially as it relates to HIPAA guidance and non-discrimination. It’s something to monitor as the details are worked out by HHS and other federal agencies.

CONGRESS:

After more than a year of on-again, off-again efforts, Senate Democrats finally passed their party-line social services bill, called “The Inflation Reduction Act”, using a procedural tool called Reconciliation. Procedurally, the bill heads to the House where it’s expected to pass quickly. The vote is scheduled for Friday. While the 755-page bill (PDF) represents the most ambitious effort by Democrats to reform social services, the bill does little to directly impact the industry. Axios has a solid summary of the big-ticket items in the bill. For our purposes, broadly speaking, the bill is split up into three parts:

• Healthcare – Congress is giving Medicare the authority to negotiate the price of up to 20 drugs. They’re also instituting an out-of-pocket cap of $2,000 for Medicare beneficiary spending on medication.

• Climate change – the bill invests nearly $370 billion in climate change efforts. For our purposes, there will be a whole slew of incentives coming to increase usage of renewable energy sources, which may be helpful for individual facilities to lower their energy costs.

• Taxes – Congress is investing up to $80 billion to beef up IRS enforcement to better collect what’s already owed in taxes. They are several provisions that impact large, public corporations. For our purposes, the final bill does NOT contain the elimination of the carried-interest loophole, leaving in place the lower tax rate on private equity firms (among others).

While these are the broad strokes of the bill, it’s important to remember that many of the practical provisions need to be finalized via regulatory agencies and the practical impact may change as they are rolled out .

ELECTIONS:

Several noteworthy items on the elections front:

• The biggest news came from Kansas this week, where the red state overwhelmingly voted in support of keeping abortion protections in the state constitution intact. The only sure thing is that it energized voters to turn out to the election. Beyond that, it’s anyone’s guess.

• We’ve mentioned a few times about the perceived lack of strong GOP candidates for Senate races. 538 did a deep dive into track records for candidates with little experience in politics, unsurprisingly finding that experience does matter (although it’s not locked in stone).

• We often talk about money in politics. The Atlantic has a very insightful analysis (paywalled) into money, influence and engagement in politics, using a Democratic primary in Michigan, where an AIPAC-supported, pro-Israel Democrat defeated her anti-Israel opponent, as a test case. The bottom line is that, beyond the baseline of support needed to run a competent campaign, the quality of the candidate matters. One key quote from the article: “Money is not magic, and no amount of funding can transform a bad candidate into a good one.”

• With the GOP likely to take the House, and divided government a real possibility, it’s important to explore what areas can serve as common ground for political activity. To that end, a group of centrist Republicans released broad outlines of their agenda should they take the House. The agenda can be accessed here (PDF).

• Former President Trump’s endorsement continues to matter as his support was key in several GOP primaries, particularly in Arizona.

AGENCIES:

Thanks to Medicaid expansion, along with provisions in the CARES Act, HHS published a new report showing that the uninsured rate has reach an all-time low of around 8%. The report is available here (PDF). This can help with fiscal planning and understanding patient demographics.

CMS announced the release the Inpatient Prospective and LTC Hospital final rule this week, with a specific focus on maternal health. For those of you involved with home health agencies, CMS also announced a new guidance that will allow states to tap into Medicaid funding to create a home health benefit for children with “Medically Complex” conditions. The guidance is available here (PDF).

CMS held an open-door forum for the industry. While a dry, technical call, they did touch upon several important topics, including what the staffing bill may look like. McKnight’s has an accurate summary of the call.

We didn’t cover this in last week’s summary of the SNF FY 2023 payment rule, but CMS made a technical fix to the FSES life safety compliance rule related to NFPA 101A that affects many older facilities. Jensen Hughes, a leading professional engineering firm with extensive expertise in life safety codes, has an overview of the change here (PDF).

OTHER:

On the non-agency front:

• For those of you in New York, the state launched their $1.3 billion bonus program for front line workers. More details are available at the state page for the program.
• For those of you in Georgia, your staff may appreciate this. Following up on the recent court cases related to abortion, the state issued formal guidance that allows any unborn child with a heartbeat to be claimed as a dependent on their state taxes. This can be worth up to $3,000 per child.
• For those of you in Pennsylvania, the state created a $55 million program to help with student loan debt relief for nurses. Notices should have started going out last week.
• Nevada received a $1.6 million grant from HRSA to develop an oral health delivery system for Medicaid participants.
• We’ve talked a lot about the end of the PHE and the estimate 15 million who are at risk of losing their Medicaid coverage. Kaiser Health News had a visceral description this week of what it looks like in real life.
• They also had a look at a county facility in upstate NY that is suing relatives of residents to collect outstanding debt.
• On January 1^st, 2022, the No Surprises Act went into effect. The bill is designed to provide consumer protections for out-of-network insurance costs. Modern Healthcare provides (paywalled) a look into how the act is impacting negotiations with insurance providers.
• HealthAffairs ran an extensive analysis of total Medicaid spending at the state level, something that can help identify states with more robust Medicaid environments.
• The Institute for New Economic Thinking, a somewhat left-leaning think tank, published an analysis of the relationship between REIT’s and nursing homes/hospitals and calling for more active oversight on the REIT’s.

z-INTEL is going to be at Zimmetwood in Mohegan Sun in CT, starting this Wednesday morning. Come hear z-INTEL co-founder Marc Zimmet provide the real story on Skilled Nursing reimbursement at his opening remarks on Wednesday morning. We’d also love to see you at your booth in the Exhibition Hall.

Questions? Email us at support@myzpax.com.

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