WHITE HOUSE:

The White House focused this week on several initiatives designed to increase private & federal investment in underserved communities, lower energy costs for families by allowing renters to connect to solar power, and creating additional resources for small and disadvantaged businesses to access federal contracting opportunities. For our purposes, two indirect items of note:

• They continued their efforts to invest in school based mental health services for children. While specifically aimed at school-based treatment, if you work with behavioral health centers near a school there may be partnership opportunities at the local level.

• As part of the Administration’s Housing Supply Action Plan, the Treasury Department released updated guidance on how state & local communities can use ARP funding to create more affordable housing. In theory, there may be opportunities to identify more affordable housing near rural facilities to facilitate placement for healthcare staff. You can find the formal guidance here (PDF). They also published a “how-to” for state governments (pdf).

CONGRESS:

With the August recess right around the corner, Congress made major strides on the two pieces of legislation we’ve been tracking over the last few weeks:

• Reconciliation – this has a more direct impact on the industry. With Senator Manchin finally on board, Senators Schumer and Manchin released the bill, called the “The Inflation Reduction Act of 2022”. You can access the full 725-page bill here (PDF) and the one-page summary here (PDF). The Committee for a Responsible Federal Budget does a deep dive into the specifics here. While passage isn't guaranteed, this is the farthest Congress has made it in months on this effort. Additionally, there are procedural and logistical hurdles to be cleared before passage. For now, here is a brief breakdown of the key pieces:

• Medicare Drug negotiation – Congress is giving Medicare the authority to negotiate drug prices for the first time. The Kaiser Family Foundation has a good breakdown of how it works. The pharmaceutical lobby is fighting heavily against it, but there isn’t much time to change the specifics.

• ACA subsidies – The bill contains $64 billion to extend ACA subsidies for families. Democrats are also trying to include an insulin pricing provision, but that will be an uphill lift to fit within the complicated procedural rules that govern reconciliation.

• Tax impact - To raise funds, they are closing the carried interest loophole, a move that will have significant tax implications for investments and private-equity. It’s also expected to be a key sticking point for Senator Sinema, the swing-vote for the Democrats on passage. The bill may also raise taxes on folks earning more than $400,000 a year. Finally, they are investing significantly in IRS enforcement capacities on tax collection.

• The tax elements of the bill are significant and something to monitor. Keep an eye out for a breakdown of the tax implications that will be posted here at the eCap Intel Community by Kuno Bell. While the specifics need to be worked out, it’s important that you consult with your tax advisors on how they may impact you.

• There’s a significant investment on climate change action, but it doesn’t appear to directly impact our industry.

• Chips & Science Act – this bill invests $280 billion in domestic manufacturing and STEM research. The House passed the Senate version on Thursday and sent the bill to the President, who’s expected to sign it asap. There’s a full breakdown of the different pieces of the bill, including the full text and summary ,at the Senate Commerce Committee CHIPS+ page.

• This is more impactful for next session of Congress, but a House Committee advanced legislation that would streamline Prior Authorization requirements for Medicare Advantage plans. The bill has significant bipartisan support. You can access a copy of the bill here (PDF).

ELECTIONS:

On the elections front:

• We’ve been tracking the political environment as we cross the 100 days mark to the midterms, but over the last few weeks the outlook for Democrats have slowly improved. 538 now has them (very slightly) favored to hold onto the Senate, although they’re still likely to lose the House.

• As mentioned, a part of the problem for the GOP is their slate of (perceived) weak Senate candidates. Politico did a deep dive into the problems facing the GOP in Pennsylvania.

• One other interesting read for the politically inclined: 538 explored the relationship between the low presidential approval rating and the improving Democratic outlook.

AGENCIES:

On the 32^nd anniversary of the Americans with Disabilities Act (ADA), HHS announced a proposed rule regarding nondiscrimination in healthcare settings. The full rule can be accessed here (PDF). The rule will be formally published at the Federal Register on August 4, 2022, which will kick off the 60-day comment period. A fact sheet can be found here. Please share with your legal advisors to determine how it applies to SNF’s.

The OIG at HHS released two audits of interests this week:

• Several nursing homes may not have complied with federal requirements regarding infection control surveys. You can download the full report and summary (both PDF).
• They called out CMS for not collecting overpayments that the agency had identified and leaving over $226 million on the table. You can download the full report and summary (both PDF).

CMS had a very busy week. The primary news for us is that they published the final FY23 SNF payment rule. Thanks to the sustained comments submitted by operators, the final rule was mostly positive. The final rule is available here (PDF) and will be published to the Federal Register on August 3^rd. They also posted a press release and fact sheet. For our purposes, three primary items on initial glance:

• Recognizing the intense inflationary environment and increased agency/staffing costs, they upped the market basket index increase to 5.1%.
• They committed to the 4.6% PDPM cut, but will phase it in over two years, resulting in a net 2.7% Medicare increase this year.
• In a change from past years, they recognized that recent staffing pricing increases are out of whack with historical data and incorporated the recent information to more accurately reflect what’s happening out in the world.

Quite a few other items from CMS this week:

• They put out a Request for Information (RFI) on how to improve Medicare Advantage programs. Comments can be submitted at the Federal Register through August 31^st, 2022. You can download the RFI here (PDF).
• They launched the enhanced nursing home compare site. They also published a fact sheet with technical details.
• They published the final payment rules for Inpatient Rehab facilities, Inpatient Psychiatric facilities, and Hospice.
• They hosted the latest webinar in their series on unwinding of the PHE. This month primarily focused on CHIP. The transcript & slides will be available here in a few weeks.
• Finally, for the more wonky among us, the CMS Innovation Center (CMMI) posted an analysis of different Medicare payment models, which you can download here (PDF).

A couple of other interesting agency items:

• The USDA extended a waiver of the WIC program that allows WIC funds to be used on non-contract formula. As many staff rely on the program, they may be interested in hearing about it.
• The AHRQ published a guide on controlling diagnostic errors in healthcare settings. You can download the full guide and infographic (both PDF).

OTHER INTERESTING TIDBITS:

On the non-agency front:

• Politico has a long but important read on how immigration is an essential component of solving the staffing crisis, specifically in nursing homes.
• The Hill published an opinion piece, primarily aimed at hospital settings (in light of their solution), that recognizes that staffing minimums don’t solve staffing shortages.
• KFF explored the trend of private equity in hospice.
• JAMA published a study on the association between state vaccine mandates and staffing shortages.
• In addition to their recent budgetary efforts, PA created a $55 million fund to afford student loan debt relief for nurses. Notices for eligible recipients should be going out this week.
• Michigan House Bill 5609, which we referenced a few weeks back, has been signed by the Governor. In theory, this should lead to a more equitable and consistent survey process.

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