WHITE HOUSE:

The White House focused this week on the President’s trip to the Middle East, the continuing high inflation numbers and the Administration’s response to Roe v. Wade, including specific guidance to healthcare workers that has already sparked lawsuits. For our purposes, two items of note:

• The White House announced that $40 billion worth of American Rescue Plan funds have already been committed towards workforce development projects, including healthcare specific goals, with more to come. What’s interesting is that there are opportunities all the way down to the city level. The announcement specifically highlights several cities (such as Rochester, NY or Chicago) using the funding to create programs designed to increase the healthcare workforce.

• This is more targeted for those of our readers who are invested in Israeli companies, but they announced a new “Strategic High-Level Dialogue” between Israel and the United States that is designed to encourage the flow of information and innovation between the two countries.

CONGRESS/ELECTIONS:

That didn’t last long. After we mentioned last week that talks had started on reconciliation, but that the non-healthcare pieces (that scuttled the bill last time) could blow up the negotiations, that’s exactly what happened when Senator Manchin announced he’d only support the drug prices agreement that was already worked out. While a slimmed down healthcare bill may still move forward, the high inflation numbers will continue to prevent a larger bill from going through.

A few elections items of note from Congress:

• 538’s election forecast continues to keep the Senate as a toss-up on flipping to the GOP (a function of several “weak” Republican candidates).

• This came up a lot in the 2020 elections, but the President’s approval rating is not necessarily correlated with how the party does in the elections.

• With the President’s approval rating historically low and his age making the Democratic party uncomfortable, we have our first notable progressive group announcing that they’re going to start an ad campaign encouraging the President not to run again.

AGENCIES (HHS/CMS):

HHS officially extended the PHE this afternoon. As this is the first PHE extension since we started our SNF Digest series, a brief primer on what the PHE means for the industry is in order:

• Congress instituted a temporary 6.2% FMAP increase that will end on the last day of the fiscal quarter in which the PHE ends. FMAP is the percentage of Medicaid expenditures paid by the federal government to each state. For now, with the PHE currently scheduled to end on October 15, 2022, the FMAP increase will continue through December 31, 2022. (If you want a real wonky breakdown of FMAP, the Congressional Research Service has you covered (PDF)).

• As long as a state is taking the extra federal dollars, they have certain obligations to the federal government and the public. CMS has an extensive breakdown in a FAQ (PDF), but for our purposes, the most important is that states are not allowed to remove anyone from their Medicaid rolls during the PHE. This has created a situation where public health officials are concerned that nearly 15 million people may lose access to Medicaid when the PHE ends. CMS has created an entire resource page to help with the “unwinding” (their terminology for the transition) of the PHE.

• CMS has also created a series of waivers of federal regulations while the PHE is in effect. A complete list can be found here (PDF). Among the notable waivers still in place is that of the 3-day stay requirement. These waivers are only linked to the PHE for as long as CMS chooses to keep them in place.

• Several states (for example, Texas) have created temporary rate increases for SNF’s that are tied to the PHE and will end when the PHE does.

• Back in January 2021, in a letter to the nation’s governors (PDF), the Biden Administration publicly promised a 60-day warning before ending the PHE, a promise that was reiterated by current HHS Secretary Becerra in an interview in March.

As mentioned last week, there is a renewed focus on HIPAA compliance in DC right now. HHS announced several HIPAA fines, including to a SNF, related to compliance with HIPAA rules. This is a good reminder to make sure that you’ve got solid HIPAA compliance rules in place. You can access the corrective plan for the facility here (as an example of what HHS is looking for).

For those of you with mental health access plans in place for your staff, the US began their transition for the suicide prevention hotline to 988 on Saturday.

This is primarily aimed at retail pharmacies, but HHS notified pharmacies of their obligations related to reproductive rights. You can find the guidance here (PDF).

This happened last week, but I skipped it as it’s a very long shot as it would require significant Congressional approval. Several folk ended up asking about it so I’m including it here. As required by the IMPACT Act of 2014, CMS provided a report (PDF) on what a unified payment system for Medicare post-acute care beneficiaries would look like.

This coming Tuesday, July 19^th, the CMS Administrator will host a national stakeholder call at 1 PM EST. This is not geared specifically at SNF’s but is a good opportunity to get insight into CMS’ thinking. You can register here.

The CDC provided updated guidance on “Enhanced Barrier Protections” in nursing homes for infection control measures. AHCA has a good explainer on their blog.

OTHER:

On the non-federal front:

• We mentioned last week about Pennsylvania’s big Medicaid rate bump. Our very own Ari Stawis posted a breakdown here. The Pittsburgh Post-Gazette provided more background and context to the long-overdue increase.

• Many of the residents in SNF’s are voters. On the heels of the 2020 election, quite a few states have enacted new laws related to voting registration and other election penalties. As our buildings are potentially at risk for many of the alleged issues (such as helping seniors vote), there’s a valuable spreadsheet (put together by States Newsroom, a left-leaning organization that focuses on state policy) that breaks down, by state, the many new laws in effect.

• Innovation in Aging (a publication of the Gerontological Society of America) collected a series of academic insights into new approaches to SNF issues. The full issue can be found here. The new introduction is here.

• HealthAffairs published a rundown of MACPAC’s call to build more integrated care strategies for dual-eligibles.

• The American College of Physicians, in their Annals of Internal Medicine, called for the creation of better insurance programs for older Americans.

• The Guardian did a deep dive into the troubled state of Australian nursing homes, something that can help inform the public arguments here in the US.

• Finally, the Kaiser Family Foundation published their 50-state survey on the landscape of Medicaid enrollment as the PHE unwinding gets underway.

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