The White House continued their public focus on a post Roe v. Wade world, an effort to revitalize the nation’s airports, and a new effort to support educational programs called the National Partnership for Student Success. For our purposes, two items of note:

• The White House issued vast new proposed regulations related to student loan relief programs. As many of you offer some form of student loan debt relief to encourage staff retention, there may be parts of the rule that impact you. You can find the fact sheet here (PDF) and the proposed regulations here (PDF).

• As part of the Executive Order related to Roe, the White House tasked HHS with expanding HIPAA protection related to reproductive health care. While it doesn’t appear to directly impact SNF’s (yet), there is a renewed devotion to patient privacy and HIPAA in DC, which may impact the HIPAA rules governing our residents. It can also impact the rules governing telehealth, as well as any emerging digital technologies.

Talks are starting to heat up on a new party-line, social services reconciliation bill. While the bill will be significantly smaller than originally envisioned, as currently constituted, there are a few pieces of interest to us. The caveat here, of course, is the fact that the pieces that Senator Manchin objected to the first time around (that it needs to be paid for, energy & climate change, other social elements) still need to be negotiated. For now, a few notes:

• There’s a provision that would allow Medicare to negotiate drug prices. The Washington Post has the most extensive public report on the deal. You can find the 190-page current text of the legislation here (PDF) for those who are interested. For the fiscal wonks, the Congressional Budget Office (CBO) estimated (PDF) that the plan would generate nearly $300 billion in revenue over the next ten years, an important procedural number that makes the path to passage more politically feasible. The Committee for a Responsible Federal Budget, a non-partisan think tank that analyzes the federal budget has a good explainer on this specific piece of reconciliation.

• They want to close a loophole on the net investment income tax [NIIT] for those earning more than $400,000, with any revenue going towards the solvency of the Medicare program.

A few items on the elections front, especially with the August Congressional recess coming up:

• We mentioned last week about the impact that Roe can have on the Congressional outlook in November. In early polling, it does seem to be having a pro-Democrat impact, but, as always, the gap between now and November is significant.

• 538 did a deep dive on whether the traditional Democratic appeal to the “working class” can help them reverse the outlook for the 2022 midterm elections.

• Continuing a theme we’ve been tracking, the Washington Post did an analysis of several high-profile Republicans choosing to endorse candidates opposed by former President Trump.

• Finally, Politico highlighted several Republican House members that will be key to passing legislation should the GOP take back the house as expected.

Following up on items we’ve mentioned over the last few weeks regarding increased oversight on Managed Care program, HHS announced a new suite of tools and requirement to help states provide more oversight on their MCO programs. The guidance from CMS can be found here (PDF).

The OIG at HHS released their annual report (PDF) on health care fraud and abuse. They also issued a new advisory opinion (PDF) on whether charitable donations to support a Veteran’s care would potentially run afoul of kickback laws.

CMS released their proposed FY 2023 Physician payment rule fee schedule which contain significant changes to the Shared Savings program and ACO’s. They also issued a fact sheet with guidance on the major provisions. The full rule will be published to the Federal Register on 7/29. The full 2,000-page proposed rule can be downloaded here. Buried deep in the rule (starting on page 1,036 of the PDF), there is a proposal to change SNF’s to the “high-risk” screening category and require background/fingerprinting checks. The 60-day comment period will begin when the rule is formally published.

CMS also released their updated quarterly report (PDF) on the technical changes related to the five star system, including the information related to weekend and staffing turnover.

We mentioned CMS’ new QSO last week that removed the requirements that surveyors be vaccinated. McKnight’s had a report on a public presentation by Evan Shulman, the head of CMS’ division on nursing homes, in which he reiterated that CMS doesn’t “have the authority” to require surveyors be vaccinated.

OSHA is indefinitely extending their “National Emphasis Program” that calls for inspections on facilities with high-risk exposure to Covid, including SNF’s. They’re also raising their inspection goal to 10 percent of facilities. The program had been scheduled to expire this week.

A federal court ruled that providers in Illinois can sue the state to recover Medicaid payments that have been denied by MCO’s, a ruling that can have national implications for dealing with MCO’s.

In the non-agency items of the week:

• Pennsylvania passed a new budget that includes a significant boost for SNF’s.

• Michigan passed the law we referenced a few weeks ago regarding creating more consistent surveys and is awaiting signature by the Governor.

• Arizona created a $15 million pool to strengthen nursing programs at local universities and help ease the state’s staffing crisis.

• California announced a $100 million plan to create their own insulin.

• On the innovative front, robots made their debut in nursing homes.

• Modern Healthcare had an article (locked behind a paywall) on how international founders of digital technologies (such as AI programs) are looking for US based help in navigating the market.

• Health Affairs (a research blog that is well-read at CMS) called for more access to dental care for residents in SNF’s.

• This may help your clinical teams better assess residents that are at a higher risk for rehospitalization. A study from the University of Missouri, published in BMC Health Services Research, found that black residents and those under 65 were significantly more likely to have repeated hospital transfers.