WHITE HOUSE:

This week, the White House introduced a new initiative to grow off-shore wind energy, tackle high gas prices (which will require Congressional support that doesn’t appear to exist) and getting ready to sign the bipartisan gun control law that Congress passed Friday. While bigger societal issues were the focus, the President signed two interesting pieces of legislation that may indirectly impact SNF’s:

• S.2520: this bill requires the Department of Homeland Security to increase collaboration and strengthen a state’s ability to implement cybersecurity measures. While the available funding is directly for state agencies, the idea is to create a more robust federal & state response against cybersecurity challenges (like ransomware), including those that have affected SNF’s in the past.

• HR 4591: this bill strengthens Congressional oversight over the Department of Veteran Affair’s Electronic Health Record Modernization efforts, which has consistently run behind schedule and over budget. In theory, this should lead to a smoother rollout of the program, which will hopefully make it easier to work with the VA.

CONGRESS:

Congress finalized passage of two notable pieces of social reform legislation, both of which indirectly impact the industry:

• S.2938: This is the bipartisan gun control bill, the first significant federal action on gun control. Leaving aside the larger social issues, the bill authorizes significant federal investment in mental and behavioral health, as well as telehealth resources, related to gun violence. I don’t yet know if facilities that behavioral health programs will be eligible to apply, but it’s something to monitor. The summary of the legislation can be found here. The President signed the bill yesterday.

• S.2089: The “Keep Kids Fed Act” authorizes an extension of free school lunches for at least the next three months. Many of the employees in our industry qualify for the program and will benefit from the legislation. This is something they may appreciate hearing about. The President also signed this yesterday.

ELECTIONS:

On the elections front, Friday’s Supreme Court decision overturning Roe v. Wade can upend the calculus of the upcoming election. Democrats are already responding to the ruling by encouraging volunteers to sign up and organize campaigning around messaging centered on abortion rights. This doesn’t make it any easier for Democrats nationally to hold onto Congress (as inflation and the President’s low approval rating continue to hurt downstream Democrats), but it may significantly impact several specific gubernatorial races, as well as the Senate race in Wisconsin. A few other election notes:

• The results of Tuesday’s primaries continued a basic theme that crops out throughout the primaries: by and large, candidates endorsed by former President Trump are winning their primaries.

• 538 had an interesting analysis of the decline of competitive districts resulting from redistricting.

• Perhaps reading a little too much of the tea leaves, but this will impact both 2022 and 2024: Politico Florida dove deep into Governor Ron DeSantis’ decision to not seek an endorsement from Trump.

• Conservative Senator Josh Hawley (R – MO) suggested in an interview that in the long run, the court’s Roe v. Wade ruling will benefit the GOP and strengthen their hold on the electoral college.

• Finally, The Hill did an analysis of the seven Senate seats most likely to flip this November.

AGENCIES:

Back in June 2021, Colorado passed a “public option” (a state based insurance program). It took until last week, but HHS announced formal approval of Colorado’s application for the program, becoming the first state to receive approval for this type of program. While SNF services aren’t covered in the plan, this development is something to monitor as it can significantly impact how managed care organizations and other commercial health insurers reimburse care. A breakdown of the waiver can be found here. The formal approval letter can be downloaded from the CMS website.

The OIG at HHS released an advisory opinion (PDF) on the legality of DME manufacturers providing zero-interest financing to customers to finance their DME purchases.

They also released a report that identified inaccuracies in Medicare’s collection of race & ethnicity data. While they don’t recommend additional reporting requirements for Medicare residents in SNF’s, it’s something to keep an eye on. The full report can be downloaded here (PDF).

CMS released the proposed payment rule for End Stage Renal Disease (ESRD) providers that would increase payments between 3.1% (freestanding facilities) & 3.7% (hospital-based facilities). The rule will be formally published to the federal register on 6/28, at which point the 60 day comment period begins.

CMS held the second of their webinar series on “Unwinding the PHE”, the terminology they use to describe the process that will take place related to Medicaid beneficiaries and the end of the PHE. The slides and transcripts will be available on their unwinding page in a few weeks.

LEGAL:

While all the news was on the Supreme Court’s Roe v. Wade decision, there were three other decisions this week that impacted the industry:

• They declined to hear a challenge by United Health’s MA plan on a CMS overpayment rule; essentially requiring that MA plans reimburse the federal government for any overpayments within 60 days.

• Marrieta v. Davita: The court ruled that private health insurers can set their rates for ESRD at artificially low rates, a move that is likely to shift these patients onto Medicare.

• Becerra v. Empire Health: The court held that HHS accurately calculated the correct payment methodology in a way that lowers payments to safety-net hospitals. While exceedingly complex, this solidifies the deference that courts give to the agency in figuring out payment methodologies.

In the non-agency news of the week:

• In January of this year, Mark Cuban launched a new drug company that charges a flat rate of cost plus ~15% for over 100 generic drugs. A study was released this week that showed that for many drugs, the costs to purchase directly was significantly lower than the cost that Medicare paid for the drugs. There may be a cost savings opportunity here for generics used in facilities.

• The comment period for Maryland’s plan to include dental services in their Medicaid services closed Friday. The plan is to provide more robust coverage of dental services starting on January 1, 2023.

• Louisiana passed a law that expands Medicaid coverage for dental services to individuals in intermediate care facilities. The text of the law can be found here.

• The Los Angeles city council approved a plan that boosts the minimum wage for private hospitals in the city to $25 an hour.

• Governing.com (an online trade magazine aimed at public officials) analyzed a study from the University of Illinois-Chicago on how state and local municipalities are spending the $350 billion from the American Rescue Plan. This impacts state-level advocacy as several states have used their ARPA funding to provide Medicaid rate increases.

• ATI Advisory published a comprehensive report (PDF) on the public-private partnership that exists in long-term care, calling upon Congress to do more to support the industry. Be on the lookout for z-INTEL Co-Founder Marc Zimmet’s insights on the report, to be published right here at the z-INTEL Community.

Did we miss something? Let us know in the comments below!