WHITE HOUSE:

The White House focused this week on diversity issues, the ongoing inflation crisis (with the Federal Reserve issuing the largest interest rate hike in nearly 30 years) and the “Major Economies Forum”, a consortium of the largest nations in the world aiming to collaborate on global climate change initiatives. There were several announcements that, tangentially, impact the SNF industry:

• The President announced a “Talent Pipeline Challenge” aimed at training and developing workforce. The primary sectors are infrastructure related (i.e. construction or electrical work), but the feds are encouraging states to use the funding they received in the American Rescue Plan Act of 2021 (ARP) for this purpose.
• This is more election related, but the Biden Administration is shifting its focus from healthcare as they (finally) realize that most of the country has long stopped focusing on Covid with more pressing issues (like the cost of gas and the economy) on their minds. For our purposes, this simply means that, at least at the federal level, the political will to invest more in SNF’s is less likely.

CONGRESS:

Congress continues to work on the text of the bipartisan framework for gun control reform, the first significant bipartisan talks on gun control in a long time, as well as the ongoing January 6^th hearings. While the gun control discussions were the focus, a couple of important notes on several pieces of legislation that were introduced:

• Senator Kevin Cramer (R – ND) introduced a bill to require the Government Accountability Office (GAO) to investigate the business practices of agencies. Several of the leading health care advocacy groups, such as the American Hospital Association (AHA) & the American Health Care Association (AHCA) sent in letters of support.
• Two Democratic Congressional members (Rep. Adam Smith of WA & Rep. Lucille-Roybal Allard of CA) introduced three immigration bills specifically focused on immigration and the healthcare workforce. Leading Age has a solid summary of the three bills, but here are the concise details. (As no bill text is yet available for HR 8021 & 8022, the links below take you to the one-page pdf summary):
• HR 8019 – this bill would help integrate US citizens who have been trained overseas into healthcare systems in the US.
• HR 8021 – this bill would help immigrants enter the healthcare workforce, regardless of prior medical training.
• HR 8022 – this bill would help ease the transition into the US of immigrants with medical training.
• While it’s very early in the legislative process for these bills, hopefully it’s a sign that these ideas are starting to gain traction on the Hill.
• In a high-profile special election in Texas, the GOP flipped a House seat in a district that was heavily slanted towards the D’s in 2020. It’s important to note that special elections often have somewhat anomalous outcomes that aren’t predictive of the election.
• Politico ran a comprehensive piece on how the primaries seem to be pushing elected officials away from a centrist philosophy.
• 538 posted an updated version of their analysis of the redistricting map now that nearly all states (except for Louisiana) have settled on their Congressional map. As expected, the numbers favor Congress flipping to the GOP in November.
• This is more of a wonky note, but often when Congress wants to pass something that might be controversial, they attach it to “must-pass” legislation, like raising the debt ceiling. The Bipartisan Policy Center released an analysis this week that anticipates the US won’t hit the debt ceiling till the end of Q3 2023, significantly later than earlier predicted. This is likely to slow down, even further, Congress’ ability to move legislation.
• Finally, many states have passed laws that recalibrate how folks can register to vote. As many SNF residents are voters, this is something to monitor if you’re in states that have changed the rules.

AGENCIES:

HHS issued new HIPAA guidance for how audio-only telehealth can be conducted in a way that is HIPAA-compliant. The guidance is available at the HHS HIPAA resources page.

The OIG at HHS (HHS, Office of Inspector General) released an analysis that found that when medical services are provided at provider-based facilities (i.e. hospital locations), the costs were significantly higher than when offered at a freestanding facility. This continues to highlight the argument that a disproportionate focus of CMS is on SNF’s versus hospitals. The complete report can be found here (PDF).

CMS issued two important Quality, Safety & Oversight Memos (QSO’s, the tool CMS uses to communicate guidance to state survey agencies) this week. (Links take you to the PDF):

• QSO-22-17 – this QSO limits required survey oversight on staff vaccine compliance to initial & recertification surveys. States can choose to have a more comprehensive requirement. Previously, every survey had a vaccine compliance element.
• QSO-22-18 – this QSO rescinds the earlier QSO (22-10) which required all surveyors to be vaccinated. Moving forward, surveyors will only need to be vaccinated if the state requires it.

CMS released their 2023 payment rule for Home Health Agencies (HHA’s) with an approximate 4.2% cut to payments. The rule will be published to the Federal Register on 6/23. Comments can then be submitted through August 16^th, 2023.

In 2020, when Congress passed the CARES Act, they instituted a 6.2% FMAP increase (the federal match for state Medicaid programs) that will end on the last day of the fiscal quarter in which the Covid Public Health Emergency (PHE) ends. As long as a state is taking the extra 6.2%, they are not allowed to remove any Medicaid beneficiaries from their programs, leading to a concern that nearly 16 million beneficiaries will lose access to Medicaid benefits when the PHE ends. As states & providers prepare for the end of the PHE (at this point, potentially in October), CMS is hosting a series of webinars titled “Unwinding the PHE”. The second in the series is this Wednesday, June 22^nd, at 12 PM EST. You can register here. The slides and transcripts from the first webinar in May can be downloaded in a ZIP file directly from CMS here. The full “unwinding” resource page is here.

LEGAL:

The Supreme Court ruled in favor of hospitals in the 340B program, a drug rebate program requiring pharmaceutical manufacturers to provide discounted drugs to hospitals that serve low-income populations. The court held that HHS could not unilaterally cut rates to hospitals that participate in the program.

OTHER NOTABLE ITEMS:

• Michigan is slowly moving forward on a fascinating bill that would attempt to rein in the vindictive survey process at the state level, requiring the state to establish some form of quality assurance process in ensuring a uniformity of surveys across the state. This could be a model for attempting to reform the survey process elsewhere.
• Kaiser Health News had a significant expose on private equity and rural hospitals, further highlighting the argument that the White House focus on private equity in SNF’s (which runs at about 3-5%) is misplaced and they should be focusing on PE in hospitals.
• For those involved in telehealth, NBC News ran a report on how telehealth access is slowly dwindling as pandemic-era waivers start to lapse.
• Every June, MEDPAC (a non-partisan government agency that advises Congress on the Medicare program) releases a report to Congress on the Medicare payment system. The full 267-page June 2022 report can be found here, if you’re interested in some light reading.

The goal of the SNF digest is to help breakdown the impact that government has on the skilled nursing facility industry. If there’s a government program or agency that you want us to post an explainer or detailed guidance on, please let us know in the comments below.

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