SNF Digest #198

MIDTERMS RECAP:

(All election results are as of ~2 PM EST on Sunday, November 8^th)

It was an absolute bloodbath for the GOP in the midterms at all levels. Democrats locked up the Senate Majority with at least 54 seats (Alaska & Mississippi remain too close to call although Dems lead in both. They also secured a huge House Majority, currently 252 – 161, with 22 races yet to be called.

Meanwhile, things were no better at the state level, where Dems dominated. It was a complete shellacking (this is an up-to-date link of all state legislative races), as Dems have already picked up nearly 500 seats across state legislatures, have at least 6 new trifectas (full legislative control) and flipped 12 chambers.

A few other quick thoughts:

·      We’re not gonna editorialize on “What it all means”, but one thing does seem to be clear: the election was more about voting for the other guy, and not about a return to progressive Democrats. In fact, moderate Democrats, by and large, outperformed progressives.

·      One particularly notable outcome was in Texas, where the Governor and Lieutenant Governor both lost, as Democrats won statewide races for the first time in more than 30 years. 

·      In terms of leadership, expectations are that Senator Schumer will become the next Senate Majority Leader and Congressman Hakeem Jeffries will be the next Speaker of the House, despite oppositionto both.

·      Meanwhile, Republicans will have a new House Minority Leader as Speaker Johnson announced he will not seek the position again.

·      The final tally of the redistricting wars was not kind to the GOP.

·      If you’re more the video type, Mark Parkinson and I did a short recap of the election the morning after.

WHITE HOUSE NEWSROOM:

As the midterms was the focus of the week, even at the White House, it was a relatively quiet week. They released a new Executive Order declaring the Oval Office a national monument, issued the “American Declaration of Freedom in Space”, and announced Stephen Miller as the President’s next Chief of Staff. One item of interest:

·      They highlighted the Administration’s efforts in finally bringing drug prices down through an op-ed that outlined the many steps the Administration has taken. Given that the first step was initiated by the original Medicare Drug Price Negotiation program that started under the Biden Administration, this could be one of the efforts that Democrats will build upon when they take over Congress in January.

CONGRESS:

We covered the midterms up above. In terms of what comes next legislatively, the GOP remains in charge through the swearing-in of the next Congress on January 3rd, 2027. There’s quite a few itemson the to-do list, but the big-ticket item, as always, is government funding. The funding deadline is December 11, but with such a decisive Democratic majority incoming, it’s unclear what kind of deal the GOP will be able to put together. As the dust settles on the midterms, the GOP is going to have to figure out how to navigate their final weeks in control. Elsewhere in the political arena:

·      It’s important to remember that despite Democratic control of Congress, legislation will still need the President’s buy-in. As we’ve mentioned in the past, that leaves oversight as their main agenda.  

·      As the Democrats take over, it’s time to get to know the main caucuses of the current Democratic party.

·      At least for now, the likelihood is that the large Democratic majority will marginalize the power of the extremists within the party to dictate policy, even as the progressive wing thinks about how to grow their influence.

·      An entertaining read on the reality facing the many, many new Democratic members of Congress.

·      The final numbers are in and they are staggering. There was nearly $12 billion in political ad spending in the midterms.

AGENCIES:

CMS released a major deregulatory rule with significant implications for SNFs. The proposed rule is scheduled for publication to the Federal Register on November 10, but if you’re so inclined, you can access a prepublication copy of the 378-page rule here (PDF).

CMS released the final home health rule, which provides more “Medicare Integrity” changes for Medicare. A Fact Sheet can be found here while the full final rule is available at the Federal Register.

CMS issued the next Medicare Drug Price Negotiation Program final rule that locks in the guidance for 2029 and beyond. The central resource page for the program is here. The latest timeline update for the program is here (PDF). The full final rule can be found at the Federal Register.

CMS issued several other final rules:

·      Hospital Outpatient Final Rule, which includes changes to the 340B program.

·      The Physician Fee final rule, which includes more protections for duplicate billing and ACO oversight, among other provisions. The full rule can be found at the Federal Register.

Somewhat under the radar, but in his remarks at the end of October (PDF), Federal Reserve Chairman Kevin Warsh announced that they would be changing the cadence of ongoing meetings, with the goal of reducing the number of rate-setting votes. The details are still being worked out, but this can impact the cost of borrowing.

The OIG at HHS performed an audit on HRSA’s Provider Relief Fund Phase 3 payments and found more than $658 million in potential overpayments. The summary is here (PDF) while the full report is here(PDF).

FROM THE NOTEBOOK:

·      New York is projected to spend more than $133 billion on its Medicaid program this year, according to the state’s mid-year financial plan (PDF).

·      First on the agenda for PA Governor Josh Shapiro with his new trifecta? A minimum wage increase.

·      The Kaiser Family Foundation explored the new Medicaid payment transparency rules.

·      CVS is splitting their retail pharmacy and insurance/PBM business into two separate companies.

·      Humana is expanding a prior authorization collaboration with AthenaHealth.

·      Modern Healthcare highlighted a new trend: MA plans keep filing lawsuits against CMS to change their star ratings.

·      McKnight’s has a good summary of a new study from HealthAffairs that found MA beneficiaries are less likely to be admitted to higher-rated SNF’s. The full study is here, although it’s behind a paywall.

·      Kaiser Health News reported about a delay in announcing the 2027 Rural Health Transformation Fund awards.