Shutdown is Over: The Pieces

The longest government shutdown in United States history concluded on November 12. Yesterday, I wrote a post summarizing the process until resolution – https://rhislop3.com/congress-medicaid-subsidies-whats-next/ Despite the cessation of the shutdown, pivotal issues—most notably the future of enhanced premium tax credits under the Affordable Care Act (ACA), which remain a point of contention for Democratic policymakers—are … Read more

Congress, Medicaid Subsidies – What’s Next

The Senate has approved a spending bill to keep the federal government running through January 30, though any decisions about extending the ACA enhanced premium tax credits have been postponed until December. Here are the main highlights: The package, passed with a 60-40 vote, will fund the Department of Agriculture, Food and Drug Administration, and … Read more

Medicaid Spending Reductions, Part III

Policy Options and Alternatives to Reduce Medicaid Costs This is part three of a series I wrote on Medicaid spending reductions (proposed). Recent Republican budgets have targeted Medicaid for $800 plus billion in spending reductions. This final post in the series covers the likely choices available from a policy perspective, to achieve the savings target. … Read more

Arbitration Agreements: AZ Atty. General Seeks to End Secrecy Provisions

Arizona’s Attorney General, Kris Mayes, is challenging a major nursing home operator in the state with a new legal initiative aimed at ending the concealment of elder abuse and neglect. In March 2022, a resident with dementia was found face-down at Sun West Choice Health and Rehab. He had a massive bedsore − a telltale … Read more

Private Equity Investment in Nursing Home Sector Generates Regulatory Scrutiny

Private equity investment in the nursing home and assisted living sector (other post-acute as well) continues to be a focus of regulatory activity in Congress.  This is despite private equity investment in the nursing home sector to be involve about 5% of facilities. Home health has seen an increasing investment interest as well from private … Read more

Iowa Lawsuit = More Bad News for Assisted Living

In January of 2022, a resident with dementia wandered out of her Assisted Living Memory Care facility in Iowa and ultimately, froze to death. The State of Iowa investigation uncovered that the resident wandered outside of the building at 9:30 p.m. the previous night. Her absence went unnoticed for eight hours plus even though the alarm … Read more

Humana, United Health: Class Action Suits over AI use in Coverage Determination

It was only a matter of time before litigation came forward regarding the use of Artificial Intelligence (AI) in primarily, Medicare Advantage plans, where coverage denials/determinations are at issue. This week, a class action suit dropped in the U.S. Circuit Court of Western Kentucky against Humana. A link to the suit is here: https://www.scribd.com/document/692182281/Humana-AI-NaviHealth-MA-lawsuit In … Read more

Senators Seek Survey Accountability for SNFs

Last Thursday, Senators Bob Casey (Pennsylvania), Ron Wyden (Oregon), and Chucky Grassley (Iowa) sent a letter to CMS asking that the agency “take immediate steps to strengthen the nursing home oversight system”. Their letter is a follow-up to a report from the Senate Committee on Aging, chaired by Casey, detailing a myriad of problems with … Read more

Senate Back and Forth on Psychoactive Medication Regs

Last week, Senators Kohl, Grassley and Blumenthal introduced an amendment to an existing FDA bill that would require the informed consent of nursing home patients or their legal surrogates before certain anti-psychotic/psychoactive medications were given.  The target of this legislative initiative is to reduce the use of certain types of drugs commonly used to treat serious, chronic … Read more