Updates from Argentum

Shutdown Averted: Government Funded into New Year

President Biden signed into law H.R. 6363, a continuing resolution (CR) that will fund the government until after the New Year, and thereby avert a shutdown that would have occurred over this past weekend. The CR funds most of the government through February 2, while four spending bills would be funded through January 19: Agriculture, Energy and Water, Military Construction-VA and Transportation-HUD.

The package passed the House on Tuesday by a vote of 336-95, with 207 Democrats joining 127 Republicans to secure passage. Notably, even more Republican voted against the package than with the CR negotiated by then-Speaker Kevin McCarthy (R-CA) to avert the would-be shutdown on October 1. The Senate passed the package on Wednesday by a vote of 87-11 (10 Republicans and one Democrat opposed).

The passage of the CR now sets up what will likely be intense negotiations between the House and Senate on the fiscal year 2024 appropriations. The House has pushed for drastic spending cuts, including to federal programs for workforce development that are critical for addressing shortages in long-term care, while the Senate has pushed for a more status-quo approach.

Lawmakers must also contend with a provision that was included in the debt ceiling deal Fiscal Responsibility Act (FRA), enacted this Spring. That legislation established discretionary spending limits for two years and called for across-the-board automatic spending cuts of 1% if appropriations bills aren't passed by January 1.

Joint Employer Rule Pushed into February; Congress Seeks to Overturn Rule

The National Labor Relations Board (NLRB) announced last week that it has delayed implementation of the new Standard for Determining Joint-Employer Status until February 26, 2024. Under the new standard, an entity may be considered a joint employer of a group of employees if each entity has an employment relationship with the employees and they share or codetermine one or more of the employees’ essential terms and conditions of employment, which are defined exclusively as:

1. Wages, benefits, and other compensation;
2. Hours of work and scheduling;
3. The assignment of duties to be performed;
4. The supervision of the performance of duties;
5. Work rules and directions governing the manner, means, and methods of the performance of duties and the grounds for discipline;
6. The tenure of employment, including hiring and discharge; and
7. Working conditions related to the safety and health of employees.

House Speaker Mike Johnson (R-LA), joined by Representatives John James (R-MI), and Virginia Foxx (R-NC), and Senate Majority Leader Mitch McConnell (R-KY) and Senators Bill Cassidy (R-LA) and Joe Manchin (D-WV) introduced a Congressional Review Act (CRA) resolution to overturn the joint employer standard. Congress has the authority under the CRA to overturn final rules issued by federal agencies by passing a joint resolution disapproving of the rule and prohibiting it from going into effect. A simple majority in both chambers is needed to send the measure to the president’s desk, where it would likely be vetoed. If vetoed, a two-thirds majority in both chambers is necessary to override.

Additionally, the Coalition for a Democratic Workplace, of which Argentum is a member, and other industry and business associations including the U.S. Chamber of Commerce and National Retail Federation, sued the NLRB in the U.S. District Court for the Eastern District of Texas challenging the new rule.

CMS Opens Application for GUIDE Model

The Centers for Medicare & Medicaid Services (CMS) announced that it is now accepting applications for the Guiding an Improved Dementia Experience (GUIDE) Model, a package of care coordination and management, caregiver education and support, and respite services to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities.

The GUIDE model is primarily focused on better supporting caregivers of people with dementia through care coordination (primary and behavioral health services). It calls for providing a care navigator to help access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations. GUIDE will be tested nationwide from 2024-2032 as a voluntary alternative payment model (APM) through the CMS Center for Medicare and Medicaid Innovation (CMMI). The model will launch on July 1, 2024.

Qualified participating health care providers will deliver comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Providers eligible to be GUIDE participants are Medicare Part B-enrolled providers and suppliers. If an applicant cannot meet the GUIDE care delivery requirements alone, they may contract with another Medicare provider/supplier to meet the care delivery requirements.

CMS encourages eligible applicants to initiate the application process as soon as possible to familiarize themselves with the model requirements and application process. The application deadline is January 30, 2024.

For additional information, see the GUIDE Model Fact Sheet, FAQ, and press release.