USDA Improves Nutrition Standards for Free & Reduced Lunch Program

USDA finished changes to the nutrition standards they expect participating schools to follow who take part in the USDA’s free and reduced breakfast/lunch programs. Schools across our country are serving breakfasts and lunches to nearly 30 million children every day.

Healthy school meals are the main source of nutrition for more than half of these students and are an essential part of the educational landscape.

USDA says their new standards were”… shaped by a host of stakeholders, including parents, devoted teachers, school administrators, school nutrition directors, and industry leaders, and are informed by the latest Dietary Guidelines for Americans”.

Here are the top line changes that will be implemented over the next couple of years:

  • Reduced added sugars in school breakfasts;
  • Making it easier to offer healthy proteins at breakfast;
  • Scaling back sodium levels;
  • Incentivizing fruits and vegetables and whole grains;
  • Making it easier for schools to accommodate vegetarian diets and the cultural and religious food preferences of students.

To learn more about the updated school nutrition standards, please visit the USDA Food and Nutrition Service website.

 

Biden Administration to Reschedule Cannabis Under the Controlled Substances Act

What Are the Implications?

In a surprise move, Biden Administration insiders have signaled that a few executive branch agencies will be moving in unison to reschedule marijuana from what’s called a “Schedule I” drug to a Schedule III drug under the Controlled Substances Act.

What is the Controlled Substances Act?

The Controlled Substances Act is the main federal law that regulates many aspects of controlled substances. Drugs or substances are examined for their medical (beneficial) use, potential for abuse, safety and the likelihood that people would become dependent on the substance.

Congress enacted the CSA way back in 1970 so drugs with a potential for abuse could be available for medical, scientific, and research purposes, while trying to prevent them from being diverted for illegal reasons like drug abuse and trafficking activities.

What is the DEA’s Role?

The CSA is mainly under the prevue of the Drug Enforcement Administration (DEA), not the Food and Drug Administration. The DEA is housed within the US Department of Justice…  which tells you their mission is really enforcement of laws regarding who can possess drugs rather than how drugs are licensed, prescribed, and filled.

The DEA uses the Controlled Substances Act language to classify drugs or substances with those characteristics into one of 5 categories – ranging from Schedule I (those with no medical use and potential for abuse and dependency) – to Schedule V. Schedule V drugs tend to have legit medical uses and a low risk of abuse and dependency.

DEA’s algorithm for classifying drugs is based on these criteria:

  • Its actual or relative potential for abuse
  • Scientific evidence of its pharmacological effect
  • The state of current scientific knowledge
  • Its history and current pattern of abuse
  • The scope, duration, and significance of abuse
  • What, if any, risk there is to the public health
  • Its psychic or physiological dependence liability
  • Whether it’s an immediate precursor of a controlled substance

Here are some examples of where drugs lie on the Schedule spectrum:

  • Schedule I: Marijuana, ecstasy, heroin, LSD, and peyote
  • Schedule II: Methamphetamine, cocaine, fentanyl, Vicodin, oxycodone, and Adderall.
  • Schedule III: Anabolic steroids, testosterone, and ketamine, Tylenol with codeine.
  • Schedule IV: Xanax, Ambien, Ativan, and Valium.
  • Schedule V: Cough suppressants.

Alphabetical listing of Controlled Substances

A lower schedule number corresponds to greater restrictions, so substances in Schedule I are subject to the strictest controls, while substances in Schedule V are subject to the least strict. Schedule I drugs, where marijuana has been since 1970, aren’t authorized for anything.

That classification is a primary reason why marijuana was an enforcement priority for the DEA for many years. That has changed over time as more and more states adopted medical marijuana laws followed by laws that make it available for recreational purposes.

How Fast will Rescheduling Happen?

The rescheduling of marijuana from Schedule I to Schedule III won’t happen overnight. There is a defined process that needs to happen first. This week’s announcements were just the first steps in the rescheduling process.

The first step of the Office of Management and Budget to sign off on rescheduling marijuana to Schedule III. HHS has already recommended that marijuana be moved to a lower Schedule. After the public comment period (and a review by an administrative judge) DEA could publish the final rule.

After it’s rescheduled, marijuana would still be subject to various rules for Schedule III drugs and there could still be federal prosecution of people who traffic in the drugs without permission. Presumably, the feds will continue to mostly avoid prosecuting people for marijuana possession in states with medical or recreational marijuana laws (like Arizona).

However, it’s unlikely dispensaries operating in states like AZ would meet the federal Schedule III production, record-keeping, prescribing and other requirements… so those will be enforcement matters for DEA to still figure out.

Researching Marijuana will Become a Lot Easier

Marijuana’s status as a Schedule I drug has made it really hard to conduct authorized clinical studies that involve administering the drug. That’s created a bit of a conundrum: we’ve needed more research on Cannabis for a long time, but its Schedule I status was a huge barrier to actually doing it. Those barriers will be largely removed after rescheduling, making marijuana much easier to research for clinical/medical purposes.

Banking and Taxation Issues

Dispensaries haven’t been able to deduct rent, payroll or various other expenses that other businesses can write off because marijuana is Schedule I. Under the tax code, dispensaries are considered traffickers of an illegal substance because of its Schedule I status. Once Cannabis moves to Schedule III dispensaries will be treated like any other business.

Marijuana’s Schedule I status has been locking dispensaries out of banking services (especially loans). Rescheduling may not immediately (or directly) affect dispensaries’ ability to access banks because the federally regulated institutions are wary of the drug’s legal status, but that should change with rescheduling. Dispensaries have been trying to get the SAFE Banking Act to fix that. Some say passing the Act won’t be necessary if DEA actually reschedules.

Likewise, dispensary customers will likely begin to be able to use credit cards to buy product – but that remains to be seen as it’s the bank and credit card company’s decision.

Dispensaries operating in states like AZ currently don’t meet the federal Schedule III production, record-keeping, prescribing and other requirements so they’d presumably need to come into compliance with those requirements to enjoy the banking (and tax) benefits. Some in the industry worry that the IRS and banks would only consider medical marijuana dispensaries to be in compliance with new regulations – meaning retail dispensaries wouldn’t enjoy tax and banking benefits of rescheduling.

Why? Because Schedule III drugs require a prescription to be issued and filled by a ‘practitioner’. Recreational buyers don’t have a prescription nor are dispensary agents likely to be considered practitioners.

Will Big Pharma Get Involved & Compete with Dispensaries?

Once marijuana is rescheduled, pharmaceutical companies can start applying for licenses from the FDA for drugs/medications that use Cannabis. Once approved, those drugs could become available in local pharmacies.

Theoretically big pharma might see rescheduling as an opportunity to get a piece of the Cannabis action by applying for licenses to sell things like edibles for therapeutic purposes…  think gummies with a combo of CBD & THC as a sleep aid as an example. Like other drugs – they’ll need to prove to the FDA that they’re safe and effective to get them approved.

Honestly though, drug companies tend to like to get patents and drug approvals for medicines that are unique and have no biosimilar competitors because they can charge much higher prices. There are a host of competing drugs containing marijuana in states that have medical and retail programs – so I think it’s unlikely pharmaceutical companies will get involved, but I could be wrong. There’s no way FDA is going to approve marijuana buds etc. – so there won’t be any new competition on that front.

CMS Establishes Minimum Staffing Standards for Long-Term Care Facilities

Centers for Medicare & Medicaid Services pay for a big chunk of the care at skilled nursing facilities via their Medicaid and Medicare programs. As such – they have a keen interest in making sure the care for the people they’re paying for is good.

For the last couple of years, they’ve been reevaluating their standards and expectations for facilities that serve folks via Medicare and Medicaid (nearly 1.2 million residents live in Medicare- and Medicaid-certified long-term care facilities paid for by CMS).

See: Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F) | CMS

Last week, after reviewing 46,000 public CMS just established new rules that will a total nurse staffing standard of 3.48 hours per resident day. CMS is also finishing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

See: How The Republic reported on resident harm in senior living facilities

CMS will also require states (ADHS) to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

They’ll be offering hardship exemptions in limited circumstances to the 3.48 hours of nursing per resident per day and 24/7 onsite RN requirements if they meet several geographic staffing unavailability, financial commitment to staffing, and good faith efforts to hire.

Enforcement is largely up to the state health departments who contract with CMS to do the certification inspections, in our case ADHS.

See Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era &

 The Arizona Republic’s The Bitter End Series

Last week’s directive from Hobbs to agency directors ordering them to implement a hiring freeze (and send her a plan to cut 4% from their current-year spending and additional 2% cuts next FY) undercuts the department’s efforts to improve their performance.

Hobbs’ budget letter points to cuts, hiring freeze for Arizona government

Those moves cast an uncertain shadow on ADHS’ ability to hire and keep adequate staffing to ensure folks are receiving adequate care in licensed care facilities.

For now, I will give the administration the benefit of the doubt that ADHS Licensing (which lives mostly off licensing fees) and the Arizona State Hospital will be exempt from this new directive. For now, those positions in Licensing and ASH are still posted on AZ State Jobs