SNF #195

WHITE HOUSE:

The White House focused this week on relaxing sanctions on Russia, the First Lady’s “challenge” to better integrate AI into K-12 education, and holding the inaugural meeting of the new task force on AI. Two items of interest for us:

·      The Vice President launched a new “pledge” for government officials to join him in continuing their effort to root out Fraud, Waste, and Abuse (FWA). This has been a major focus of the Administration with real impact in the healthcare sector and worth continuing to monitor.

·      The President signed several Congressional bills, including the S.2403, the “Retire Through Ownership Act”, which adds some legal and regulatory guidance to ESOPs, which are Employee Stock Ownership Plans. As I know that several of you are implementing ESOPs, please ask your tax advisor if there are any practical implications.

CONGRESS:

With Congress home through the Midterm elections, we’re going straight to the political roundup:

·      With Democratic control of Congress firmly on the radar, Senator Wyden is looking for input on how to implement a “Major Overhaul” of long-term care. The full 81-page RFI can be accessed here (PDF).

·      As the bleak polling continues for Republicans, they’re exploring if they can get a last-ditchReconciliation bill done in lame duck session before the new Congress gets sworn in.

·      With Republicans starting to give up on several districts and Democrats outraising them locally in competitive races, Republicans are reminding everyone that polls aren’t infallible.

·      Both the conservative Right (in the form of the House Freedom Caucus) and the progressive Left (the Democratic Socialists of America) are thinking about how they can be more effective in a new Congress.

·      It’s always sobering to see just how much money is spent on elections. The Washington Post highlighted the more than $2 billion that outside megadonors have spent in the 2026 cycle.

·      Forget 2028. Republican Congressional members are already jockeying for the role of Chairman of the Ways & Means Committee in 2029!

·      One relevant CRS report this week: A guide for Congressional offices on Executive Actions that the Administration has taken on H1B visas.

AGENCIES:

CMS released a new proposed rule to increase transparency in MA and Part D plans, including specific requirements for PBMs. They also issued a Fact Sheet with more details. The full rule is scheduled for publication to the Federal Register on Tuesday, October 20, but if you’re in the mood for some light reading, you can download a prepublication copy of the 265-page rule here (PDF).

Another batch of Rural Health Transformation Program awards from CMS this week:

·      Delaware

·      Missouri

·      Montana

·      Nebraska

·      New Hampshire

·      Ohio

·      Texas

Very quietly, HHS published a notice to the Federal Register outlining a delegation of “Exclusionary Authority” to the Agency. Here’s a good summary of what that means for providers.  

HHS, via CMS, announced the removal of another 189,000 enrollees from the federal marketplace as they continue their efforts at tackling FWA.

Continuing their efforts to help small employers bring down healthcare costs, they held an event in Ohio highlighting a new concept called CHOICE.

HHS, via the FDA, launched the “Rare Disease Framework” to help guide research and development of drug development for rare diseases. The central resource page is here. A white paper on the effort can be accessed here (PDF).

The FDA announced the creation of a new board to review drug exclusivity determinations.

The IRS and the Treasury released a new set of proposed regulations related to the “Premium Tax Credit” that helps subsidize the purchase of health insurance through the exchange. The proposed regulations can be found at the Federal Register where comments can be submitted through November 30.

The Social Security Administration announced a 3.6% COLA increase for 2027, the largest increase in several years.

 The DOJ and CVS finalized a $315 million agreement to settle allegations that CVS was paid for illegally filled opioid prescriptions.

FROM THE NOTEBOOK:

·      A bipartisan group of eight states, led by Arkansas, filed a lawsuit against OpenAI, alleging safety issues in ChatGPT.

·      The Kaiser Family Foundation did a deep dive into Medigap enrollment for Medicare beneficiaries, as well as several regulatory and enrollment issues.

·      Alignment Healthcare, a MA plan that received a serious drop in their star ratings from CMS, is suing the agency to reverse the ratings.

·      It was a banner week for lawsuits against the agency as NABIP, a trade association representing insurance brokers, filed a lawsuit against HHS & CMS for the moratorium on new brokers entering the marketplace. Their press release is here (PDF).

·      Epic is launching a new “Prescription Marketplace”, in conjunction with Amazon and Mark Cuban’s Cost Plus Drugs, to help patients compare pharmaceutical prices.

·      JAMA published a new study that looked at Medicaid’s “Lesser of” rules and whether it reduces access to SNF’s for dual eligible beneficiaries.

·      A new study in the Journal of Nursing Management found that increased staffing ratios alone do not lead to improved patient outcomes. McKnight’s has a good summary of the study.

·      Modern Healthcare released a pair of summaries on two different federal efforts:

o   What’s left for CMS as they implement the One Big Beautiful Bill

o   How states are spending their grants from the Rural Health Transformation Fund