Creator: JJ Rabinowich
SNF Digest #194
From the White House to Congress to the regulatory agencies, JJ gives you the inside word on what is what for this week.
WHITE HOUSE:
Over the last few weeks, the White House focused on a new Executive Order to address high diesel prices, announcing an investment of more than $6 billion in new scientific initiatives at the “Science: A New Golden Age” summit, tackling a pest problem in Washington, DC, rebranding AI in the executive branch to “Super Intelligence”, signing a new voluntary “accord” with leading AI companies, and the official state visit from China. Three items of indirect interest for us:
They announced a one-time payment of $90 out of the Medicare Improvement Fund for most eligible part B beneficiaries to pay for prescription drugs. CMS provided more details on eligible beneficiaries and delivery details in a Fact Sheet.
They launched America.gov, a new AI entry point designed to make it easier to help Americans navigate federal agencies and questions. Created by the GSA, and powered by existing AI tools like Grok and Gemini, while the site currently is mainly an informational tool for the federal government, the long term plan for the site includes the ability to natively handle transactions like passport renewals and Medicare enrollment.
They finalized the automatic enrollment for children under 18 in Trump Accounts. The WSJ has morespecific details along with some potential concerns. You can get started here.
CONGRESS:
With Congress home through the midterm elections, we’re going straight to the political roundup:
Right before the Senate left town, they passed the “Choices for Increased Mobility Act”, a bill that will make it easier for Medicare Part B beneficiaries to get ultralight wheelchairs. The bill is waiting for the President’s signature.
As we get closer to the midterms and the polling gets worse for Republicans, it looks like even seats in deep red districts are potentially competitive. Of course, the question of just how accurate polling is remains open.
Recognizing the difficult voting environment, the White House is doing what they can to help.
Democrats put together a comprehensive healthcare policy agenda if they take back Congress. The full agenda can be accessed here (PDF).
Ever wonder what all the spending on ads gets you? The Washington Post sat through $1.6 billion in political ads so that you don’t have to.
A wonky read on how bills become law when the President doesn’t want to sign the bill or veto it.
A bipartisan pair of Senators want to make it easier for the Senate to get legislation done. The overview is here (PDF).
The Build America Caucus, a bipartisan 43-member group of Congress that is looking to rethink how America tackles infrastructure and growth laid out a policy agenda for the next Congress. The full 95-page agenda can be accessed here (PDF).
The political divide even extends to where the parties dine out in Washington DC…
A trio of relevant CRS reports:
o R49436: An overview on digital health interoperability
o IF12892: An updated guide to prevailing wage requirements for H1B visas
o IF13326: A dive into Medicaid Program Integrity
AGENCIES:
CMS announced the release of the final “Transparency in Coverage” rules, designed to increase pricing transparency and provide more information as to what healthcare actually costs for consumers. The Fact Sheet is here. The full rule can be found at the Federal Register.
A whole slew of awards from the Rural Health Transformation Program:
CMS released the 2027 Medicare Advantage and Part D Star Ratings.
HHS, via the ACL, released more than $27 million for three different “Falls Prevention” initiatives.
CMS hosted a gathering of experts to talk about the federal Independent Resolution Process (IDR).
CMS finalized the GLOBE model, a mandatory drug payment program for Medicare Part B beneficiaries. You can find the final rule at the Federal Register.
The Vice President announced that they are suspending several tech companies, including Microsoft, among others, from utilizing the H1B visa program. Axios has more on how the suspension will work.
The OIG at HHS released a trio of audits over the last few weeks:
They found that CMS’s oversight process for the way Managed Medicaid programs submit their MLR data needs to be strengthened. Here’s the summary (PDF) and full report (PDF).
Oh look; another state, another time that UnitedHealthcare’s MA plan got overpaid, this time out of Texas. Here’s the summary (PDF) and here’s the full report (PDF).
They also found that MA organizations and private drug plans paid more than $70 million to folks on the CMS preclusion list. Here’s the summary (PDF) and here’s the full report (PDF).
Unrelated to SNFs but likely of interest to many of you. The Treasury Department released the proposed regulations related to the new Federal Scholarship Tax Credit, which will provide tax credit for contributions for K-12 scholarships. The proposed rule can be found at the Federal Register, where comments can be submitted through December 1.
The DOJ settled another claim of overpayments to a MA plan, this time with Blue Cross of Pennsylvania.
The DOJ released a new memo outlining their “comprehensive” approach in the fight against fraud. The full memo is here (PDF).
The FTC sent letters to 24 hospitals warning them against deceptive pricing practices. It’s all part of the Administration’s efforts to increase transparency.
No formal announcement yet, but multiple outlets are reporting that the FTC will be launching a probe into the AI companies.
FROM THE NOTEBOOK:
Texas is investigating UnitedHealth for deceptive practices in the state.
The state lawsuits adds to the litany of lawsuits being filed against United Healthcare, including from CalPERS (California’s largest pension) and Ohio’s Chamber of Commerce.
BCBS released an analysis that claims hospitals are using AI to increase coding and maximize billing, resulting in nearly $1 billion in added costs. Given insurers’ track records of using AI for denials, it’s a good excuse for me to post my favorite AI comic.
Speaking of Blue Cross Blue Shield, Michigan filed a lawsuit against the insurance company alleging an illegal health insurance monopoly.
The Kaiser Family Foundation released their latest data brief on MA plan availability.
Another state hospital system, this time in Tennessee, is dropping out UnitedHealth’s MA plan.
Elevance announced new billing policies to try to lower healthcare costs. Fierce Healthcare has a good summary.
A new report found that MA plans are cutting the benefits they offer potential beneficiaries, especially related to dental care coverage.
Certify announced the launch of a national shared credentialing program to make it easier for providers to get verified.
NYC’s new “Click to Cancel” rule has gone into effect.
As California gets ready to vote on a new billionaire’s tax, the state’s tax board is gearing up for the challenge of how to implement the tax on those who leave the state.
A good read on the challenges facing states as the population ages, and the birthrate declines, seen through the prism of Pennsylvania.
Modern Healthcare has a good roundup on different action CMS has taken over the last few months as they roll out the One Big Beautiful Bill, and in many cases, go beyond what Congress asked for.
Several deep dives from Health Affairs over the last few weeks that are worthy of a read:
o A deep dive on MA rebates.
o A summary of a round table on how to improve MA.
o Their latest analysis of healthcare spending in the US.
