WHITE HOUSE:

The White House focused this week on the President’s efforts with NATO, the strikes in Iran, and issuing guidance to federal agencies on incorporating “Gold Standard Science” into their research activities. The full guidance is here (PDF).

CONGRESS:

Late Saturday night, the Senate agreed to a procedural motion that allowed debate on the One Big, Beautifull Bill to move forward. The new bill, clocking in at a robust 940 pages (PDF), was released late Friday night by Senator Graham. For our readers, the bill, as currently constituted, cuts provider taxes for hospitals starting in 2028, but explicitly carves out SNF’s from this provision. While there may be a halo effect for state budgets with significant Medicaid cuts for hospitals, SNF’s, for now, are in a great spot relative to other healthcare providers. The Senate bill also increases retroactive eligibility for traditional Medicaid enrollees to 60 days (which is down from the current 90 days, but more than the House’s version of 30 days). In terms of timing, the Senate is expected to go through a series of amendment votes on Monday and the House is tentatively expected to get something to vote upon later this week. Buckle up as this plays out over the next few days. A few other notes from DC:

• As we’ve touched upon many times, the rules for what can be included in the party-line bill are arcane and technical, but ultimately is up to the Parliamentarian, a non-elected official who works for the Senate. Throughout the week, and continuing through till today, there are many elements of the bill that have been excluded and reworked, including the provider tax language, the FMAP provisions related to states that provide healthcare for non-citizens, and many other policy areas that fall afoul of the “Byrd Rule” that governs Reconciliation. While the Senate has overruled the Parliamentarian, Senate Majority Leader John Thune said that he doesn’t plan to do so for Reconciliation.

• • For those so inclined, the new provider tax section is section 71117.

• • The rulings of the Parliamentarian are only released to Senate offices; not the public. Several news outlets are tracking the rulings, including Axios and the New York Times.

• • Several Senate Democrats are promoting a new study that found nearly 600 SNF’s are at risk of closure. It’s important to note the study reflects current conditions, and the situation may be exacerbated by the Medicaid cuts in the One Big, Beautiful Bill. The full analysis is here (PDF). McKnight’s has a good summary.

• • Shocking news out of New York City this week where a 33 year old progressive upset the Democratic establishment pick in the Mayoral race. The think pieces as to What It All Means for Democrats are coming in fast and furious.

• • In a true test of the new era of politics, a new MAGA Pac has been formed to oust a Republican who’s been a thorn in the President’s side.

• • With work requirement likely to be included in the One Big Beautiful Bill, the CRS updated their guide to existing programs.

AGENCIES:

CMS announced a new voluntary model, called Wasteful and Inappropriate Service Reduction (WISeR) Model, with the goal of building a smarter prior authorization process, using modern technologies, including AI, for specific types of services. The central resource page is here. The fact sheet is here (PDF). The FAQ can be found here. The model will be published to the federal register on July 1^st, but you can download a pre-publication copy of the proposed model here (PDF).

In a voluntary move, the major insurers announced a series of changes to the prior authorization process. The changes, announced at a joint press conference with HHS & CMS, are designed to stave off federal interference. For now, CMS is promoting the changes.

FROM THE NOTEBOOK:

• • A very comprehensive read from NPR on the double whammy to SNF’s of the immigration crackdown and Medicaid cuts.

• • The Kaiser Family Foundation did a deep dive into the “state directed payments” provisions in Reconciliation and how they would affect SNF’s.

• • Wisconsin’s budget discussions have stalled…

• • A group of Iowa businesses are suing against the state’s new PBM law.

• • Louisiana is very unhappy with CVS for the text messages sent to customers regarding legislation the state was considering and has filed three separate lawsuits against the company.