CMS COMMENT PERIOD:

While the political focus has been on provider taxes, one of the most direct ways of advocacy is by submitting public comments on CMS rules. CMS reads every one and it shapes their way of thinking. To that end, CMS has an open RFI for public comment on how to deregulate the Medicare program. The deadline is June 10^th, 2025. Full details, and the site where can comments can be submitted, are available here.

WHITE HOUSE:

With Memorial Day this past week, it was a quiet week out of the White House. The main focus was supporting the "One, Big Beautiful Bill" as it heads to the Senate, navigating the legal minefield enveloping the President’s Tariffs, and modernizing the federal government’s permitting process (including a full action plan - PDF).

CONGRESS:

With Congress out of town for a Memorial Day week recess, the battle over Reconciliation moved into the public sphere, where voters made it known that they aren’t happy with the proposed cuts. Senator Ron Johnson (R – WI) has been the most vocal about the need to cut more spending in the bill, although others, including Iowa Senator Joni Ernst (R – IA), are also supporting more cuts. Senator Josh Hawley (R – MO) continues to loudly proclaim the need to protect Medicaid in the bill, setting the stage for a redux of the conservative vs. moderates battle that marked the House’s passage of Reconciliation. Adding to the complexity for Senate Majority Leader John Thune (R – SD) is the arcane rules of the Senate that limit the policy measures that can be included in the bill, potentially excluding several GOP priorities and complicating the budget math needed to make the bill work. As Congress returns to town, expect the debate to rage on. Elsewhere in the political world:

• • Even as Elon Musk bows out of the scene, and several top staffers move on, the agency is continuing its efforts to cut spending, and the White House is looking to embed those cuts in Congress.

• • A good read on how the federal government is working more closely than ever with silicon valley leaders on a new approach to AI regulation. While the 10 year moratorium on state regulation of AI the House snuck into the Reconciliation bill might not survive the Senate’s rules, understanding the federal landscape has never been more important.

• • With Senator Tommy Tuberville of AL becoming the latest Senator to announce a run for governor, the trend of DC folk looking for an exit continues to pick up steam.

• • The CRS produced an analysis of all the tax provisions within the One Big Beautiful Bill, including the ERC.

AGENCIES:

CMS announced that they’re going to be cracking down on states that are using federal funds for healthcare for undocumented immigrants. Along with the 10% FMAP penalty included in Reconciliation, this has become a focus of the federal government.

Nothing formal from the agency, but reports are that CMS will continue to roll out the $75 million staffing campaign that was included in the minimum staffing rule.

CMS released the updated 2025 Spousal impoverishment standards.

The Government Accountability Office (GAO) released a new report urging CMS to include behavioral health services in their audits of MA plans.

FROM THE NOTEBOOK:

• • Connecticut announced a new three-year agreement to provide wage increases for direct care staff.

• • We covered California’s decision to eliminate their asset limit for the state’s Medicaid program a few years ago. Well, in the face of ballooning healthcare costs, and a severe budget crunch, Governor Newsom wants to bring the asset test back.

• • We covered the new PBM law that Arkansas passed back in April. Among other regulations, the laws bars PBM’s from owning pharmacies. As expected, the lawsuits have started.

• • As part of their analyses of the Reconciliation bill, the Kaiser Family Foundation updated their guide to 5 key facts about SNF’s and Medicaid.

• • A new study found that SNF’s can change their 5-star ratings more frequently than originally thought.

• • A good look at how states can enhance behavioral health care in SNF’s.

• • Even as the population continues to age, SNF’s are closing at an alarming rate. McKnight’s has a good summary.

• • Another hospital system, this time in Rhode Island, warned patients that they may be cutting ties with United Healthcare’s MA plan.

• • Two new studies looked at the use of AI in predictive analyses related to seniors: one related to antimicrobial resistance and one related to cognitive frailty.