WHITE HOUSE:

This week, the President held his first cabinet meeting (heavily featuring special guest Elon Musk), featured a plan, via an op-ed in the Wall Street Journal from the USDA Secretary to lower egg prices, issuing a new Memorandum that rethinks foreign investment, as well as a memorandum that explores how to protect American companies from foreign taxes. 3 items of interest for us:

• • They issued an Executive Order to speed up full implementation of the hospital price transparency program that was crafted during the President’s first Administration. There is already a central CMS resource page on the program. While specifically targeting hospitals, more transparency in healthcare pricing can have unpredictable outcomes for other healthcare providers.

• • Further cementing the work of DOGE within the fabric of the federal bureaucracy, the President issued another Executive Order that would direct federal agencies to create a centralized system to track contracts. As with all things DOGE, the practical impact remains to be seen, but in theory, it should increase the ability of DOGE to better perform its goal of trimming waste.

• • As the current Administration looks to chart their own path forward on AI, they issued a RFI asking for public comment on how to build a new action plan on AI. Comments can be submitted at the Federal Register through March 15^th.

CONGRESS:

The House cleared the first hurdle on the path to Reconciliation with the adoption of a Budget Resolution that serves as step one in the Reconciliation process. It wasn’t easy, featuring a false start, but Speaker Johnson got it done with 1 vote to spare. The next step is the Senate, which is already pushing back on the House’s plan, and potentially heading for a messy fight. For our purposes, the biggest challenge is that the budget resolution requires an $880 billion cut from healthcare costs, which will be very difficult to achieve without fundamental changes to Medicaid. Although Speaker Johnson has committed to not making deep cuts to the program, they are looking very closely at how states fund their portion of Medicaid, even as conservative lawmakers recognize that these changes are simply passing the buck to the states.

On top of Reconciliation, let’s not lose sight of the core government funding discussion, with the government currently slated to shut down on March 14^th if a new agreement isn’t reached. The current approach is to create a year-long Continuing Resolution (CR) that essentially just keeps the government funded at current levels. The big issue is that Speaker Johnson will need Democratic votes to adopt the CR and avert a shutdown, but they want him to limit the President’s authority on spending, something that the Speaker isn’t keen to do. With so much discussion on funding in DC, and Democrats in a bind, the game’s afoot. Elsewhere in DC:

• • It’s important to note that Medicaid cuts are extremely unpopular and has Republicans concerned about the political impact, something that happened in 2018. This political math will shape the final budget passage.

• • With a Republican trifecta in control, Democratic pushback is mainly happening through the court system and Democratic attorney generals.

• • The public and behind the scenes jockeying by lawmakers impacted by DOGE continued, as lawmakers appealed to the White House for relief and folks on the Hill are figuring out how to navigate the DOGE noise.

• • One group that is getting royally burnt out by the chaos in DC? Hill staffers.

AGENCIES:

The Treasury announced that they would NOT be enforcing the beneficial ownership information (BOI) requirements of the Corporate Transparency Act, ending a long legal saga that was going back and forth in the courts system. They do plan on issuing an interim Final Rule by March 21^st that will provide more clarity on how they intend to implement those requirements.

As DOGE continues to be the main federal agency in action these days, we finally know who the acting Administrator for the agency is. The Washington Post did a deep dive into how DOGE is operating, while a federal judge is skeptical of the Agency’s efforts.

HHS quietly announced, via publication to the Federal Register, that they are changing the rules for public comments on grant programs and other agency decisions. Reuters has a good summary of the change, while McKnight’s explored the implications for providers.

Following last week’s report that the DOJ was looking into United’s billing practices, Senator Chuck Grassley sent a letter, available here (PDF), to United seeking more information. The Wall Street Journal has more on the letter.

CMS released updated MA enrollment data this week, and it looks like United was the big winner in terms of enrollment.

CMS released the updated Section S portion of the forthcoming MDS Data Specifications.

HHS told their employees that a response to the DOGE 5 bullet points email was voluntary.

FROM THE NOTEBOOK:

• • The Kaiser Family Foundation released three helpful policy briefs this week, covering Medicaid Managed Care, block grants and overall federal healthcare spending.

• • Even as work requirements remain politically feasible, yet another report that it’s not clear if they actually accomplish their stated goals.

• • An interesting poll from 538 found that the President is more popular than his agenda.

• • Add Arizona to the list of states exploring legislation that would allow cameras in long term care facilities.

• • More than a dozen SNF’s have closed in New York in the last few years as the state continues to fall behind on reimbursement.