WHITE HOUSE:

With a short holiday week, it was relatively quiet out of the White House. The focus was on the “Genesis Mission”, a new effort to integrate AI into scientific research, continuing to fight terrorism, and further efforts to bring peace to Ukraine.

CONGRESS:

With Congress scheduled to return following the Thanksgiving plate, they’ve got a pretty full plate. As we’ve been mentioning, top of the agenda, especially on the healthcare front, is how to deal with the expiring healthcare subsidies. A possible proposal from the White House that would have extended the subsidies was scrapped following strong conservative pushback, highlighting the tightrope that Speaker Mike Johnson will have to navigate, especially as Congress is showing signs of resisting the White House’s legislative agenda. With questions circulating about his leadership, frustrations rising in Congress, and a government to fund, it’s gonna be a grind in the final three legislative weeks of the year.

Elsewhere in DC:

·         Not so fast, Indiana. After an intense pressure campaign, Indiana is back on the redistricting train. With the Texas redistricting campaign in the hands of the Supreme Court, it’s still an open question who will come out ahead.

·         While all the attention was on the NYC mayoral race, below the radar Democrats made real gains across New York, potentially highlighting a coming “blue wave”.

·         Taking a page out of the GOP’s populist playbook, Democrats are honing in on rising electric bills and data centers as winning political messages.

·         After rumors that Congress was trying to put in a moratorium on state legislation of AI into the must-pass defense bill, more than 200 state lawmakers sent a letter to Congress urging them to reconsider.

·         Another House Republican is calling it quits.

·         One CRS report from the week: a guide to Congressional offices on the White House’s new H1-B fees.

AGENCIES:

CMS issued the 2027 Medicare Advantage proposed rule. As part of the rule, CMS put out a RFI seeking information on how to reform the MA plans to provide regulatory relief as well as one looking for more information on special needs plans, like I-SNP’s. It also included several changes to create a more focused star ratings system for MA plans. A fact sheet on the rule can be found here. The proposed rule can be accessed at the Federal Register, where comments can be submitted through January 26, 2026.

CMS released the next set of 15 drugs chosen for the Medicare Drug Pricing Negotiation program. The list is here (PDF). CMS central resource page on the program is here.

CMS issued the 2026 home health final rule, which also included several changes to the DME competitive bidding program. The final rule is scheduled to be published to the Federal Register on December 2^nd, but if you can’t wait, you can download a prepublication copy of the 762 page rule (PDF).

The OIG at HHS performed an audit on Continuous Glucose Monitors (CGM’s), finding that Medicare likely overpaid for CGM’s. The full report is here (PDF) while the summary is here (PDF).

CMS put together a new central site encouraging states to partner with CMS in “Crushing Fraud, Waste, & Abuse”. As part of the effort, CMS Administrator Dr. Oz sent a letter (PDF) to governors asking them to join in.

An internal FDA memo suggests that the federal government will be issuing stricter guidelines for vaccine approvals.

FROM THE NOTEBOOK:

·         In a quiet move, the Department of Education decided that nursing isn’t considered a “professional” degree, which has implications for student loans.

·         Kaiser Health News found that CMS rarely enforces network adequacy requirements for MA plans.

·         A study in HealthAffairs found that automating Medicaid renewals reduced procedural denials.

·         Another recent study in HealthAffairs found the real culprit for overpayments in the US healthcare system: overpayments to MA and Managed Medicaid are estimated to total nearly $2 trillion over the next 10 years.

·         As Americans age, Social Security’s impending depletion and the lack of retirement savings is back in the limelight.

·         The Private Equity Stakeholder Project, a non-profit focused on private equity in healthcare, issued a report (PDF) looking at recent state efforts to regulate private equity investments healthcare.  They also released an online tool to track legislation around the country.