WHITE HOUSE:

The White House focused this week on new importation rules for semiconductors and minerals, the President’s new plan for Gaza, and a new partnership with Zoom, organized by the First Lady, to facilitate the deployment of AI in education. One item of interest:

·         The President unveiled his long-awaited healthcare plan that aims to control healthcare costs. The primary goals of the plan can be found at the central resource page here, as well as in the Fact Sheet (PDF). Many of the stated goals, such as lowering drug prices and insurance premiums, are extremely popular and will build off existing Executive Orders. Still, with quite a few of the components requiring Congressional buy-in, and many of the technical details still to be worked out, how this plays out in the coming months will be an important trend to monitor.

CONGRESS:

We’re halfway home to a funded government with six of the twelve appropriations bills done. The Senate will be out this week, leaving themselves little margin for error when they return with days to go before a government shutdown on January 30^th.  The bipartisan healthcare talks to revive the ACA subsidies are on the rocks, despite an unlikely push from Republican Senator Bernie Moreno (R – OH), and are only going to get harder with the White House’s push for the President’s new plan. With Speaker Mike Johnson’s Republican majority shrinking, pushback from the rank & file rising, and Congress not following the President’s spending cut goals, it’s sure to be a tight race to the finish. Elsewhere in DC:

·         Senator Chuck Grassley released a report exploring how United Health Group gamed the MA system by aggressive upcoding. The full report can be found here (PDF).

·         The House Energy & Commerce Committee, led by Chairman Brett Guthrie and Health Subcommittee Chair Morgan Griffith will be holding a hearing on rising health insurance costs.

·         A look at the electoral calendar for 2026.

·         Just when you thought the redistricting discussions had quieted down, Virginia is on the table for the Democrats, especially with a new Governor sworn in this week.

·         At a House Panel hearing on AI, the White House offered few details on plans for a national AI standard.

AGENCIES:

CMS sent a memo to state survey agencies, lowering survey expectations for state agencies by approximately 20%, corresponding to the federal shutdown. The full QSO is here (PDF).

CMS issued their annual improper payments report, estimating that there was 6.55% improper payments in the Medicare FFS program.

HHS announced, and then within 24 hours, reversed, more than $2 billion in cuts to mental health and addiction service providers.

The DOJ announced a $556 million settlement with Kaiser Permanente to resolve allegations that Kaiser had upcoded in their MA plan.

FROM THE NOTEBOOK:

·         UnitedHealth announced a new pilot program in 4 states that aims to get MA payments to rural hospitals within 15 days, an acceleration of 50%.

·         Back in July, Wisconsin rushed through a budget to get an increase in the hospital provider tax in place before the One Big Beautiful bill went in to effect. Well, it’s not clear it worked as the state waits on clarity from CMS…

·         A study in JAMA found that SNF census capacity has dropped by 5% since the beginning of Covid. McKnight’s has a good summary.

·         Epic, along with a group of other healthcare providers, announced a lawsuit against HealthGorilla regarding access to patient data.

·         Anthropic became the latest AI giant to introduce a healthcare specific tool, announcing the launch of Claude for Healthcare.

·         North Dakota gets a 3-day special session this week.

·         South Dakota must spend $106 million in federal pandemic funds this year, or it goes back to the feds.

·         North Carolina wants to get its Rural Health Transformation Fund projects off the ground in quick order.

·         Idaho’s legislative session is off and running. The big topic? The projected budget shortfall.