WHITE HOUSE:

The White House focused this week on a new Executive Order launching the “Freedom 250 Grand Prix” in Washington DC as part of America’s 250^th birthday celebrations, new tariffs related to Cuba, the launch of a new tech platform to help federal agencies speed up environmental permitting, and a new EO to expedite the rebuilding of LA following last year’s wildfires. Two items of indirect interest:

·         The President signed an Executive Order launching the “Great American Recovery Initiative”, a new plan to coordinate the federal government’s response to addiction and identify new strategies to help folks receive treatment.

·         While not immediately pressing to SNF’s, the President’s Council of Economic Advisors issued an analysis of the “Economic Impact of State Income Tax Elimination”. With states like Kentucky, Mississippi, and Oklahoma on the path to no income tax, and gubernatorial candidates in other states making the elimination of the income tax a core campaign promise, it’s worthwhile to understand the impact elimination would have. The full report is here (PDF).

CONGRESS:

Well, we’re in a bit of a weird spot right now. The government is “partially” shutdown as the Senate agreed to terms on a new funding package that strips out the controversial Homeland Security/ICE funding portion, while keeping intact everything else. Procedurally, the Senate’s version now goes back to the House, where a vote is expected by Tuesday. As with all things Congress these days it’s not a given that it’ll get through the House, in light of the Republican’s tight majority and Democrats in the House raising concerns, but Speaker Johnson is optimistic that he’ll get the House's approval. Assuming all goes well, the government (with the exception of DHS/ICE) will be funded through September 30th. Elsewhere in the political world:

·         Early fundraising numbers are in and Democrats are ahead in Senate races, while Republicans lead in the House.

·         The majority margin keep getting smaller for Republicans as a Democrat won (as expected) a special election to fill an open seat in Texas.

·         Democrats won a pair of special elections at the state level in Minnesota, with the result that the state house is tied 67-67.

·         In a stunner out of Texas, Democrats flipped a state Senate seat in a solid GOP district.

·         One interesting CRS report from the week: LSB11390 - a look at the litigation targeting state efforts to lower prescription drug costs.

AGENCIES:

CMS released the 2027 Medicare Advantage payment rates along with a fact sheet outlining the major changes and an advanced notice of payment methodology (PDF). The agency proposed an increase of only 0.09% for MA plans, coming in well under expectations. Additionally, and perhaps more impactful, is that the rule makes administrative changes designed to limit upcoding on the part of MA plans.

CMS also issued a final rule related to provider taxes. This rule specifically dealt with the MCO provider taxes, while also touching upon a few administrative guidances related to the provider tax provisions of the One Big Beautiful Bill. For New York, the rule translates into a welcome extension for another nine months. The fact sheet is here, while the final rule can be found at the Federal Register.

CMS announced the third round of drugs chosen for the Medicare Drug Price Negotiation program, including the first ever batch of Part B drugs. The summary is here (PDF).

CMS released a new QSO that provided an update to the SFF program, with a renewed focus on falls.

CMS issued an update to Chapters 5 & 7 of the State Operations Manual. The 310-page memo can be found here (PDF). 

As we’ve touched upon multiple times, as a result of the One Big Beautiful Act states are going to have to implement work requirements. With many worried about the tight timelines to roll out the systems, CMS announced a voluntary pledge from several tech companies to invest up to $600 million to help out states.

CMS wants to hear from the public on how to strengthen the domestic supply of PPE and essential medicines to avoid the types of shortages that happened during Covid. Comments can be submitted at the Federal Register.

The Department of Labor issued a proposed rule that would require PBM’s to be more transparent and disclose to employer health plans more information related to their financial arrangement with manufacturers. The full 212 page proposed rule is here (PDF).

The OIG at HHS released a new guidance (PDF) for pharmaceutical manufacturers, paving the legal path for them to offer drugs direct to consumers on TrumpRX.gov. While the site was expected to go live before the end of January, it’s slightly delayed.

HHS announced a new chair and 10 new members of the Advisory Council on Alzheimer’s Research.

The IRS published a new set of FAQ’s related to the deductions for qualified overtime provisions included in the One Big Beautiful Bill.  

FROM THE NOTEBOOK:

·         Oklahoma Governor Kevin Stitt issued an Executive Order targeting MA plans. It’s an extensive list of requirements on insurers that would really help protect beneficiaries in the state. The full EO is worth the read and can be found here (PDF).

·         With so much uncertainty surrounding state budgets, Pew did a deep dive on the five biggest issues that states will have to navigate in 2026.

·         Park Place Live CEO Mark Parkinson set the record straight on the repeal of minimum staffing role, following the NY Times article on the subject.

·         Reports are emerging that the Department of Transportation is exploring the use of AI to draft new rules.

·         Modern Healthcare looked at launch of the CMS model using AI in prior authorization one month in.

·         Texas Governor Greg Abbott told state agencies to freeze the usage of H1B’s visas for state universities and agencies. The full letter is here (PDF). The directive only applies to state entities.