WHITE HOUSE:

Over the last two weeks, the White House focused on new tariffs on steel and pharmaceuticals, continuing the partnership with Hungary, new deregulatory guidance on infrastructure projects, and a new executive order on college sports. One item of indirect interest:

• The President signed an Executive Order designed to require citizenship verification for elections as well modernize security around mail-in ballots. While the order has already been challenged in courts as unconstitutional, both from congressional Democrats as well as state attorney generals, it’s something to monitor, especially in light of the importance of voting to residents.

CONGRESS:

Congress comes back to town with little settled as the partial shutdown continues. While the President’s Executive Order directing Department of Homeland Security (DHS) employees to be paid eased immediate concerns, it’s unclear how long the situation can last without, y’know, an actual government funding plan. The ongoing stalemate has juiced talks about a new party-line Reconciliation effort, narrowly focused on funding immigration and specific elements of DHS. While the plan has the support of GOP leadership and the President, although the House Freedom Caucus is making noise about blocking the effort. With Republicans finding it tough to build any sort of consensus, there’s not a ton of optimism on the Hill right now. Elsewhere in the political world:

• A group of Democratic Senators, led by Elizabeth Warren, sent a letter to Dr. Oz urging more oversight into Medicare Advantage plans for their “persistent abuses” of the Medicare program. The full letter, available here (PDF), is worth a read as it neatly outlines many of the challenges raised by MA.
  
  

• The President released his 2027 budget, but it’s important to remember that the purse strings are ultimately controlled by Congress, who have their own ideas about what should be funded. Here’s a good summary of what’s in the budget ask.
  
  

• One of the big-ticket messaging items for Democrats for the mid-terms and 2028: healthcare spending.
  
  

• A good look at the Illinois race for Lt. Governor that highlighted, yet again, money isn’t everything in politics.
  
  

• Of course, that doesn’t stop folks from spending on politics. Republicans unveiled a $340 million plan to keep control of the Senate.
  
  

• One relevant CRS report: an updated guide for Congressional offices on healthcare spending in the US.

AGENCIES:

CMS released the FY 2027 SNF payment rule. In addition to the 2.4% rate increase, the rule also contains a RFI looking for more information on potential updates to PDPM and how to eliminate upcoding. The proposed rule is available at the Federal Register, where comments can be submitted through June 1st.

CMS also released the final MA & Part D rule. The fact sheet for the rule is here. They also released the rate announcement for MA and Part D, available here (PDF). The fact sheet is here. The full final rule can be found at the Federal Register.

CMS released a new proposed rule to speed up prior authorization for drugs. The fact sheet is here. The full proposed rule is scheduled to be published to the Federal Register on April 14th. In the meantime, if you simply can’t wait to read the 511-page rule, a prepublication copy is available here (PDF).

CMS announced the launch of the “first wave” of new HealthTech tools. Details and links are available at CMS’ Health Tech Ecosystem central site.

CMS released a new QSO, updating several sections of Chapters 5 & 7 of the State Operations Manual. The QSO is here (PDF).

CMS issued a new QSO with clarifications related to nurse aide evaluation program requirements. It’s available here (PDF).

HHS continued their modernization efforts by replacing their legacy payroll system with a cloud-based platform. While an internal move, it’s a good sign of the Administration’s commitment to start utilizing modern era tools in government healthcare programs.

CMS, via CMMI, announced a new model that would allow for eligible hemp-products to be incorporated into patient care. It’s the first time that Medicare is getting involved in covering cannabis products.

As part of the FY 2027 Hospice payment rule, CMS proposed a whole slew of new oversight measures on hospice providers. The fact sheet is here. The proposed rule is available at the Federal Register.

CMS wants to expand their existing Comprehensive Care for Joint Replacement (CJR) model nationwide, making it mandatory for most hospitals starting in October 2027. The full details of the model are available at the central CMMI page.

CMS released a few other 2027 payment rules:

• Inpatient and Long-Term Care Hospitals

• Medicare Inpatient Psychiatric Facility

• Inpatient Rehab Facility

CMS released a new special alert memo for hospitals, reminding them of their obligations to patient nutrition. It’s available here (PDF). This is geared specifically to hospitals, but given the HHS’ Secretary, it’s worth keeping an eye on in case they want other providers to follow.

HUD’s Office of Residential Care Facilities (ORCF) announced more expansive underwriting guidelines related to IGT programs, potentially positively impacting facilities in Indiana and Texas. Assistant Secretary Frank Cassidy shared more details in a LinkedIn post.

FROM THE NOTEBOOK:

• An interesting bill out of Iowa, where Governor Kim Reynolds signed a bill that temporarily increases taxes on insurers to cover a shortfall in the state’s Medicaid budget. It’s always fascinating when a Republican state passes a new tax to cover the state’s Medicaid program…

  
  

• Inflation was up higher than expected in March. While obviously concerning for the direct financial impact in more expensive goods and supplies, CPI is an integral component of health care formulas used by the federal government.

  
  

• A new study attempts to create a way to compare Medicaid pricing for long-term care spending across state lines.

  
  

• Oops… The Administration admits it made several mistakes in Dr. Oz’s letter to New York about fraud in NY’s Medicaid program.

  
  

• Minnesota’s attempt to establish a new wage floor for SNF workers still hasn’t gotten CMS approval.

  
  

• Axios did a deep dive into how states are navigating the expected tough budgets that are coming for Medicaid in the wake of the One Big Beautiful Bill.

  
  

• Louisiana is taking a look at the state’s moratorium on new SNF beds.

  
  

• The ongoing fight between hospitals and the federal government over the 340B program continues, even as Indiana considers dropping the state’s Medicaid program out of the program.

  
  

• UnitedHealth is joining the AI health revolution with the launch of a new “generative AI companion”.

  
  

• Nothing to do with SNF’s and long-term care, but in yet another sign of just how… corporate these companies really are, a health insurer canceled a member’s plan over the whopping sum of a nickel.