WHITE HOUSE:

With the President off on a trip to China, it was another quiet week out of the White House. The Administration announced a new trade deal with China, launched a new website for new and expectant mothers (www.Moms.gov), and looked back at 180 days since the issuance of an Executive Order on “Fostering the Future” which focused on strengthening support for children in foster care.

CONGRESS:

It was a hectic week on the Hill as the party-line Reconciliation bill that funded the government and ended the recent shutdown continued to wind its way through the process. Several provisions, most notably that of funding for the White House’s ballroom project, need to be redrafted as they run afoul of the strict rules governing what can be included in these bills, although this is par for the course for Reconciliation. The bigger issue, for our purposes, is what this means for a third Reconciliation bill, focused on other Republican priorities. With appropriators already starting work on FY2027 bills, it’s never a dull moment for funding in DC. Elsewhere in the political sphere:

• For the first time since 2012, an incumbent Senator lost his seat in a primary when Senator Bill Cassidy of LA was ousted earlier this week. It was another sign of the President’s dominance of the GOP in elections, even as the rank and file show more backbone when it comes to legislation.

  
  

• The loss immediately set off the scramble to replace Senator Cassidy as the Chair of the Senate’s Heath Committee, with Kansas Republican Dr. Roger Marshall angling for the job.

  
  

• A good read from Politico on the brewing fight between hospitals, pharma, and insurance companies on who’s to blame for the rise in healthcare costs. Here’s an example of the type of site that gets created in this political fight. The folks behind the website are an $11 billion health system…

  
  

• The Senate unanimously agreed to a new policy that will freeze Senators pay during any future government shutdowns.

  
  

• With acrimony mounting among the partisan politics of DC, we’re at more than 56 House Members not coming back next year.

  
  

• One of the most important House committees for healthcare is the Ways & Means committee, making these comments by current Chair Jason Smith interesting. Meanwhile, the likely Democratic chair of the committee, should the Dems take back the House, has plans.

  
  

• Pennsylvania goes out to vote in their primaries this week, and one Democratic race in particular is capturing national attention.

  
  

• One interesting CRS report from the week:

  
  

  o   IF13133 – an updated guide for Congressional offices on CMS’ WISeR model, the new pilot program that utilizes AI as part a prior authorization initiative in Medicare.

AGENCIES:

CMS announced a six-month moratorium on the enrollment of new hospice and home health agencies. The specific announcements were published to the Federal Register and can be found here (home health) and here (hospice).

The news comes the same week that the Vice President announced to states that they’re launching an audit of the Medicaid Fraud Control Units (MFCU) that are responsible for ensuring states are complying with federal guidelines for Medicaid funding.

CMS announced a new effort by early adopters to work together to ease the prior authorization process. (Let’s just say that the medical profession is skeptical that voluntary efforts are going to get the job done…)

CMS released the final rule for the state exchanges for the Affordable Care Act. Continuing the theme of the administration, the rule is heavy on cracking down on FWA (fraud, waste, and abuse) among several other provisions. The fact sheet can be found here. If you’re so inclined, you can access a copy of the 1,121-page final rule here (PDF).

The first meeting of the new Healthcare Advisory Committee meeting will take place later this week.

CMS reported their best year in terms of ROI and program integrity. The infographic with data is here (PDF).

The OIG at HHS performed an audit on inpatient rehab facilities and found that unclear Medicare guidance led to confusion in billing. The summary is here (PDF) and the full report is here (PDF).

The OIG at HHS added a new work item to its series on MA Organizations use of prior authorization in post-acute care.

The Office of Management & Budget is planning on sunsetting and rebuilding the federal IT Dashboard, a website that tracks federal IT projects.

FROM THE NOTEBOOK:

• A useful tracker from NCSL on state budgets and whether they’ve been enacted yet.

  
  

• Iowa became the latest state to tackle prior authorization at the state level, as the Governor signed a new bill that eliminates prior authorization requests for certain types of medical care. It also adds timelines and governs the use of AI. The full bill can be found here.

  
  

• The Kaiser Family Foundation released a new brief on CMS’ new approach to potential fraud: holding on to the money before it goes out the door. The brief is timely as the feds announced they’re deferring the release of more than $1.3 billion in Medicaid dollars to California over fraud suspicions.

  
  

• Speaking of California, Governor Newsom announced his latest budget as he looks to plug a huge budget hole. It might be in for rough time with the Legislature.

  
  

• A good read from McKnight’s on CMS’ plan to start tinkering with more deregulation. It’s a synopsis of a call that CMS did with stakeholders last week.

  
  

• UnitedHealth is changing how their PBM model works. The news came even as Optum is suing California for its new PBM law.

  
  

• A new study explored outcomes for beneficiaries enrolled in MA and found that those in MA received less intensive care than traditional Medicare enrollees. McKnight’s has a good summary.