WHITE HOUSE:

Over the last week, the White House issued new Executive Orders to better align US vaccine practices with other countries, update the regulations for accessing federal lands, and highlighting the Administration’s push to encourage younger Americans to seek skilled trade work. One item of interest for us:

• They provided an update on the “White House’s Task Force to Eliminate Fraud” efforts to eliminate waste and abuse in federal program. The primary source of their efforts is the official X feed for the task force. 

CONGRESS:

Following a week off, Congress returns to pretty much right where they left off: figuring out how the heck to keep the government open and running. On the table is the Reconciliation bill that would fund DHS and ICE, which remains stalled thanks to GOP opposition to the White House’s “anti-weaponization” fund. There are several other priorities jockeying for attention, but all eyes remain, as ever, on funding. Elsewhere in the political arena:

• Senators Susan Collins (R – ME) and Peter Welch (D – VT) introduced bipartisan legislation to allow observation stays to count towards the three-day stay rule.

  
  

• Yet another incumbent fell this week, as Texas attorney general Ken Paxton, riding the endorsement of the President, cruised to victory in the Texas GOP primary runoff over incumbent John Cornyn. Unfortunately for the GOP, Paxton is perceived to be a weaker candidate in the general election and his win actually increased the elections odds in favor of Democrats. Still, the win highlighted, yet again, the strength of the President with the GOP base.

  
  

• One downside of the President’s success in ousting incumbents is the position it leaves the GOP as it tries to enact policy.

  
  

• With Iowa going to the primaries this week, both Democrats and Republicans thinks it may hold the key to Congressional control, especially with Democrats more optimistic than ever about being competitive in the state. Overall, Dems remain hopeful about their Senate chances.

  
  

• One interesting CRS report from the week: a deep dive into Medicare Part B spending on drugs.

AGENCIES:

CMS issued the final rule to strengthen the No Surprises Act by making the Federal Independent Dispute Resolution process neater. The Fact Sheet is here. For now, a prepublication copy of the 607-page final rule can be accessed here (PDF), pending final publication to the Federal Register. One interesting part of the rule is the creation of a new “IDR Gateway” that will act as a one-stop shop to manage the dispute process.

HHS, via CMS and SAMHSA, announced that 10 new states will be joining the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Waiver demonstration, which provides states with more funding to expand access to mental health treatment.

CMS announced, in their latest MLN Connects Newsletter, that they’re relaunching the PEPPER (Program for Evaluating Payment Patterns Electronic Report) in the “coming months”. McKnight’s has a good breakdown.

CMS is looking to hire more than 1,200 people, primarily with IT experience, to stock up their fraud prevention efforts.

FROM THE NOTEBOOK:

• Congrats New York! The state finally enacted a budget and recognized the need to invest in their SNFs. The full text of the healthcare budget bill is here.

  
  

• Florida finally passed its budget, after nearly two months’ worth of delays. There’s some good news for SNFs in there.

  
  

• Massachusetts is suing UnitedHealth alleging that the company defrauded the state’s Medicaid program out of more than $100 million through upcoding. Are states beginning to catch on to the fact that maybe Managed Care for long-term care isn’t the best idea???

  
  

• Five months into the pilot program testing out the use of AI to prescribe drugs, Utah published an assessment of the program (PDF).

  
  

• A state saying that we’ve got too many long-term care regulations? Bless you, Maine.

  
  

• Politico took a long look at how states are navigating the costs in implementing the work requirements provisions of the OBBBA.\

  
  

• The Illinois Legislature sent SB 315, the strongest AI safety bill in the country, to the Governor.

  
  

• United Healthcare continues to eliminate prior authorization requirements, this time announcing the cut of more than two thirds of those in pediatric care.

  
  

• CVS filed a lawsuit to block the rollout of a new Tennessee state law that bans PBM’s from owning pharmacies in the state.

  
  

• California’s Office of Health Care Affordability (OHCA) proposed draft regulations to implement the state’s new oversight law into private equity transactions related to healthcare providers. The regs are here (PDF).

  
  

• The Kaiser Family Foundation did a deep dive into how North Carolina is implementing OBBBA’s Medicaid provisions and how it’s impacting their budget.