Creator: JJ Rabinowich
SNF Digest #184
From the White House to Congress to the regulatory agencies, JJ gives you the inside word on what is what for this week.
WHITE HOUSE:
Over the last few weeks, the White House focused on further deregulation related to chemicals used in specific industries, reducing the size of several national parks, hosting the first inaugural “Fentanyl Free America Summit”, issuing a proclamation related to the import of parts for commercial air travel, and convincing foreign allies to invest more deeply in NATO. One item of indirect interest:
They announced the formal launch of Gold Eagle, a public-private partnership that will act as a central clearinghouse to better coordinate responses to cybersecurity vulnerabilities. While details of how it’s going to work in practice remain unclear, every effort to increase cybersecurity protections is worth monitoring.
CONGRESS:
As we enter the final week before Congress leaves for the August recess, the House is rushing to get a few funding bills through. First up on the agenda is Reconciliation 3.0, which passed out of a House Committee. The bill is relatively small (at least by DC standards) at only $95 billion, mainly for defense spending, but even that is facing opposition by Congressional Republicans, to say nothing of the Senate. On top of that, Speaker Mike Johnson is trying to get a Continuing Resolution passed that would fund the government through December. That is also running into opposition, including from Conservative members of the GOP. Oh, and let’s not forget that since it’s just a small Reconciliation bill, there are folks who wanna do a Reconciliation 4.0. All in all, it’s shaping up to be a jam-packed final week. Elsewhere in DC:
The House Ways & Means Committee unanimously voted to move HR 3514 out of Committee. The bill would require health insurance plans to reform the prior authorization process and provide more transparency. A fact sheet is here (PDF). The next step is a vote on Monday, July 20th, at the Energy & Commerce committee, before heading to the full House.
Two Senators sent a bipartisan letter to several MA plans, including United, Humana, and CVS, among others, asking for more information related to their practices of denial of care to seniors. The letter is here (PDF). The letter was based on the OIG’s findings last month that found over 95 percent of denials by the MA plans were later overturned, if appealed.
The sudden and untimely passing of Senator Lindsey Graham means, at least in legislative terms, the ascension of Senator Ron Johnson to the Senate’s Budget Committee chair, where he’ll now be tasked with the Senate’s version of Reconciliation 3.0.
As far as a replacement goes, Darline Graham, the younger sister of Lindsey Graham, was sworn in to fill out the remainder of the term through January 2027. There will be a special primary election in mid-August to name the Republican nominee who will appear on the ballot in November. As you can imagine, quite a few folks are putting in their name to run for the seat.
Meanwhile, Democrats have their own replacement drama going on in Maine, where the official nominee dropped out following yet another scandal.
There’s also election drama going on in Nebraska, where the official Democratic nominee wants to drop out, but it’s not clear that the state will honor the request…
Despite all the drama, Democrats remain hopeful that they can take back the Senate.
Wisconsin’s gubernatorial race is turning into a mess.
We’ve mentioned before that in the event the Democrats take over one of the Chambers of Congress, a major tool that can be wielded is the Congressional ability to initiate hearings and oversight. This a new tracker to keep an eye on the different oversight efforts of Congressional committees.
Several relevant CRS reports over the last few weeks:
o IF13266: A guide on helping Congressional offices connect senior centers in their state to federal grants.
o IF10623: An updated version of their guide for Congressional offices on the State Health Insurance Assistance Program (SHIP), a federal program that providers funding to states to help their Medicare beneficiaries better access information on federal programs.
o IF13270: More political in nature, but a guide to the recent Supreme Court decision that ruled limits on coordinated political expenditures are unconstitutional.
AGENCIES:
CMS announced the nationwide expansion of the “Risk-Based” survey process that changes how surveys are performed for higher- and lower- performing SNF’s. The QSO is here (PDF).
CMS announced the release of the 2027 physician fee payment rule, which includes a series of changes to ACOs and physician payments. The fact sheet on the physician fee schedule is here. The fact sheet on the shared savings programs for ACO’s is here. The blog post on their goals for the program is here.
CMS released the latest 2028 draft guidance for the Medicare Drug Pricing Negotiation program. The guidance is available here (PDF).
HHS, the VA entered into a MOU to accelerate the research into the usage of psychedelic drugs to help veterans with mental illnesses. Separately, the VA and the FDA also entered into a MOU to pursue the subject. The FDA’s central resource page is here.
HHS & CMS announced the formal launch of the “Make Hospital Food Healthier” pledge, a national push to get hospitals to start serving healthier food.
The OIG at HHS released an audit that found New York needs to do a better job of ensuring SNFs in the state comply with federal background check requirements. The summary is here (PDF) while the full report is here (PDF).
CMS Administrator Dr. Oz and Deputy Administrator Kim Brandy penned an op-ed outlining the success the agency is having in preventing federal dollars from going out to fraudsters.
The Government Accountability Office (GAO) found that CMS needs to do a better job of protecting beneficiaries from having their plans changed. On his Twitter page, Dr. Oz supported the report.
The Department of Labor announced an award of over $160 million to expand several registered apprenticeship programs.
The FTC announced a settlement of its lawsuit against CVS’ PBM.
FROM THE NOTEBOOK:
Congrats to the folks in PA on the passage of a new budget that significantly raised the floor of the Budget Adjustment Factor.
A whistleblower filed a lawsuit against a MA plan alleging that the MA plan inflated its profitability…
Another look at the workforce shortage crisis that is coming for long-term care.
Health Affairs looked at the latest on US healthcare spending by income.
Kaiser Health News did a deep dive into Washington State’s new long-term care public insurance.
In the latest shocking development, it looks like insurers are backing away from their voluntary pledges to CMS to improve the prior authorization process.
Modern Healthcare looked at how states are navigating the belt tightening resulting from the One Big Beautiful Bill.
Stat Healthcare did a deep dive into family caregivers, an area that’s been particularly hard hit.
A theory on why high drug prices get the bad press, while high hospital costs barely rate.
The Kaiser Family Foundation did a deep dive into SNF deficiencies.
One way that states are hoping to recoup some of the losses? Going after employers that have large numbers of employees on the state’s Medicaid rolls.
