Creator: JJ Rabinowich
SNF Digest #192
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 week, the White House focused on the ongoing tariff back and forth with Canada, signing a slew of legislation sent over by Congress, and a new Executive Order to modernize data management and sharing for veterans. One item of indirect interest:
While not quite the $5,000 checks promised by the President (for which he’d need Congressional approval) they announced that they are issuing $500 refunds for nearly 1 million Americans that got overcharged through the Obamacare exchanges. The mechanics of the refunds remain unclear, but, in theory, they won’t need Congressional approval for this.
CONGRESS:
With Congress only in for an abbreviated session, and not too much on the table that affects us, we’re going straight to the political roundup:
While only a short session, there were a few items on the agenda this week, although nothing of the must-pass variety.
Following calls by Anthropic’s CEO and a former researcher at the major AI companies to slow downthe technology, bipartisan efforts are forming to properly regulate AI. Of course, this being Congress, there isn’t a whole lot of consensus on the best approach, to say nothing of a strong industry lobbying effort.
Polling continues to highlight the Democrats chances of taking back Congress, and even the Senate appears to be in play.
Should the Democrats take back Congress, the President is ready for divided government.
Democrats are looking to build their own DOGE teams.
A good look at how the GOP is thinking about messaging (PDF) on data centers, a topic that is popping up repeatedly around the country.
The Democratic nominee for Wisconsin’s gubernatorial race has quite the story.
Three CRS reports of note:
o IF11545: An updated guide to SNFs for Congressional offices
o IF13311: A look at the 340B Drug Discount program
o R49340: A look at budget items excluded from the statutory PAYGO requirements. PAYGO is wonky but considering that this is a major part of sequestration, which pops up every time Congress is late on a budget, it’s worth a read.
AGENCIES:
CMS’s latest batch of Rural Health Transformation Program fund awards are out:
Vermont – this is notable as the first to fully focus on SNF’s
CMS is expanding their ACCESS model to offer more technological solutions for Medicare beneficiaries dealing with heart failure and other diseases.
More from CMS on the CHOICE health care plans that small business can now offer their employees.
It was a big week for HHS to dole out funding for a wide variety of efforts and health goals:
Via HRSA: $25 million for rural hospitals.
Via HRSA: $380 million for behavioral health response around the country.
Via SAMHSA: Supplemental funding for three states to strengthen faith-based prevention efforts.
Via ACF: $225 million for Head Start programs.
The OIG at HHS did an audit on UnitedHealth’s MA plan in Wisconsin and found that they didn’t comply with federal requirements, resulting in nearly $50 million in overpayments over the last several years. The summary is here (PDF) while the full report is here (PDF).
They also did an analysis of DME fraud in MA organizations and recommended that CMS strengthen oversight of MA organizations efforts to eliminate fraud in the program. The summary is here (PDF) and the full report is here (PDF).
CMS provided more guidance (PDF) to states on implementing the “Medical Frailty” exemptions for work requirements.
The GSA is expanding their partnership with OpenAI.
The Department of Veterans Affairs OIG reported that the health system is suffering from “severe personal staffing shortages”. The full report is here (PDF). Sound familiar?
FROM THE NOTEBOOK:
Kaiser Health News highlighted an important trend in the way CMS is greenlighting projects for the Rural Health Transformation Fund: they truly want transformative and innovative projects and aren’t simply looking to make providers whole.
The Electronic Frontier Foundation did a deep dive on CMS’s WISeR prior authorization model. Their conclusion? The program is causing delays and chaos.
Oracle is launching a new AI Agent for nurses.
Unrelated to SNFs, but an eye-opening fiscal dashboard from the Committee for a Responsible Federal Budget on the federal debt.
A new study suggests that the new State Direct Payment limits are going to decrease Medicaid spending by anywhere from 10% – 25% in 17 states.
It looks like the Administration’s efforts to implement Most Favored Nation pricing on drugs may have an impact elsewhere as drugmakers look to offset the American losses.
Modern Healthcare explored the landscape of Managed Medicaid programs across the country.
A deep dive into the Administration’s efforts to expand the use of AI in healthcare.
California enacted a new law that bans “addictive” social media features for anyone under 16.
Yet another report found that nearly half of health insurer denials are overturned.
