Summary
The House and Senate are both in recess this week, while the Department of Homeland Security remains shutdown as negotiations continue between Democrats and Republicans. Additional updates follow.
DOGE Medicaid Data Set
On Friday, the Department of Health and Human Services (HHS) Department of Government Efficiency (DOGE) released an open source Medicaid dataset, which includes aggregated, provider-level claims data for a specific billing code over time. This effort continues the Administration’s focus on fraud, waste, and abuse, with the post asserting that such data can be used to detect “large-scale autism diagnosis fraud seen in Minnesota.”
MAHA Update
Recently, HHS Secretary Robert Kennedy announced enhancements to the agency’s management team to advance President Trump’s Great Healthcare Plan and the Make America Healthy Again agenda. This includes the following:
- Chris Klomp will become Chief Counselor at HHS and oversee all operations of the Department.
- Kyle Diamantas and Grace Graham were named Senior Counselors for the Food and Drug Administration (FDA).
- John Brooks was appointed as Senior Counselor for the Centers for Medicare & Medicaid Services (CMS).
Secretary Kennedy notes that each individual will continue to serve in the current roles in addition to serving in the Secretary’s office.
Regulatory Update
The Office of Management and Budget completed its review of the following:
- Coverage and Payment:
- Medicaid:
- State Directed Payments. A proposed rule titled, “Medicaid Managed Care-State Directed Payments.” The proposed rule appears intended to advance a presidential memorandum released on June 6, which directs HHS to “eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payments rates are not higher than Medicare, to the extent permitted by applicable law.”
- Medicaid Tax Waivers. A proposed rule titled, “Amending the Indirect Hold Harmless Threshold of Health Care-Related Taxes.”
- Medicaid:
- The FY 2027 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System proposed rule.
- No Surprises Act. A final rule titled, “Independent Dispute Resolution Operations.” Thing long-awaited rule was proposed in November 2023 by the Biden Administration.
- Prescription Drugs
- Prior Authorization. A proposed rule on interoperability standards and prior authorization for drugs.
- Oversight and Integrity
- Fraud and Abuse. A proposed rule titled, “Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).”
- Accrediting Organizations. A final rule titled, “Strengthening Oversight of Accrediting Organizations (AO), Burden Reduction, and Related Provisions.”
- Other Topics:
- Health Technology. A final rule titled, “Administrative Simplification: Adoption of Standards for Health Care Attachment Transactions and Electronic Signatures.”
- An interim final rule titled, “Unaccompanied Children Program Foundational Rule; Update to Include Proof of Identity and Income Verification Standards.”
- Nutrition Assistance. A proposed rule titled, “Supplemental Nutrition Assistance Program: Reforming Categorical Eligibility.”
- Medication-Assisted Treatment. A final rule titled, “Implementation of the SUPPORT Act: Dispensing and Administering Controlled Substances for Medication-Assisted Treatment.”