Week in Washington

Election Updates

While several races remain uncalled, last week’s election did produce significant changes. At the national level, Democrats flipped control of both House and the Senate. Once Democrats take control in January, they are expected to pursue legislation to delay Medicaid work requirements and reinstate enhanced premium tax credits for the Marketplaces. They could also pursue areas of greater bipartisan agreement, such as expanding drug price negotiations or limiting corporate integration.

There were also significant changes at the state level. Democrats gained governorships and, in several states, unified control of state government. As a result, Medicaid Expansion could be attempted in several states, such as Wisconsin, Texas, and Georgia.

Patient Monitoring

CMS delayed for two years a planned restriction on billing for remote physiologic and therapeutic monitoring services furnished by clinical staff of third-party vendors.

The restriction had been scheduled for January 1, 2027. Under the finalized Physician Fee Schedule, it will instead take effect on January 1, 2029. Practices can continue using external vendors for technology, software, connectivity, and related support while preparing for the eventual clinical-staff restriction.

STARS Lawsuit

Becker’s Payer Issues offers a helpful summary of the various lawsuits over the 2027 Medicare Advantage star ratings. The lawsuits claim CMS’s ratings will cost the plans over $4 billion. Additional lawsuits are likely. The SCAN lawsuit, which opened the door for this additional wave of lawsuits, was appealed by CMS, and a hearing is scheduled for this winter.

Arkansas Waiver Gets Reprieve

CMS approved a temporary six-month extension of Arkansas’ Medicaid expansion waiver. Previously, CMS had denied Arkansas’ renewal waiver because of the new budget neutrality standards. As of November 1, Arkansas’ Medicaid expansion program, ARHOME, had about 210,000 beneficiaries.