June 27, 2025
GOP leader sets Saturday vote on Trump ‘big, beautiful bill’ despite Republican pushback
BY ALEXANDER BOLTON – 06/27/25 THE HILL
Senate Majority Leader John Thune (R-S.D.) told Senate Republicans to expect to see the legislative text of the budget reconciliation package on Friday evening and then to vote at noon Saturday to begin debate on President Trump’s tax and spending bill.Thune gave GOP senators the updated schedule after they met with Treasury Secretary Scott Bessent to discuss a tentative deal between the White House and House Republicans from New York, New Jersey and California to raise the cap on state and local tax (SALT) deductions from $10,000 to $40,000 for a period of five years.But Thune acknowledged after the meeting that the schedule could slip, calling the Saturday vote “aspirational.”“All of it depends on we got a few things we’re waiting on, outcomes from the parliamentarian. If we can get some of those questions, issues landed then my expectation is at some point, yeah, tomorrow we’ll be ready to go,” Thune told reporters.“I said, again, aspirationally, that we’d try to do it at some point in the middle of the day,” he said of the plan to vote Saturday to proceed to the bill.Senate Republicans control a 53-seat majority and can afford three GOP defections on the bill and still pass it with a tiebreaking vote from Vice President Vance.Several GOP senators, however, refused to say whether they would vote to proceed to the bill, including Sens. Bill Cassidy (La.), Lisa Murkowski (Alaska) and Ron Johnson (Wis.).
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Senate slated to take first vote on megabill Saturday
Speaker Mike Johnson also pitched Senate Republicans on the tentative SALT deal during a lunch.
By JORDAIN CARNEY and MEREDITH LEE HILL, Politico06/27/2025
Senate Republicans are planning to take an initial vote at noon on Saturday to take up the megabill.
Leadership laid out the timeline during a closed-door lunch on Friday, Sen. John Kennedy (R-La.) and John Hoeven (R-N.D.) said after the lunch. A person granted anonymity to discuss internal scheduling confirmed the noon timeline but cautioned Republicans haven’t locked in the schedule yet.
During the meeting, House Speaker Mike Johnson pitched Senate Republicans on the tentative SALT deal, according to three people in the room. He said the deal was as good as Republican can get, according to the people.
Johnson noted he still has “one holdout” — an apparent reference to New York Republican Nick LaLota, who said in a brief interview Friday that if there was a deal, he was not part of it.
Leaving the meeting, Johnson was asked by reporters whether he thought Senate Republicans would accept the SALT deal. “I believe they will,” he replied. “They’re going to digest the final calculations, but I think we’re very, very close to closing that issue.”
In the meeting, Treasury Secretary Scott Bessent and Johnson laid out details of the fragile agreement, telling Senate Republicans the House SALT deal would be cut in half, to total roughly $192 billion. They restated it would raise the SALT cap to $40,000 for five years under the current House-negotiated SALT deal, and snap back to the current $10,000 cap after that.
In related matters:
– Kennedy and Hoeven also said the Senate will keep its provider tax proposal but delay its implementation, which Republicans believe will help it comply with budget rules.
– Johnson told Senate Republicans that he wants to do another reconciliation bill — which senators took to mean they would get another opportunity to secure spending cuts or provisions passed that have been squeezed out of the megabill.
– Sen. Lisa Murkowski (R-Alaska) left the lunch and told reporters she’s still waiting to see if GOP leaders alter language around cuts to food aid. The megabill’s controversial SNAP cost-share provision would financially hammer her state of Alaska. It is poised to push billions in food aid costs to states in the coming years, hitting states like Alaska with the highest payment error rates especially hard.
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Trump backs away from July 4 megabill deadline: President Donald Trump today backed off the July 4 deadline he set for Congress to pass his megabill, acknowledging the timing could slip as Republicans work through a series of political and logistical hurdles. “It’s not the end-all,” Trump said of the self-imposed Independence Day goal. “It can go longer, but we’d like to get it done by that time if possible.” The remarks represented a clear softening of the White House’s position from just a day earlier, when Trump administration officials insisted the GOP lawmakers pass the domestic policy package within a week despite a series of fresh obstacles. Senate Republican leaders are still struggling to lock down the necessary 51 votes for the bill, amid objections from competing factions over the depth of the legislation’s Medicaid cuts.
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ADVOCACY OPPORTUNITY
- A message from Public Strategies LLC on behalf of Community Service Society:
ON MAY 22ND, THE U.S. HOUSE OF REPRESENTATIVES VOTED TO GUT MEDICAID AND THE AFFORDABLE CARE ACT (ACA), APPROVING A BUDGET PLAN THAT WOULD LEAVE MILLIONS WITHOUT HEALTH INSURANCE AND RAVAGE STATE BUDGETS ACROSS THE COUNTRY TO FUND TAX BREAKS FOR THE RICH. NEW YORKERS WOULD MAKE UP MORE THAN 10 PERCENT (1.5 MILLION) OF THE 16 MILLION AMERICANS AT RISK OF BECOMING UNINSURED. ANY OF THE SEVEN NEW YORK REPUBLICAN MEMBERS OF CONGRESS HAD THE POWER TO STOP THIS BILL, WHICH PASSED BY A ONE-VOTE MARGIN, BUT NONE DID. THE SENATE HAS PROPOSED AN EVEN WORSE VERSION OF THE BILL, WHICH WILL BE VOTED ON IN THE SENATE BEFORE IT IS SENT BACK TO THE HOUSE AND THEN TO THE PRESIDENT’S DESK. USE OUR NEW DASHBOARD TO SEE HOW THE HOUSE RECONCILIATION BILL WILL DEVASTATE NEW YORK’S HEALTH CARE SYSTEM, BUDGET, AND ECONOMY BY CONGRESSIONAL DISTRICT AND TO DOWNLOAD OUR NEW UPDATED ONE-PAGERS.MAKE YOUR VOICE HEARD: HOLD KEY CONGRESS MEMBERS ACCOUNTABLE FOR VOTING FOR EGREGIOUS CUTS AND ASK THEM TO STAND UP FOR THEIR CONSTITUENTS.THERE’S STILL TIME TO FIGHT BACK. PLEASE SHARE THESE RESOURCES WITH YOUR NETWORKS!
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CMS Approves New York SPA to Reimburse for Multidimensional Family Therapy Services within CFTSS Program
CMS recently approved a New York’s State Plan Amendment (SPA) that authorizes payment for evidence-based practices (EBPs) provided within Children and Family Treatment and Support Services (CFTSS) programs. Specifically, the State has identified Multidimensional Family Therapy (MDFT) as a reimbursable EBP under CFTSS. To receive reimbursement, agencies must be designated to provide Community Psychiatric Supports and Treatment (CPST) or Other Licensed Practitioner (OLP) services and have completed the EBP training and certification process.
State Plan Amendment: https://www.health.ny.gov/regulations/state_plans/status/non-inst/original/docs/os_2025-03-28_spa_25-03.pdf
CMS Approval Letter:
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SED Adopts Final Regulations Expanding Scope of Practice for RNs
Earlier this week the New York State Education Department (SED) adopted final regulations that permit registered professional nurses (RNs) to execute non-patient specific orders written by physician assistants (PAs) for a defined set of services, including but not limited to immunizations, emergency anaphylaxis treatment, pregnancy testing, opioid overdose reversal treatment, and Covid-19/flu testing. This change adds PAs – along with physicians and nurse practitioners (NPs) – to the list of professionals authorized to issue such standing orders.
State Register posting is here: https://dos.ny.gov/system/files/documents/2025/06/062525.pdf
(CMS Newsroom, 6/27/25)
CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare
Model will leverage enhanced technologies to protect Medicare beneficiaries, federal taxpayers from unnecessary services, fraud, waste, and abuse
The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the U.S. Department of Health and Human Services and CMS on Monday.
“CMS is committed to crushing fraud, waste, and abuse, and the WISeR Model will help root out waste in Original Medicare,” said CMS Administrator Dr. Mehmet Oz. “Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures.””
Wasteful care, including services that provide little to no clinical benefit, not only increase costs, but also put patients at risk. Waste in healthcare represents up to 25% of healthcare spending in the United States. The Medicare Payment Advisory Commission estimates that up to $5.8 billion in Medicare spending in 2022 alone was spent on services with minimal benefit.
“Low-value services, such as those of focus in WISeR, offer patients minimal benefit and, in some cases, can result in physical harm and psychological stress,” said Abe Sutton, Director of the CMS Innovation Center. “They also increase patient costs, while inflating health care spending.”
The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for select items and services that have been identified as particularly vulnerable to fraud, waste, and abuse, or inappropriate use. These items and services include, but are not limited to, skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. The model excludes inpatient-only services, emergency services, and services that would pose a substantial risk to patients if significantly delayed.
Companies selected to participate in the model will operate in assigned geographic regions and must have clinicians with appropriate expertise to conduct medical reviews and validate coverage determinations. Importantly, while technology will support the review process, final decisions that a request for one of the selected services does not meet Medicare coverage requirements will be made by licensed clinicians, not machines.
Model participants will receive payments based on their ability to reduce unnecessary or non- covered services (inappropriate utilization) and lower spending in Original Medicare. Participants’ payments will be adjusted based on their performance against established quality and process measures that measure the model participants’ ability to support faster decision-making for providers and suppliers and improve provider, supplier and beneficiary experience with the prior authorization process.
The WISeR Model will not change Medicare coverage or payment criteria. Health care coverage for Original Medicare beneficiaries remains the same, and beneficiaries retain the freedom to seek care from their provider or supplier of choice. Under the model, providers and suppliers in the assigned regions will have the choice of submitting prior authorization requests for selected items and services or their claim will be subject to pre-payment medical review. Those providers and suppliers that choose to submit a prior authorization may either submit their request directly to model participants or to their Medicare Administrative Contractor that will forward the request to the model participant. CMS may include a pathway in the future that would allow providers and suppliers with strong compliance records to qualify for exemptions from WISeR review, which would further reduce administrative burden and allow greater focus on high-risk areas. The WISeR Model does not impact people enrolled in Medicare Advantage.
CMS has issued a Request for Applications for companies interested in participating in the WISeR Model.
To view the Model Overview fact sheet, visit: https://www.cms.gov/files/document/wiser-fact-sheet.pdf.
For more information on the WISeR Model, visit: https://www.cms.gov/priorities/innovation/innovation-models/wiser.
The WISeR Model can be seen on the Federal Register at: https://www.federalregister.gov/d/2025-12195.