The president’s initiative on mental health would require insurers to cover three mental health visits a year, at no cost to members.
President Joe Biden struck a cautiously optimistic tone on the pandemic during his recent State of the Union address. The president also used the pandemic as an underlying springboard for other issues throughout his speech, which included Russia’s invasion of Ukraine, climate change, and the economy.
Two days after his speech, the administration released a 96-page COVID preparedness plan that reflects Biden’s cautious optimism. The plan, for example, envisions acceleration of the development of a single COVID vaccine to protect against any and all new COVID variants. The plan also emphasizes the need to prevent future economic and school shutdowns ‒ and a plan to vaccinate the world.
The president also used the State of the Union as a platform to launch a mental health initiative, focusing on school-age children in particular. Part of the initiative would be to require insurers to cover three mental health visits a year, at no cost to members.
The president also talked about lowering drug and healthcare costs, including a plan to cap out-of-pocket insulin at $35 a month. That initiative has bipartisan support, so it should be a slam dunk, but analysts are saying that partisan politics may get in the way. As they say, nothing is easy in D.C.
In a related move, soon after Biden’s speech, the Federal Trade Commission (FTC) announced that it would launch a probe into pharmacy benefit managers, or PBMs, which manage prescription drug coverage. The study would look at how PBM incentives may be exacerbating drug pricing.
The president also talked about his cancer moonshot initiative, which he started when he was vice president under Obama, and which he reignited at the start of his own administration. The initiative aims to cut death rates from cancer in half before 2050.
Finally, the president set out steps his administration wants to take to overhaul the quality of nursing homes through 20 specific actions, including setting staffing levels and beefing up inspections.
You can find more information on the administration’s nursing home initiatives on the RACmonitor news site, in an article by Mark Spivey. Like many of the initiatives announced by Biden in Tuesday’s speech, the nursing home initiative will require funding, and in some cases, statutory authority from Congress.
Returning to COVID, Biden said there would soon be “test and treat” programs across the country, wherein consumers who receive a positive result from a COVID test given at a pharmacy would immediately be given antiviral therapy to fight the virus. The president said these one-stop shops would be available in 100 locations this month.
Moving away from the State of the Union, in other D.C. news, a bipartisan group of senators have introduced legislation that would update and modernize the Health Insurance Portability and Accountability Act (HIPAA) to deal with the digital age. As many of you are aware, recent interoperability rules will allow consumers to share their electronic health records with mobile apps and other third parties. Among other things, the legislation would broaden HIPAA applicability to include those third parties that are now not considered HIPAA-covered entities.
In 2020, healthcare accounted for nearly 20 percent of this country’s gross domestic product. Federal government spending on healthcare grew 36 percent, while American household spending on healthcare increased by 26 percent.
Biden’s emphasis on healthcare in his national address is a reflection of the fact that so much of this country’s time and resources are directed toward healthcare.
Programming Note: Listen to Matthew Albright’s live reports on federal healthcare legislation Mondays on Monitor Monday 10 Eastern, sponsored by Zelis.
“PAYGO” (Pay-As-You-Go) refers to a budget enforcement rule designed to impose fiscal discipline: when lawmakers pass legislation that increases mandatory spending or reduces revenue without
As we conclude National Case Management Week 2025 with the theme of “Guiding Journeys,” we are making a point of celebrating case management professionals who
Please log in to your account to comment on this article.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
