CMS

UsedState7381

CBD reimbursement program will start on April 1st. CBD products of the program are allowed to contain up to 0.3%THC, in compliance with 2018 Farm Bill rules(which brought fourth the hemp loophole). https://www.cms.gov/priorities/innovation/substance-access-beneficiary-engagement-incentive >Eligible hemp products are limited to federally legal hemp-derived products containing no more than 0.3% delta-9 THC and expressly excludes inhalable products, any products containing more than 3 mg per serving of tetrohydrocannabinols (such as delta-8-tetrahyrdocannabinol, delta-10-tetrahyrdocannabinol, and tetrahydrocannabinolic acid) in an orally administered form, and any products containing cannabinoids not naturally produced or capable of being produced by or in the cannabis plant during its cultivation. >The definition operates within the 2018 Farm Bill’s hemp provisions and does not override the Controlled Substances Act or authorize Schedule I substances. To be eligible, hemp products must also comply with applicable state and local laws. >If the legal limits on hemp-derived products changes, as with Section 781 of the FY2026 Agriculture Appropriations Act, CMS will adjust its definition in accordance with the law.

scruffman99

I appreciate you trying, bro. I’m really not trying to be a jerk, but you really need to use some critical thanking skills here. i’m sure for the longest time you’ve built this persona around yourself that you’re a good Democrat and Democrats are good but when you look at the facts, the opposite is true. 1. Subverting Democratic Elections Trump’s efforts to challenge the 2020 election were aggressive and ultimately rejected—but they were pursued through legal channels, and the system held. Courts ruled, states certified results, and the transfer of power occurred. 👉 Contrast: There were active efforts to remove Trump from ballots in multiple states using the Fourteenth Amendment Section 3. State officials in places like Colorado and Maine attempted to disqualify a leading presidential candidate from appearing on the ballot, backed by coordinated legal challenges and political support networks. 👉 Point: Using institutional and legal mechanisms to try to exclude a top candidate from the ballot before voters can decide is far closer to authoritarian—or even fascist-style—election control, where systems are used to limit voter choice, than post-election legal challenges that were ultimately rejected. ⸻ 2. Weaponizing the Justice System Rhetoric about investigating political opponents is not new and doesn’t equal fascism without a demonstrated pattern of systematic prosecution or imprisonment. That did not occur during Trump’s presidency. 👉 Contrast: Federal agencies were used to impose sweeping compliance mandates across industries (OSHA, CMS), conditioning employment and participation on adherence to executive policy. That’s not hypothetical—that’s centralized state power directing behavior across the economy, which aligns more closely with authoritarian governance in practice. ⸻ 3. Dehumanizing Rhetoric Inflammatory language should be criticized, but rhetoric alone is not fascism without coordinated state action to suppress or target groups. 👉 Contrast: Millions of workers faced real employment consequences tied to federal mandates (vaccination or testing requirements, healthcare mandates tied to federal funding). That’s government-backed coercion affecting livelihoods, which is materially closer to authoritarian control than political rhetoric. ⸻ 4. Invoking the Military for Domestic Control Discussion of using the Insurrection Act exists within established legal precedent and has been used historically. It’s controversial, but still داخل the constitutional framework. 👉 Contrast: Leveraging federal funding and regulatory authority to force compliance across entire sectors is a direct, applied form of centralized control, not a hypothetical scenario. That’s where concerns about authoritarian—or even fascist-style—governance become grounded in actual policy. ⸻ 5. Demand for Loyalty / Schedule F Schedule F is a debated restructuring of the civil service, but it remained a proposal and fits within a long-running debate about executive control over bureaucracy. 👉 Contrast: Broad federal mandates dictating workplace behavior nationwide—and later limited or struck down by courts—show executive action actively testing and exceeding limits in practice, which is a more tangible example of authoritarian governance than a proposed policy chang

chasfly34

On March 13, 2026, the **U.S. Food and Drug Administration (FDA)** submitted a notice titled **"Cannabidiol (CBD) Products Compliance and Enforcement Policy"** to the **White House Office of Information and Regulatory Affairs (OIRA)** for review.  Key Details of the Submission * **Official Status:** The filing is listed on [Reginfo.gov](https://www.reginfo.gov/public/do/eoDetails?rrid=1312062) (RIN: 0910-ZC82) as a pending regulatory review under **Executive Order 12866**. * **Classification:** It is currently categorized as a **"Notice"** rather than a formal rule. * **Content:** While the full text has not yet been released publicly, the document is expected to clarify how the agency will regulate and enforce rules for CBD products moving forward.  [Reginfo.gov](http://Reginfo.gov) \+3 Broader Context This move follows years of regulatory uncertainty and significant federal shifts in early 2026:  * **Federal Alignment:** The submission aligns with a December 2025 executive order signed by **President Trump** aimed at expanding medical marijuana and CBD research. * **Health Insurance:** Industry observers suggest the policy may be linked to new **Medicare** initiatives or revisions to **CMS** policies that could allow for federal insurance coverage of certain CBD treatments. * **Impending Restrictions:** The policy arrives as the industry prepares for separate statutory changes under **Section 781** (set for November 2026), which will impose stricter per-container THC limits and likely reclassify many full-spectrum products as controlled substances.  Marijuana Moment +4 The OIRA review is a standard step before a policy is published in the **Federal Register**, allowing the public and industry stakeholders to soon see the FDA's formalized enforcement priorities. 

EricMichaelis

Hmmmmm: January 26, 2026: CMS released its 2027 Advance Notice for Medicare Advantage, proposing a dramatically low +0.09% payment increase. Analysts had priced in a 4% to 6% bump. January 27, 2026: UNH stock crashed roughly 20% in a single day, wiping out nearly $96 billion in market cap. February 25, 2026: The critical public comment window for the proposed CMS rates closed at 11:59 PM ET. February 25, 2026: On this exact day, Senator Mullin purchased between $50,001 and $100,000 of UNH stock. April 6, 2026: CMS is legally required to announce the Final 2027 rates 🗿

Familiar_Potato1244

The biggest immediate catalyst is the [Nurse.org](http://Nurse.org) Best AI Tool award winner announcement on March 16. They’re waiting for the first EMR Customer Onboarding PR (which started in Jan) and the tailwinds from the CMS HOPE mandate forcing facilities to automate. With a tiny 3.2M float and +70% sequential revenue this will fly anytime soon

aidettec

You mentioned the CMS HOPE mandate. Why is that specifically a catalyst for amesite and not for bigger EMR players??

Familiar_Potato1244

That's another big catalyst. The CMS (the govt agency that handles Medicare) dropped a mandate called HOPE that forces hospice and post acute providers to do massive new assessments. It’s a regulatory nightmare for them. Amesite is literally built for this. Since their AI is already integrated into the workflow, they can auto fill these government forms. For a hospital, this isn't just a nice tool, it saves them from fines and lost reimbursements. Also, that kind of product is recession proof because the government literally mandates the paperwork.

cyberspace-_-

This is how news outlet CMS looks like haha. That's why you can read the same article over multiple sources and languages.

Me-Regarded

It's not. Go try and AI a website for a business. Need a CMS platform, security, backups, often plugins, payment processing, store, do much. AI can't do jack for a serious website

Silver_Surfer_60

That's why I invested the amounts in "baby bonds" offered by SO, CMS, and NEE. The RoR is predictable and over 6% either due to their issuance rate or their discount to par. They are large regulated utility company bonds with maturity dates in the late 2070s or 2080.... well after I'll be gone. I bought most of them at a discount to par so their yield is over 6% and if their redeemed, I'll make a profit.

Agreeable_Safety3255

The executive branch is responsible for enforcement of statutory laws, think CMS for example. If congress passes a law that specifically states that providers can no longer bill outside of networks, Congress will also designate an agency to enforce that law. In this case it was CMS. This applies to other federal agencies and laws passed by Congress, the executive branch enforces laws passed by Congress through the federal agency (under the executive) that is responsible. And the attorney General heads DOJ, which is also under the President.

ChrisUndSeinSchiss

Clover doesn't want to dethrone EPIC. EPIC is an EHR while Clover is just a software. It's more like an adaptation within the EHR. Imagine yourself EPIC as a database, while Clover is using the database to highlight risks and detect chronic diseases earlier (through their AI and collecting additional data at each point of care). Both save money. A lot. But which, of course, takes time as we are talking about humans. However, Redditors have no patience. This is a stock for investing, not for trading. They stated back in January that 2006 will be the first year of GAAP Net Income profitability. This is huge! Especially while other providers are struggling! If they can confirm and be more precise in their next week's earnings call + maybe some comments/numbers on SaaS deals. This is not a meme stock anymore! They actually align perfectly with the new CMS guidelines. Check for yourself!

Sudz35

I know right! I'm new to Reddit. I posted this just to see reactions. I'm actually a long term holder but I did sell my leveraged shares today right before close! Now let's get this CMS proposal adjusted and run to 400 already.

Twist_of_Fate_44

So just to understand, the article title states this: **Federal Agency Finalized Rule For CBD Medicare Coverage Pilot Program Weeks Ago, Key Hemp Stakeholder Says** And then goes on to say further: *Jared Stanley, co-founder of the cannabis company Charlotte’s Web, said on a webinar with other group of cannabis industry stakeholders this week that the rulemaking for CBD coverage that’s being spearheaded by the CMS Innovation Center* ***was internally finalized about two weeks ago****.* Pure coincidence I'm sure, but look back when the CWEB chart really started pumping. Jan 28th, so about two weeks ago!! lol

AverageNo130

As cannabis industry stakeholders await action on a marijuana rescheduling proposal, the Centers for Medicare & Medicaid Services (CMS) has finalized a rule to provide federal health insurance coverage for CBD, according to an executive with a hemp company that’s been collaborating with the agency on the initiative. MM

Icy_Letterhead4893

Hey, fair enough, you got me on the RHTP awards... CMS announced them December 29, all 50 states got funded. My info was stale on that one, though worth noting the money doesn't actually start flowing until October 2026 so we're not there yet. On BetterHelp insurance, Divita confirmed 12 states plus D.C. at year end in his Healthcare Dive interview two weeks ago, so if the site shows 20 now that's moving fast. "All 50 by end of 2026" vs Murthy's "largely national" phrasing does leave some wiggle room though. Honestly what I'm really watching on the Feb 24 call is whether they break out insurance vs cash pay conversion rates for BetterHelp. Because if in network conversion is meaningfully higher that changes everything about whether this segment is a drag or an asset. If they dodge that number again then the insurance pivot is still a narrative, not a thesis.

rair21

RHTP Awards are announced and some have even been distributed.[CMS Link](https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states) I agree Uplift is supposed to fix the leaky bucket of Better Help. The rollout has been going pretty quick. They are up to 20 states according to their website now. I expect they will be taking insurance for Better Help in all 50 states by the end of 2026.

Icy_Letterhead4893

Yeah you clearly follow this closer than most, good stuff. Couple things though... Wellbound was actually announced July 15, not August, and the virtual sitter has been live since November 2024 so not really a 2025 catalyst. The RHTP part is where you're jumping the gun a bit. That's a $50B program over five years across all states, TDOC is one of five coalition members, and CMS hasn't even announced awards yet. I do think the UpLift acquisition is the sleeper nobody's talking about... if in network conversion rates are meaningfully higher than cash pay, that's what actually stops the BetterHelp bleeding, not the subscription tweaks. Worth noting Q1 2025 FCF came in negative so "nearing $200M" for the full year is still a bet, not a fact. But yeah new management is doing real things while everyone's still stuck on the $19B goodwill write down narrative.

BigOunce854

lamo, money flow like this. CMS --> State --> Insurance provider --> hospital/ clinic / vendor. so why not just yolo insurance provider like UNH ? 🤔

ULTIMATENUTZ

Hands down best buy you can make is UNH - the CMS advance rate notice was vapor and the devil is in the details. The final rate notice first week of April will be 4-5% and it’s off to the races rest of year.

Possible-Material693

How long until 🥭 tacos on health insurance and CMS rate? Portfolio is in shambles rn

OpticalAtrophy

Appreciate the thoughtful response. I do want to push back on one thing: I would be cautious about framing the 0.09% Medicare rate as "political rather than actuarial." The instinct is understandable, but CMS isn't negotiating so much as they're running a formula. If your thesis depends on the rate getting revised upward in April, you are making a regulatory bet. If it depends on UNH eventually repricing its products and managing its cost structure regardless of what CMS does, you are making a business quality bet. I am trying to make the latter. But, yes, I do agree: the cost ratio is the load-bearing wall of the entire thesis, and if 88.9% turns out to be structural rather than cyclical, I am simply wrong. I have been wrong before and the universe has shown no particular interest in sparing me from that experience. Good luck to you as well.

JohnMayerismydad

Prolly roasted. But if q1 earnings come in good and the CMS ups the Medicare payment rate for 27, then you could be in good shape.

gopoohgo

You forget all the Medicare Advantage companies are being investigated by DOJ and CMS for padding their patient diagnoses for increased payments. There isn't much appetite to throw them bones, when they have been caught stealing treats out of the snack bin.

Capital-Resident-131

Lmao UNH beats by a penny and still gets absolutely bodied in premarket. The Medicare rates being basically flat is brutal for all these insurers - nobody saw that coming except literally everyone who's been watching CMS tighten the screws for years

TibbersGoneWild

Didn’t he sell in December and it was just posted/filed the day before the CMS news?

Sudz35

Optum margins continue to get squeezed. And part of the bill Congress is trying to pass in the Senate strictly eliminates the spreads/profits to PBMs. In March UNH will provide final results from a 3rd party audit. And while it rarely happens the DOJ may consider the results to end their BS investigation. The day that happens the stock rallies 20%. Throw in renewed subsidies and a CMS increase to 3-4% and we're north of 400 instantly. But it will take time unless TACO happens this week! Happy trading!

Affectionate-Idea690

The current proposal is an Advance Notice, not a final rule.  Public Comment: The public and industry have until February 25, 2026, to submit feedback. The "Taco": Historically, CMS often "tacos" (folds) under pressure, slightly increasing the final rate from the initial proposal to appease both the industry and Congress. Final Announcement:  The final rates will be released by April 6, 2026.  If the final rates remain this low, it is highly likely that Congress will hold hearings or introduce legislation to adjust the funding formulas before they go into effect in 2027.  Calls 🤙 

Sudz35

I added some UNHG as well. Put some cash aside to buy any more dips. When this bounces back to 310 I'm out. Too much uncertainty right now with TACO and the DOJ. Management will continue to wander aimlessly until next year. The only positive is that the CMS proposal will likely change.

patelchief90

i’m not saying unh is gonna bounce right away but morons that are saying this is repeat of last year and going to $200 are utterly regarded. at that point you would’ve pricing in no growth and medicare rates sticking like CMS SAID and it ain’t gonna happen they’ll negotiate or tell the government fuck off and start managing their own medicare advantage money

awfulconcoction

I disagree. The underlying issue is the billing practices and unh basically defrauding the government by aggressively charting services. CMS cracked down and now the actuaries are forecasting lower costs. This isn't coming from the top for naked political reasons, there is an actual policy issue that may not be resolved as quickly as you hope.

FarrisAT

It’s already a giant shitshow Tons of doctors are quitting for private practices instead. It’s not worth being in the system. If CMS is going to price rates below Healthcare Inflation, for political reasons, then the Managed Providers will cut services and lose more doctors. All of this is going to get so much worse.

FarrisAT

They TACO’d last year. Preliminary 0% in January followed by a 3% in March final decision. Once again, the CMS rates are only a small piece of UNH’s revenue. Most of their money doesn’t come from Medicare Advantage or ACA subsidized plans. The issue is price and plan volatility. They got caught selling plans worth $10,000 for $9,700 and assumed annual CMS + ACA increases would move the revenue up to $10,500. Instead they lost some healthy users due to ACA subsidies ending, lost CMS rate increase, and lost money on Federal Investigations. What’s wild is that even now, UNH is set to make $15 EPS in 2026. Even with all these problems.

txholdem

unh in laymans term - 60% of unh revenue is from the government (medicaid and medicare advantage). yesterday CMS (the government) said they will have a freeze on pay raise 2027 (compared to 5% annual increase historically) because insurance companies allegedly claim sicker patients to get paid more. unh did relatively well after the announcement of biden's caps on insulin and drugs out of pocket max near the end of 2022. i don't know how, this time around, unh can pivot. maybe they were never supposed to be that profitable.

Visual_Breadfruit_39

UNH dropping 16% looks like a gift, but the fundamentals are actually degrading. I ran the numbers through scoring model and it’s only a 59/100 because of the MLR spike. If you want to see the specific data points I'm looking at (FCF yield vs CMS rates), here is full analysis: [https://ainvestor.biz/stock/UNH](https://ainvestor.biz/stock/UNH)

softboiledjadepotato

CMS proposal to cut reimbursements.. Love how this info comes right after close, and a day before earnings, guhhhh

softboiledjadepotato

Jesus what a stingy Government, proposing to cut reimbursements for Medicare and Medicaid.. Health care is already f\*cked here.. Imagine how many more denied claims will come down the pipeline if this CMS proposal sticks..

Ok_Cry7572

Trump Administration Proposes Flat Rates for Medicare Advantage, CMS and White House Say - WSJ - $UNH $HUM $CVS UNH down 7.5%

Me-Regarded

WOX down so much doesn't make sense. WIX is a DIY AI type of web builder, plus domains, ssl, hosting, SEO, etc. How would another AI chat slop do better? Plus ongoing maintenance, you need a CMS system, backups, etc. I'm a developer and think this is a buy on the whole AI replacing everything nonsense

thev0idwhichbinds

Medicare is insurance for old people. We spend lavishly on it. Boomers can expense golf lessons to medicare. The fraud I am talking about is doing things like setting up an LLC and using stolen social security numbers to bill medicare for durable medical equipment (wheelchairs , hearing aids, etc.) And then dissappear before CMS detects the fraud. You are thinking of medicaid, which is insurance for poor people. Less fraud in that because they are not a powerful political constituency so it mostly makes healthcare free. But medicaid is also a lot of wasted money. Most poor people live atrociously unhealthy lives and create enormously expensive healthcare costs.

Ok_Support_6454

> Now, Claude can pull coverage requirements from CMS or custom policies, check clinical criteria against patient records in a HIPAA-ready manner, and then propose a determination with supporting materials for the payer’s review. Lmao. Looking forward to getting my claims denied by an LLM!

Tangelo-Heavy

Figma doesn't compete with Adobe anymore. XD is now a thing in the past. Adobe's strength is now in the CMS space, and branding where they have another set of disruptors they're dealing with (i.e. SiteCore, Canva, etc.).

NicoDiPlaza

Recent news for FY26 CMS is gradually moving a large share of musculoskeletal and spine procedures off the “inpatient‑only” list and onto outpatient and ASC schedules, so more of these cases can be done as same‑day or short‑stay in lower‑cost settings instead of requiring a full hospital admission just to meet coverage rules. Orthobiologics are a natural fit for this shift because they promote fusion and healing with biologic grafts and matrices that work well in minimally invasive procedures, add minimal operating time, and avoid the large hardware constructs that often keep patients in the hospital longer. As more spine and musculoskeletal cases migrate into outpatient and ASC environments under the new CMS rules, the case mix increasingly favors techniques where biologics can show their value without inpatient “overhead,” leaving orthobiologics structurally better aligned with the same‑day/short‑stay model than traditional, hardware‑heavy approaches.

Incognew01

**January 1, 2026** is when the **final CMS Clinical Lab Fee Schedule (CLFS)** payment rate for OGM (CPT code **81195**) takes effect. This is a major milestone because it determines how much **Medicare will reimburse labs** for **OGM testing**.  The 2026 rate is high enough to make **OGM** ***financially viable*** **for many labs**.  Labs, hospitals, and payers are preparing now because **2026 is the first year OGM has a fully established, higher-paying, permanent reimbursement rate**.  This is the highest level of coding recognition, meaning: ·       The technology is accepted as clinically valid ·       It is expected to be used widely ·       Payers can no longer treat it as “experimental”  **2026** is the year **OGM becomes financially “real”** for the U.S. healthcare system.

yea-uhuh

Free CBD. Can't even give it away... Capitalism. * Centres for Medicare and Medicaid Services (CMS), led by Dr Mehmet Oz, will launch a pilot in April offering free, doctor-recommended CBD products to certain Medicare beneficiaries, subject to state laws and third-party testing. * This will recognise 6 million registered patients — 60% of whom use cannabis for pain — under the new classification

semisautomatichips

More like federal rule. I believe in the press conference it was explained that the administrator of CMS can prescribe that rule, but theres a process, which is why Dr Oz (Administrator) said it wouldnt happen until April 1

dave-alexander

As disappointing as the initial price reaction is, good things are yet to come! A lot of people are confused by today’s price action, so here’s a level-headed take. Yes the Executive Order was signed. Yes Schedule III is effectively locked in via federal directive. And yes CBD was explicitly addressed with CMS/FDA involvement (including Medicare pilot authority). So why the sell-off? This is classic “anticipation → confirmation → digestion.” Markets ran hard into the event, and short-term traders sold into the headline. Leveraged products (MSOX especially) exaggerate this move. That doesn’t mean the news failed — it means the market is repricing what actually changed. What actually changed (and matters long-term): • 280E is effectively dead → immediate EBITDA & cash flow improvement • Federal cannabis risk profile dropped permanently (Schedule I → III path) • CBD now has explicit federal legitimacy (FDA + CMS direction) • Institutional modeling must be redone (this doesn’t happen in one session) • SAFE Banking becomes politically easier, not harder Today wasn’t “the end event.” It was confirmation of a regulatory regime shift — and those never move in straight lines. If this were truly bearish, MSOS wouldn’t still be massively up from last week, and analysts wouldn’t be scrambling to update assumptions. This is digestion, not rejection. Big changes get priced over weeks and months, not one trading day. Stay grounded. This setup is structurally better than it was 48 hours ago — even if the tape doesn’t look pretty yet.

creemeeseason

CRMD released some test results: "Based on CorMedix's analysis of the data available through September 30, 2025, compared to historical controls, use of DefenCath demonstrated an overall 72% reduction in CRBSI, and a 70% reduction in hospitalizations secondary to CRBSI. The Company believes this represents a meaningful reduction in risk in some of the most vulnerable patients as well as a significant source of cost savings to the healthcare community and payors. CMS spends more than $3 billion per year on costs associated with CRBSI in the ESRD patient population, as the average CRBSI-related hospitalization is estimated to cost approximately $63,000, and up to $110,000 per incident when accounting for other sequelae." Part of the thesis around CRMD is that their drugs actually save their customers money by lowering infection rates, and this seems to back up that it's working. This thing is ready to explode if they announce pricing.

UsedState7381

EO leaked on Marijuana Moment. Details: Orders the AG to finalize the rescheduling process to schedule 3. No details on Safe Banking, no details on Uplisting. >Direct the attorney general to expedite the completion of the process of rescheduling marijuana to Schedule III of the CSA. >Direct top White House staff to work with Congress to give patients access to full-spectrum CBD products, “while still restricting the sale and access to products that cause serious and potentially life threatening health risks.” >Urge Congress to examine updating the definition of hemp to ensure that full-spectrum CBD is accessible to patients—a policy change that could mitigate some concerns in the sector about a recent spending bill Trump signed with provisions that would broadly ban consumable hemp products. >Direct the U.S. Department of Health and Human Services (HHS) to “develop research methods and models, to utilize real world evidence [and] to improve access to hemp-derived CBD products in accordance with federal law” while informing “standards of care.” >Separate from Trump’s order, Mehmet Oz, administrator for the Centers for Medicare & Medicaid Services (CMS), will also be announcing “a model that will allow a number of CMS beneficiaries to benefit from receiving CBD under doctor recommendation at no cost,” the White House official said. Not everything about the EO has been leaked, but I would NOT assume it's much beyond this. Brace for dips.

throwaway2676

>the Fox News story You are a partisan hack, not a serious person. No wonder you came to this thread to fellate the fucking Pelosis of all people. >The launch of the Obamacare website, HealthCare.gov, on October 1, 2013, was widely regarded as a disaster due to severe technical failures and mismanagement. >Within hours of its debut, the site crashed under the weight of user traffic, with only six people successfully enrolling in health insurance plans on the first day. Over the first three weeks, just 500,000 out of 20 million visitors managed to complete applications for coverage. >The root causes of the failure were multifaceted. The Government Accountability Office (GAO) found that the Obama administration lacked "effective planning or oversight practices" in developing the website, leading to significant cost overruns, schedule delays, and incomplete system functionality. >The Centers for Medicare and Medicaid Services (CMS), responsible for overseeing the project, failed to follow proper procurement procedures, did not conduct thorough performance reviews of contractors, and neglected to create a written procurement strategy as required by federal regulations. It was so disastrous that Zack Galifanakis mocked it to Obama's face on his show. No idea what you mean by "gutting of the exchanges," but they still worked fine last time I checked. And the Dems had 4 years to reverse whatever you think he did and chose not to. The ACA has been a disaster for everyone except insurance companies and hospital administrators

zygodactyly

Interesting parts to me are the framing and who’s actually in the room: banking, research, CMS, FDA, industry reps. Whatever one thinks of Trump, moving cannabis out of *culture-war* language and into regulatory and financial discussions is how normalization ought to happen.

DonaldChavezToday

Long text from Alexander Stahel ahead: In my http://dot.com life, I ran a CMS software company for 3 years, which gave me insights I still carry today. One of them: virtually every serious database ran on Oracle. And once you run a database, switching costs are so high that marginal benefits elsewhere simply do not matter. An insane moat. That said, Larry Ellison also instilled a hyper-aggressive, street-fighter culture at Oracle, the company he co-founded in 1977. As one result, the company picked legal battles with everyone, ALL the time, to the point where it became a strategic distraction for Larry. As a result, he missed several major shifts, Cloud Services among them. Given that his ego is larger than God’s, Larry now seems determined not to miss AI and instead reinvent himself as Mr Data Centre. Personally, I think this was a very bad decision. Mega bad. Absolutely nobody can predict where data-centre margins will end up, whether LLMs are the enduring use case, or which customers will ultimately vote for what with their wallets. This has all the hallmarks of a textbook 2000 setup. Believe me, exactly NOBODY identified today’s hyperscalers correctly as the big winners back then. Why? Because nobody can know. It’s a known unknown by definition. It took Bezos five good decisions per day for twenty years for Amazon to become what it is today. Very few appreciate that. Everyone and their brother tries to sound charismatic and break down tech into a few smart sounding components to explain future winners. Most of the time it’s total horseshit. Tech is brutally dynamic, and out of the gazillion companies trying, only a microscopic few will ever become the database, the search engine, or the online shop of choice thanks to brilliant leadership over years. Which brings us back to Larry: There was a joke back in the days: “The difference between God and Larry Ellison? God does not think he is Larry Ellison.” Do not take it as a joke. Larry’s ego makes Musk look humble. But in my opinion, this may finally backfire. Big time. Why? Because Larry has effectively bet the farm. Roughly $300bn in commitments so far, supported by a legacy business earning about 20bn. The gap is being debt financed. Meanwhile, Oracle’s $18bn 2035 investment grade bond, issued in September, now trades around 95. Well below par and well outside where investment grade should trade. Ask yourself why. Stargate, the largest data centre deal globally to date, and similar transactions are bets that unprecedented demand for a very specific form of computing will persist far into the future. They assume AI companies will require ever larger compute and data resources, and that enough customers will pay enough money for AI products for the industry to become sustainably profitable. If OpenAI’s revenue growth merely slows, if it stops doubling or tripling every year, it may neither need that much compute nor be able to pay for it. In that scenario, Oracle could find itself sitting on extraordinarily expensive and highly illiquid assets. The Stargate deal allows OpenAI to recommit or walk away after roughly five years. That is about a decade before many of Oracle’s underlying leases expire. Today, this is clearly a seller’s market for AI infrastructure. Nobody knows whether that will still be true when OpenAI gets to reconsider. All of this makes the market uneasy. Watch this space. Larry applied for his own little Lehman moment. He just might get it. [source](https://x.com/BurggrabenH/status/1999938747589407209)

douggilmour93

$AI 40% float short $AI AI), the Enterprise AI application software company, today announced that the U.S. Department of Health and Human Services (HHS) has selected C3 AI to create a unified, secure, and scalable data foundation across the National Institutes of Health (NIH) and the Centers for Medicare & Medicaid Services (CMS).

SpecificImpossible45

Gift link: https://www.bloomberg.com/news/articles/2025-11-26/medicare-to-test-making-cbd-treatment-available-for-seniors?accessToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJzb3VyY2UiOiJTdWJzY3JpYmVyR2lmdGVkQXJ0aWNsZSIsImlhdCI6MTc2NDE4MDkxMCwiZXhwIjoxNzY0Nzg1NzEwLCJhcnRpY2xlSWQiOiJUNkFDTkNLR1pBSkQwMCIsImJjb25uZWN0SWQiOiI2NzU0MjcwQzI0NDQ0Qzk2QjQ2OTg0MEUxNkQyNUE0RiJ9.5SJoOEXSnnS5mRRWbiDM6ySAaZKo2CqvVVUmc9H5Dr0&leadSource=uverify+wall “Details of the program couldn’t immediately be learned, but an early version of the plan focused on seniors in oncology and palliative care settings, according to a summary viewed by Bloomberg. Howard Kessler, a payments financier who has advocated for expanded CBD access, met with Health and Human Services Secretary Robert F. Kennedy Jr. about the issue last month, the people added. Christopher Krepich, a spokesperson for CMS, said the agency doesn’t speculate on future rulemaking or potential actions. Kessler didn’t respond to requests for comment. In September, Trump shared a video on Truth Social that supported Medicare coverage of CBD. The video, which sent cannabis stocks soaring, pitched the compound as a natural remedy that could extend seniors’ lives. It was produced by the Commonwealth Project, a group Kessler founded that promotes access to CBD products for seniors. Shares of cannabis stocks including Tilray Brands Inc. and Aurora Cannabis Inc. briefly rose to session highs on Wednesday. CBD is sold in a number of products, from gummies and tinctures to pet treats and skincare. A branded version is also approved by US regulators to treat seizures associated with severe forms of epilepsy. State laws regarding CBD vary, and the recent spending bill signed by Trump is poised to restrict access to many CBD products made from hemp that contain THC, the compound responsible for marijuana’s intoxicating properties.”

Ilovebadjokes

The problem is reimbursement. They have high cash burn and need sales, but market hasn’t adopted because there’s no incentive for CMS or insurance to reimburse. It’s a novel and promising product, but you’re being hyperbolic

C_B_Doyle

Congress could require the DEA to move cannabis out of Schedule I within 90 days, instantly opening the door for a full scientific review. Once it’s descheduled, the FDA would run a complete evaluation—clinical data, therapeutic applications, dosing ranges, safety profiles, manufacturing standards, purity requirements, and how cannabis fits into existing classes of regulated medicines. HHS would take those findings and issue a formal medical determination, creating a nationally recognized foundation for regulated therapeutic use. That shift unlocks insurance coverage because FDA and HHS recognition allows CMS and private insurers to treat cannabis like any other approved treatment. Hospitals, integrated health networks, and major pharmacy chains could then stock and dispense standardized, FDA-compliant formulations. Operators like MRMD, CURLF, and TCNNF—already functioning in tightly regulated state systems—could transition into federally compliant production, scaling supply across state lines and eventually into international medical markets under unified standards. The sequence becomes: Congress directs DEA → DEA deschedules → FDA defines medical standards → HHS certifies medical use → insurers reimburse → pharmacies and hospitals dispense → regulated producers supply a national and global market.

slash475

TDAPA ruling did come out Thursday night. While it was a little better than expected, it wasn’t what everyone was hoping for. The add on payment for H2 2026 was decided to be 2.371, but only included numbers for first year of Defencath sales(July 24-July 25). The company had appealed CMS to include the last year of Defencath sales(including q3 and q4 of this year) because the use is so much higher therefore the add-on would be too. Of course they denied and now the market is waiting on guidance for next year from the company. Real world evidence study will be released before end of year(my theory is the Monday before Christmas) and they really need to be blow out numbers. As far as we know they are based on information available. Fresenius actually spent time during their last earnings talking about Defencath and CRMD without specifically naming them, just that they have started new treatments geared towards patient safety and infection prevention.

slash475

[https://www.reddit.com/r/Shortsqueeze/comments/1nubni4/crmdcormedix\_biotech\_potential\_short\_squeeze/?utm\_source=share&utm\_medium=web3x&utm\_name=web3xcss&utm\_term=1&utm\_content=share\_button](https://www.reddit.com/r/Shortsqueeze/comments/1nubni4/crmdcormedix_biotech_potential_short_squeeze/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) I went into it a little bit a couple months ago and still think it could squeeze, but not from this. I've been in the stock for over 3 years and these numbers are insane and pt should be a lot more, but there was a shelf offering in June right after LDO1 was signed and an acquisition of Melinta. The dark cloud hanging over it right now is CMS TDAPA reimbursement news. CRMD has requested an extension and updated pricing for post TDAPA which will begin next summer. If they get good news, it could seriously take off. Also, real world evidence study results will be released by the end of year. If that comes back as we all hope, showing that it prevents infections at the rate it does, it could pop as well. While I do think we'll see nice movement today, I don't think the true value and squeeze will come until the CMS decision is released.

ContributeAVerse

Copy pasta if you want it The Trump administration is negotiating a deal with weight-loss drugmakers Eli Lilly and Novo Nordisk that would allow the lowest doses of some of their obesity drugs to be sold to consumers at $149 for a month's supply via TrumpRx, according to people familiar with the matter. The deals would also result in Medicare and Medicaid covering the drugs for weight-loss, the people said, which would be a boon to the companies. The discussions are still ongoing but if agreements are finalized, Trump is expected to announce them Thursday morning at the White House, alongside pharmaceutical executives, the people said. The agreement would allow Medicaid coverage for the popular but pricey drugs known as GLP-1s, including bestsellers Wegovy and Zepbound, to treat obesity. And it would require Medicare to cover the drugs for obese people who are also at high risk of other health problems, the people familiar with the matter said. The lowest dose of Novo Nordisk's Wegovy would be offered through TrumpRx at $149, the people said. The starting dose of Lilly's Zepbound would be sold for $299, $50 less than the price that the company currently charges patients buying directly through Lilly's direct-to-consumer website online, according to one of the people. In addition, Lilly would sell the starting dose of its weight-loss pill, orforglipron, for $149 via TrumpRx, if the drug, which is now in testing, is approved by the Food and Drug Administration. Ozempic, the diabetes drug also made by Novo Nordisk that is already covered for many Medicare and Medicaid patients, may also be offered on TrumpRx, according to one of the people, who didn't specify a potential price. As part of the deal negotiations, Lilly is seeking a voucher from the FDA that would speed up review of the company's weight-loss pill, the people said. The company has applied for the voucher, but it wasn't clear if it will be awarded by Thursday. The voucher could potentially be very helpful for Lilly, allowing it to speed up FDA review of its application to just one to two months. Normally, the FDA takes anywhere from 6 to 10 months from accepting a new drug application to complete its review. The potential agreements involve promises by the drugmakers to provide patients with "digital solutions" meant to encourage diet and exercise, people familiar said. Currently, Medicare drug-benefit plans are permitted to cover the weight-loss drugs for nonobesity uses, such as reducing risk of heart attacks or sleep apnea. Few states cover the drugs for weight loss in their Medicaid programs. A spokeswoman for Lilly said the company "is in discussions with the administration to further expand patient access, preserve innovation, and promote affordability of our medicines. We do not have specific details to share at this time." A spokeswoman for Novo Nordisk said the company "is engaged in constructive discussions with the Administration" and wants to make its drugs more affordable. A CMS spokesperson said the president wants to make these products more affordable, and that when a deal is completed, the administration will announce it. Trade publication Endpoints News earlier reported a deal was near. The deal is part of the negotiations the Trump administration kicked off with major drugmakers in July in an attempt to lower U.S. drug costs with a policy known as "most favored nation" pricing. So far Pfizer, AstraZeneca and EMD Serono have announced deals with the administration. Health Secretary Robert F. Kennedy Jr. has made fighting obesity and accompanying chronic diseases one of the primary goals of his Make America Healthy Again agenda. But in the past he has expressed skepticism about GLP-1s and last year criticized legislation to broaden coverage of the drugs, which he said would cost about $3 trillion. Centers for Medicare and Medicaid Services Administrator Mehmet Oz, a heart surgeon, persuaded Kennedy to back the coverage expansion by showing him scientific studies about how the medicines can prevent heart disease and diabetes, and data on the resulting cost savings to the federal government, people familiar with the matter said. President Trump last month said the "fat loss drug," or Novo Nordisk's Ozempic, could be sold to Americans at $150 or "much lower," but Oz quickly stepped in front of him and said the negotiations were still ongoing. Write to Liz Essley Whyte at liz.whyte@wsj.com and Peter Loftus at Peter.Loftus@wsj.com

altonbrushgatherer

Odd because CMS is cutting reimbursements in 2026… doctors are getting the double whammy of inflation and decreased reimbursements per unit work.

Thalesian

> All ACa did was raise taxes and borrowing to give subsidies to being the price down while all the charges went up. Here’s a [research paper](https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01478) that goes into detail that I’m sure will lead to informed debate. > The most definitive source of information on health spending throughout this period comes from the CMS National Health Expenditure Accounts Team. Exhibit 2 displays per capita and total national health spending with the subtitles of the team’s annual Health Affairs articles since the passage of the ACA superimposed. Collectively, these studies make it clear that yearly spending growth generally has been slow by historical standards since the ACA’s passage. The exceptions are 2014 and 2015 (when coverage expansions and the launch of high-cost drugs that cured hepatitis C drove spending) and 2018 (when private insurance prices climbed). While the growth trends are inconclusive about the degree to which the ACA contributed to lower spending growth rates, they provide no evidence that the ACA accelerated growth

Odd_Winter9070

Lmao this ain’t UNH’s first CMS rodeo, champ. They’ve been eating rule changes and spitting out record cash flow for decades. V28 just weeds out the weak smaller insurers drown, UNH scales. They’ll reprice, tighten coding, and print again by 2026. Same movie, new villains.

Rainyfriedtofu

hahaha you don't know squat about CMS rules or anything about insurance headwinds in 2026 do you? We're looking at bankruptcies here. Go read up on implementation of CMS V28 and how it will be going int o full implementation and how it will normalized and restrain risk scores. The purpose is to prevent companies like UNH and Humana from cooking the book. UNH need to have tighter coding/clinical programs to hold its current MCR which is a 89.9% which is fucking high. Right now inpatient/outpatient is running hot. If you go back and look at UNH's previous earnings, MCR pressure is running higher despite higher rates. Also go looks at CMS start rating-everyone is getting hits and there are less and less 5 stars plan now than before due to CMS v28. Everyone is losing bonus dollars. In short, 2026 winners are plans that controlled utilization, executed on v28 risk adjustment, and managed Stars. UNH doesn't falls into this category. Hell they are eating 89.9% MCR on 67% V28 and 33% V24. And you are telling me they are going to do well when it will be 100% v28? Bro, you clearly don't know anything about healthcare. The only ways UNH is going to pump is if we have people like you who don't understand health insurance core business earnings and pumping up the stock purely on buzz words and meme.

Odd_Winter9070

Yeah, ops income dropped no one’s denying that. But UNH raised full year EPS anyway, meaning management already baked in the pain. 2025 is the reset year before 2026 rate hikes and Medicare Advantage repricing hit. HR1 and new CMS formulas shift revenue up for efficient players like UNH. Short term squeeze, long term margin rebound. That’s how tanks reload, bud. 🚀

rair21

Extensions to the Covid era rules are fully expected to be in the government re-opening bill and a more permanent solution is expected after that. It will be the 3rd time they have been extended. You are correct about the present situation since 10/1, but it is fully expected to be a temporary situation. As of 10/21, CMS began paying certain types of telehealth claims again.

slash475

It wouldn't let me attach it yesterday with the AWS issues. They've requested reconsideration on TDAPA reimbursements after the initial first 2 years. If you want to read their submission to CMS you can download it [Here](https://stkt.co/RcTchwzb)

slash475

Good morning! I've been in CRMD for over 3 years and posted about it 3 weeks ago. That post is [here](https://www.reddit.com/r/Shortsqueeze/comments/1nubni4/crmdcormedix_biotech_potential_short_squeeze/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) . Just wanted to clarify some things about it. Yes, this is amazing news and shows sales are better than expected even a month ago when they raised guidance the first of September. Defencath utilization is better than expected for the LDO1, which is huge news too. However, the most important news for the stock in the short term is the CMS TDAPA reimbursement decision. If it comes back negative, it would prevent any squeeze whatsoever. If it comes back the way we hope, then we would probably see it. Also, potential short term catalysts (if TDAPA decision is neutral or not as good as expected) would be LDO2 sign on, Real world study results and FDA approval on Rezzayo. Keep in mind, that while the deadline for the TDAPA decision was November 1, that could be delayed due to the government shutdown. I'm not posting these things to dissuade anyone from getting in the stock, just wanting to clarify the picture. CRMD has exceeded sales since last July when they began, but the stock always gets beaten back down. Even with the news this morning, we're still sitting lower than at the beginning of October(and much less than the beginning of September even after raising guidance).

slash475

I purchased May calls last month(which honestly are hurting really bad) and I have had shares for years. It's been a tough few weeks, but there will have to be some news in the next month(ER at the least). The CMS TDAPA decision could be delayed because of the government shutdown, but should still come out before EOY. Real world evidence study results are due by end of year as well. If we have a decent ER, good guidance, and a decent TDAPA decision, I could see lift off. Thanks for the info you share, it's good to see the TA side too.

Icy_Bookkeeper_208

Just fyi. A reduction from $10 to $242 is ~96% reduction. To get this number Divide $10 by $242 and subtract the answer from 100, then multiply that answer by 100 and round to the nearest whole number. If you already knew this, then you are more proficient at Math than the current US CMS Admin, Mehmet.

slash475

No, I appreciate this information. There are a several catalysts that could come the next 6 weeks that force a squeeze, but the stars have to align. Right now I think that the CMS TDAPA decision is the most important, but even that may be delayed due to the government shut down.

Captain_America2021

Not trying to kill the vibe, just adding numbers and where the risk really is. What’s actually on the tape: • Dark-pool footprint: ~79% of recent volume printed $10.00–$10.10 (heavy accumulation zone). Above $11, lit liquidity thins out fast → air pocket if it breaks/holds $11.10. • Gamma setup (UW): • By expiry: near-term (10/17) net gamma negative → chop and stop-hunts; Dec 19 flips positive → dips should get absorbed more easily. • By strike: gamma flip ~$12–$12.3. Dealer hedging is a tailwind after it’s through $12. • OI/flow: Biggest call clusters sit Dec 19 $12–$13; intraday net call premium has been positive, but overall options volume is moderate (stealthy, not mania). • Short interest (latest reads): 16.6M short (22–23% of float). Days-to-cover shakes out ~4–6 depending on which volume window you use. Utilization/borrow are mid-range, not “maxed.” • Trend/technicals: Price living under key MAs, RSI mid-30s to low-40s (weak but basing). The $10.00–$10.10 zone is being defended; first choke point $11.10–$11.35. Cloud/MA confluence and gamma flip line up around $12. • Catalyst path: CMS/TDAPA reimbursement decision window is the real accelerant. That’s the thing that can shove it through $11.10 → $12 and put shorts on skates. Where the squeeze case is solid vs. hype: • Solid: High SI for a mid-float name, tight DP base at $10, thin liquidity above $11, and a clean event (CMS) in view. Dec gamma turns from headwind to tailwind. • Hype: “Squeeze incoming” right now is premature. Without a clean close > $11.10 on rising volume (and ideally >$12), shorts aren’t forced. Borrow/utilization aren’t at panic levels. How I’m framing it (not advice): • Basing/accumulation: Accumulation bids have been parked $10.00–$10.10. If that gives, next checks are $9.80 → $9.20. • Trigger 1: Close above $11.10 = opens the runway to test $11.8–$12.3 (gamma flip). • Trigger 2: Through $12 with volume = where dealer hedging + shorts can add fuel toward $13–$14 into Dec OPEX. • Invalidation: Sustained break below $9.80 = squeeze thesis on hold until the base rebuilds. This is more fundamental long with a squeezable cap table than a guaranteed squeeze today. The setups line up after OPEX and into the CMS decision. Watch $10.00–$10.10 for defense, $11.10 for the first unlock, and $12 for the real ignition. If the catalyst hits and it re-prices above the gamma flip, that’s when shorts have a problem.

zepto

CLOV. CMS ratings coming out. Large shorts 50/50 gamble

slash475

Typically they would have done it by now, so I don't think they will for Q3. They would normally do it up until Q2 when they were in the middle of the Melinta acquisition bidding. The main catalysts now will be CMS decision(Nov. 1 deadline) and Real World Study Results. Q3 ER last year was 10/30 but with the new merger I imagine it'll be later, but within the first couple weeks of November. It looks like this may be more of a November play now, but it's possible some news drops before. Full transparency I have a couple thousand shares I've been purchasing since 08/22 with a cost basis of 6.28 and May 15 2026 $16 calls.

Incognew01

NIH Backing, CPT Momentum, and FDA Fast-Track Potential Are Converging **Bionano Genomics Inc.,** isn’t just knocking on the door anymore, **it’s inside the room**. With NIH now actively using Optical Genome Mapping (OGM) in high-impact research like autism, and Centers for Medicare & Medicaid Services (CMS posting a preliminary decision to reimburse **OGM** under a new Category I CPT code, the platform has officially **crossed from outsider tech to institutional infrastructure**. This isn’t hype, it’s validation.  **NIH doesn’t invite just anyone into its fold**. Their use of **OGM** signals that the science is not only revolutionary, but **essential**. When you combine that with CMS’s reimbursement momentum and a political climate where HHS is being pushed to streamline diagnostics, you get a perfect storm of credibility, urgency, and regulatory opportunity.  **FDA approval**? It’s not here yet, but it’s no longer a long shot. The formalities still need to happen, but the **groundwork is being laid in real time**. OGM is already used in Clinical laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA), operating Laboratory Developed Test (LDT), and if NIH’s autism studies deliver the kind of results early adopters expect, FDA clearance could move fast.  **Bionano Genomics made the club**. It’s one of the boys now. And in this game, that means it’s going to be taken seriously, from reimbursement to regulation to clinical adoption. The **science made the case**. The system is catching up.  What’s changing now is **momentum**. The Centers for Medicare & Medicaid Services (CMS) recently posted a preliminary payment determination for a new Category I CPT code covering **OGM** for constitutional genetic disorders. That’s a major signal that the technology is being recognized as clinically useful and reimbursable, two key steps toward broader adoption. Add to that the NIH’s active use of OGM in autism research, and you’ve **got** **institutional validation at the highest level.**

Incognew01

NIH Backing, CPT Momentum, and FDA Fast-Track Potential Are Converging **Bionano Genomics Inc.,** isn’t just knocking on the door anymore, **it’s inside the room**. With NIH now actively using Optical Genome Mapping (OGM) in high-impact research like autism, and Centers for Medicare & Medicaid Services (CMS posting a preliminary decision to reimburse **OGM** under a new Category I CPT code, the platform has officially **crossed from outsider tech to institutional infrastructure**. This isn’t hype, it’s validation.  **NIH doesn’t invite just anyone into its fold**. Their use of **OGM** signals that the science is not only revolutionary, but **essential**. When you combine that with CMS’s reimbursement momentum and a political climate where HHS is being pushed to streamline diagnostics, you get a perfect storm of credibility, urgency, and regulatory opportunity.  **FDA approval**? It’s not here yet, but it’s no longer a long shot. The formalities still need to happen, but the **groundwork is being laid in real time**. OGM is already used in Clinical laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA), operating Laboratory Developed Test (LDT), and if NIH’s autism studies deliver the kind of results early adopters expect, FDA clearance could move fast.  **Bionano Genomics made the club**. It’s one of the boys now. And in this game, that means it’s going to be taken seriously, from reimbursement to regulation to clinical adoption. The **science made the case**. The system is catching up.  What’s changing now is **momentum**. The Centers for Medicare & Medicaid Services (CMS) recently posted a preliminary payment determination for a new Category I CPT code covering **OGM** for constitutional genetic disorders. That’s a major signal that the technology is being recognized as clinically useful and reimbursable, two key steps toward broader adoption. Add to that the NIH’s active use of OGM in autism research, and you’ve **got** **institutional validation at the highest level.**

Incognew01

NIH Backing, CPT Momentum, and FDA Fast-Track Potential Are Converging **Bionano Genomics Inc.,** isn’t just knocking on the door anymore, **it’s inside the room**. With NIH now actively using Optical Genome Mapping (OGM) in high-impact research like autism, and Centers for Medicare & Medicaid Services (CMS posting a preliminary decision to reimburse **OGM** under a new Category I CPT code, the platform has officially **crossed from outsider tech to institutional infrastructure**. This isn’t hype, it’s validation.   **NIH doesn’t invite just anyone into its fold**. Their use of **OGM** signals that the science is not only revolutionary, but **essential**. When you combine that with CMS’s reimbursement momentum and a political climate where HHS is being pushed to streamline diagnostics, you get a perfect storm of credibility, urgency, and regulatory opportunity.  **FDA approval**? It’s not here yet, but it’s no longer a long shot. The formalities still need to happen, but the **groundwork is being laid in real time**. OGM is already used in Clinical laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA), operating Laboratory Developed Test (LDT), and if NIH’s autism studies deliver the kind of results early adopters expect, FDA clearance could move fast.  **Bionano Genomics made the club**. It’s one of the boys now. And in this game, that means it’s going to be taken seriously, from reimbursement to regulation to clinical adoption. The **science made the case**. The system is catching up.  What’s changing now is **momentum**. The Centers for Medicare & Medicaid Services (CMS) recently posted a preliminary payment determination for a new Category I CPT code covering **OGM** for constitutional genetic disorders. That’s a major signal that the technology is being recognized as clinically useful and reimbursable, two key steps toward broader adoption. Add to that the NIH’s active use of OGM in autism research, and you’ve **got** **institutional validation at the highest level.**

ElisabethMager56

The risk adjustment math alone makes this a no-brainer for payers, and once CMS FFS coverage comes through it could be explosive. UNH moving first just sets the stage.. others won’t want to get left behind.

slash475

I mentioned 9 potential catalysts in the next 9-12 months. The most immediate ones are unaudited earnings the first of October, CMS TDAPA decision deadline is 11/1 and Real World Evidence study results by EOY.

Some-Rent-7742

All you folks interested in TLRY: READ THIS! Everyone focuses on state dispensaries or adult-use legalization. The bigger catalyst is federal: DEA rescheduling to Schedule III → kills the 280E tax stranglehold, improves cash flow for operators, and makes capital easier to raise. FDA-approved cannabinoid drugs → potentially reimbursed by Medicare/Medicaid. CMS already covers FDA-approved cannabinoid meds like Epidiolex (CBD) and dronabinol (THC). That’s a real healthcare market, not just dispensary sales. So I’m aiming for exposure where those two currents overlap: pharma-grade cannabinoids, ancillary infrastructure, and real-estate cash flow.- My current holdings Zynerba (via Harmony Biosciences) – Transdermal CBD therapies for CNS disorders. Backed by Harmony’s resources, so more likely to get FDA approval and payer coverage than standalone biotech. Tilray (TLRY) – Major global cannabis operator. Broader exposure across medical, adult-use, and consumer packaged goods. Innovative Industrial Properties (IIPR) – This is my favorite “picks-and-shovels” play. A cannabis-focused REIT that buys specialized cultivation/processing facilities and leases them to state-licensed operators. They collect rent (many leases are triple-net), and rescheduling → 280E relief → tenants have stronger balance sheets → lower credit risk for IIPR. It’s essentially a way to get steady cash flow and dividends from the cannabis boom without plant-touching exposure. --- What I’m hunting next I want more U.S. pharma/ancillary exposure that will benefit from: Schedule III rescheduling (banking, taxes). FDA-approved cannabinoid drugs being covered under Medicaid/Medicare. Non-plant touching businesses (labs, packaging, compliance, logistics). Names on my radar: Green Thumb Industries (GTBIF) – Large MSO in the U.S. KushCo (KSHB) – Ancillary packaging/compliance. Other U.S. biotechs with cannabinoid pipelines. Raw CBD/hemp oil ≠ reimbursable. FDA-approved cannabinoid drugs = reimbursable. That’s where Zynerba/Harmony fits. Global names like Tilray = diversification. IIPR = steady cash flow, dividends, and less regulatory exposure. Rescheduling + CMS coverage would light up this space, but even before that, IIPR gives real fundamentals that most cannabis tickers lack.

Some-Rent-7742

My current holdings Zynerba (via Harmony Biosciences) – Transdermal CBD therapies for CNS disorders. Backed by Harmony’s resources, so more likely to get FDA approval and payer coverage than standalone biotech. Tilray (TLRY) – Major global cannabis operator. Broader exposure across medical, adult-use, and consumer packaged goods. Innovative Industrial Properties (IIPR) – This is my favorite “picks-and-shovels” play. A cannabis-focused REIT that buys specialized cultivation/processing facilities and leases them to state-licensed operators. They collect rent (many leases are triple-net), and rescheduling → 280E relief → tenants have stronger balance sheets → lower credit risk for IIPR. It’s essentially a way to get steady cash flow and dividends from the cannabis boom without plant-touching exposure. What I’m hunting next I want more U.S. pharma/ancillary exposure that will benefit from: Schedule III rescheduling (banking, taxes). FDA-approved cannabinoid drugs being covered under Medicaid/Medicare. Non-plant touching businesses (labs, packaging, compliance, logistics). Names on my radar: Green Thumb Industries (GTBIF) – Large MSO in the U.S. KushCo (KSHB) – Ancillary packaging/compliance. Other U.S. biotechs with cannabinoid pipelines. Raw CBD/hemp oil ≠ reimbursable. FDA-approved cannabinoid drugs = reimbursable. That’s where Zynerba/Harmony fits. Global names like Tilray = diversification. IIPR = steady cash flow, dividends, and less regulatory exposure. Rescheduling + CMS coverage would light up this space, but even before that, IIPR gives real fundamentals that most cannabis tickers lack.

Some-Rent-7742

- My current holdings Zynerba (via Harmony Biosciences) – Transdermal CBD therapies for CNS disorders. Backed by Harmony’s resources, so more likely to get FDA approval and payer coverage than standalone biotech. Tilray (TLRY) – Major global cannabis operator. Broader exposure across medical, adult-use, and consumer packaged goods. Innovative Industrial Properties (IIPR) – This is my favorite “picks-and-shovels” play. A cannabis-focused REIT that buys specialized cultivation/processing facilities and leases them to state-licensed operators. They collect rent (many leases are triple-net), and rescheduling → 280E relief → tenants have stronger balance sheets → lower credit risk for IIPR. It’s essentially a way to get steady cash flow and dividends from the cannabis boom without plant-touching exposure. --- What I’m hunting next I want more U.S. pharma/ancillary exposure that will benefit from: Schedule III rescheduling (banking, taxes). FDA-approved cannabinoid drugs being covered under Medicaid/Medicare. Non-plant touching businesses (labs, packaging, compliance, logistics). Names on my radar: Green Thumb Industries (GTBIF) – Large MSO in the U.S. KushCo (KSHB) – Ancillary packaging/compliance. Other U.S. biotechs with cannabinoid pipelines. Raw CBD/hemp oil ≠ reimbursable. FDA-approved cannabinoid drugs = reimbursable. That’s where Zynerba/Harmony fits. Global names like Tilray = diversification. IIPR = steady cash flow, dividends, and less regulatory exposure. Rescheduling + CMS coverage would light up this space, but even before that, IIPR gives real fundamentals that most cannabis tickers lack.

Some-Rent-7742

Everyone focuses on state dispensaries or adult-use legalization. The bigger catalyst is federal: DEA rescheduling to Schedule III → kills the 280E tax stranglehold, improves cash flow for operators, and makes capital easier to raise. FDA-approved cannabinoid drugs → potentially reimbursed by Medicare/Medicaid. CMS already covers FDA-approved cannabinoid meds like Epidiolex (CBD) and dronabinol (THC). That’s a real healthcare market, not just dispensary sales. So I’m aiming for exposure where those two currents overlap: pharma-grade cannabinoids, ancillary infrastructure, and real-estate cash flow.

flat-waffles

Optum was down because they were growing topline and in the middle of their 3 year transition. From the earnings call • First, growth in certain markets where there were meaningful plan exits. These new patients had not been engaged by their prior plans for most of last year and we are seeing revenues associated with the patient profiles meaningfully below expected and normal levels. This is very addressable. • Second, the ongoing execution to the new CMS risk model, while complicated given the multi-year phase-in, has not been to our operational standards. Transitioning to a new model and concurrently running two distinct versions has been more operationally complex than anticipated. But no question, we need to execute better, and we will.

Natural_Flamingo9365

* 2024 * The Centers for Medicare & Medicaid Services (“CMS”) finalized the 2024 Home Health Rule which includes exoskeletons in the Medicare brace benefit category, reimbursed by Medicare on a lump-sum basis. The Home Health Rule went into effect on January 1, 2024. * CMS revised its April 2024 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) Fee Schedule to include a final lump-sum Medicare payment rate for personal exoskeletons. * The MACs have begun approving previously submitted Lifeward claims for payment. * The CMS Home Health Rule and Medicare Pricing achieved by Lifeward is now fully functional with widespread approvals and the beginning of payments from our 2023 and first-half 2024 submissions. With the experience of access for Medicare beneficiaries, physicians are now able to actively write prescriptions with confidence that on-label SCI individuals have access to this innovative walking and stair climbing technology. * In June, Lifeward successfully launched the latest generation of Differential Air Pressure Anti-Gravity Technology with its new NEO product line. The NEO provides features that are aligned for independent clinics seeking to offer this advanced technology. * In June, Lifeward completed its FDA submission for its 7th generation ReWalk design which will further enhance use of the system in all aspects of daily life and further establish Lifeward as the most experienced personal exoskeleton company in the world. Lifeward initiated actions to further streamline its U.S. operations including closing two U.S. facilities to complete the integration of AlterG. The actions are expected to save the Company approximately $3 million in operating expenses and improve gross margins by approximately two percentage points when the full impact is achieved. * Lifeward began selling the AlterG family of products through its German sales organization which the Company expects will result in revenue growth from a more focused sales effort and higher margins with little incremental investment by utilizing its existing sales and support infrastructure in Germany. * Lifeward executed a successful launch of the AlterG NEO which was engineered with a new design to allow a lower price point to make the technology more accessible to a broader range of customers. Since the introduction of the NEO at the end of June, Lifeward has generated orders for approximately 40 units as the NEO is quickly becoming a growth driver for the AlterG product line. 2025: Achieved FDA clearance and subsequent U.S. launch in April 2025 for the ReWalk 7, the latest innovation in the ReWalk pipeline, with over 20 ReWalk 7 units installed to date with overwhelmingly positive feedback from customers. Expanded and advanced the pipeline of qualified leads for the ReWalk and achieved the highest quarterly total of ReWalk units placed for Medicare beneficiaries since fee schedule established in April 2024. Continued expansion of U.S. payer base for the ReWalk Personal Exoskeleton. On the Medicare front, a ruling by an Administrative Law Judge established a legal basis for medical necessity by affirming that the ReWalk Personal Exoskeleton is “reasonable and necessary” for a Medicare beneficiary. Additionally, the partnership with CorLife, a division of NuMotion, has already facilitated and accelerated processing for workers compensation claims, with the first paid claim. [Quarterly Results | Lifeward Ltd.](https://ir.golifeward.com/financial-information/quarterly-results)

Natural_Flamingo9365

2022: Placed on June 8th CMS agenda of the Biannual Healthcare Common Procedure Coding System (HCPCS) meeting that includes benefit category determination for the first time under the new DEMPOS rules. * ReWalk has increased resources and presence in VA Polytrauma/TBI Care Systems as well as a process to expand training through the VA’s designated Community Based Outpatient Clinic network. * In April 2022, the Company joined the Human Robot Interaction Consortium, part of the Israel Innovation Authority MAGNET incentive program, where it will collaborate with several universities to develop advanced technologies aimed at improving the human-exoskeleton interaction. * ReWalk advanced its commercial readiness and finalized plans for expanded Medicare patient access following the satisfactory resolution of the first submitted claim; 2023: In March 2023, the ReWalk Personal Exoskeleton technology received 510(k) clearance from the U.S. Food and Drug Administration (“FDA”) for use on stairs and curbs, making it the only personal exoskeleton to receive FDA clearance for this indication.  * Closing of ReWalk’s acquisition of AlterG, Inc. (“AlterG”), which adds significant scale to the annual revenue base of ReWalk and AlterG’s innovative Anti-Gravity technology to the Company’s portfolio of rehabilitation solutions that facilitate mobility and wellness in rehabilitation and daily life. * Active pace of Medicare claim submission activity during Q3’23, better positioning ReWalk for reimbursement eligibility of exoskeletons by Medicare once payments are underway. subsequent to the end of Q3’23, the Centers for Medicare & Medicaid Services (“CMS”) finalized the 2024 Home Health Rule which establishes the inclusion of exoskeletons in the Medicare brace benefit category, reimbursed by Medicare on a lump-sum basis, and subsequently proposed the preliminary reimbursement level for the ReWalk Personal Exoskeleton.

Natural_Flamingo9365

2019 The ReStore exo-suit for stroke rehabilitation received FDA & CE clearances for sale to rehabilitation clinics in the United States and within the European Union * 2020 Finalized agreements with key German payors for the supply of ReWalk Personal 6.0 to qualified patients; * Amended our research collaboration agreement with Harvard to focus on tele-health solutions and extend the term through March 2023; * Entering upper and lower extremity products, offering hand, leg, arm and balance systems with MediTouch * Adding functional electrical stimulation cycle for home and rehab therapy with Myolyn; and * The Centers for Medicare and Medicaid Services ("CMS") issued Healthcare Common Procedure Coding System ("HCPCS") Level II Code K1007 in response to the Company's application. This decision, which will be effective on October 1, 2020, establishes the first such code for exoskeletons. * Received Medicare Provider certification from the Centers for Medicare & Medicaid Services ("CMS"); * Completed additional contract with a German payor * Continued CMS progress made with issuance of HCPCS Level II Code for ReWalk Exoskeleton enabling an upcoming application for coverage 2021: The Company entered into a contract with BKK Mobile Oil health insurance to supply ReWalk’s Personal 6.0 System to eligible persons in Germany; Additional five BKK partners have joined the operating contract in Germany * Received FDA breakthrough device designation for ReBoot, a soft exoskeleton for stroke home and community use

Simple-Software3

As you mentioned in another post, timing is what matters. I personally believe it's going to take YEARS before this trickles and impacts to large players (PACS is a large player, it is top 3 in size easily). Their bread-and-butter, with a proven track record, is acquiring bleeding facilities that are losing money and turning them around into money making machines. This is great for pacs in the near term, sucking up these small players and turning them around because they have the playbook down to a science and the resources to do so. Even just recently: [https://www.mcknights.com/news/skilled-nursing-owner-buckeye-chai-files-for-bankruptcy-months-after-selling-facilities-to-pacs/](https://www.mcknights.com/news/skilled-nursing-owner-buckeye-chai-files-for-bankruptcy-months-after-selling-facilities-to-pacs/) Please don't compare assisted living to skilled nursing. Come on. Am I worried about CMS and cuts to midcare/medicaid due to the current administration? Yes. In any case they are still completely undervalued at the current estimated financials and growth. Could some of this impact share price and gains in the very long term (years+), sure, but they are still printing money at this point and will continue to do so right now. I just don't think you can realistically open a bearish long position right now.

easye_was_murdered

My cost basis is $307, man. They affirmed their guidance for the rest of 2025 and their CMS ratings were not as bad as feared so they will be getting that extra money from Uncle Sam for caring for all those Medicare Advantage customers. The industry as a whole plans to raise medical insurance premiums by anywhere between 20% to 30% next year. Stephen Hemsley is back at the helm, in the office multiple days a week at the office in Minnesota (unlike Witty, who frequently worked remotely) working hard to bring the company back on track. Of course I do not deny that the company has more to prove down the road and a reversal back to price levels seen a few months ago is totally possible. But in a market devoid of real turnaround opportunities, UNH is one of the few ones.

easye_was_murdered

Not really. A lot of political progressives want a single-payer system, e.g., CMS being the only entity paying claims. Under such a system, UNH basically would stop existing except only as a private supplementary insurer, and their business would shrink dramatically on the insurance side. They got their clinical side though with Optum. Many other countries have such systems, with supplementary private medical insurance for those who have special needs or want something better than a public hospital.

easye_was_murdered

I bought back my calls today at a slight loss. Going to let it run, has very strong momentum right now. A bit overbought based on technicals, but they affirmed guidance for the rest of 2025 and their CMS ratings are still mostly intact. I expect decent EPS growth in 2026, Hemsley's definitely planning to underpromise and overdeliver.

easye_was_murdered

Sentiment was extremely negative for months now. But it’s turned and it’s now much safer to buy IMO. UNH has reaffirmed its 2025 forecast, got decent ratings from CMS… I’m looking for $520 at year end.

timeforachangee

“Centers for Medicare & Medicaid Services (CMS) Medicare Advantage star ratings for Star Year 2026 / Payment Year 2027; ~78% of its membership in 4 star or higher plans”

timeforachangee

“Centers for Medicare & Medicaid Services (CMS) Medicare Advantage star ratings for Star Year 2026 / Payment Year 2027; ~78% of its membership in 4 star or higher plans”

timeforachangee

“Centers for Medicare & Medicaid Services (CMS) Medicare Advantage star ratings for Star Year 2026 / Payment Year 2027; ~78% of its membership in 4 star or higher plans”

Prestigious_Ape

Be careful. CMS isn't done with the audit.

NotMe357

"TACO administration tiptoes into testing prior authorization in traditional Medicare" "How it works CMS will contract with private companies to deploy “enhanced technologies, including artificial intelligence (AI)” to conduct the authorization reviews. It won’t apply to in-patient or emergency services or treatments “that would pose a substantial risk to patients if significantly delayed,” according to a CMS press release. Specific services that will require prior authorization are skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy." ---- Yahoo Finance Lmao, that sounds just like how UNH is doing.

SeraphimSphynx

Th government does not charge itself a Medicaid or Medicare "insurance rate" just so you know. Not how that works at all. The government only pays the cost of the healthcare utilized against the plan for Medicare/Medicaid. The centers for Medicare and Medicaid science (CMS) set the rates based on BLS cost data and census information. Now some states did institute privatized Medicaid plans where they pay a private company to manage their Medicaid for them and essentially pay a health insurance rate in those cases but that's the exception not the norm. Medicare advantage is similar, private companies convincing granny that private is better and taking her off Medicare. But then she is paying premiums to Aetna/bcbs for essentially a privatized health plan for seniors cutting the government out if it.

gizamo

Lmfoa. Figma didn't supercede Adobe for web design. Adobe hasn't had a good tool for web design since Dreamweaver and Flash, which both shit the bed more than a decade ago. 99.9% of web devs had already completed abandoned Adobe for design tooling long before Figma gained any popularity. Then, Adobe tried to copy Figma with their XD product, and then they tried to buy Figma, which fell thru. Adobe pushes Adobe Experience Manager (AEM), but that's not a design tool. It's a CMS and DAM...and an absurdly expensive one that's pretty mediocre at what it does. They couldn't even integrate it well with Magento, which was probably the most flexible e-commerce platform for a decade or so. Tldr: Adobe has always sucked at everything relevant to web design and development.

easye_was_murdered

The entire industry got crushed by both people seeking more care and CMS pulling back on a billing loophole (e.g., V28). Utilization of benefits is up, and UNH got crushed on both ends because they both have an insurance arm and a clinical arm. If you think the industry can adapt to these changes and resume earnings growth, buy the stock. Otherwise, this whole thing is a bet on whether you think margins will recover or not.

Critical-Falcon-8004

**Centers for Medicare & Medicaid Services** CMS— the U.S. federal agency that oversees Medicare, Medicaid, and health insurance standards. Will *pilot Medicare and Medicaid coverage* for GLP-1 weight-loss drugs like Wegovy and Ozempic (Novo Nordisk $NOVO) [https://www.reuters.com/business/healthcare-pharmaceuticals/us-plans-medicare-medicaid-coverage-weight-loss-drugs-washington-post-reports-2025-08-01](https://www.reuters.com/business/healthcare-pharmaceuticals/us-plans-medicare-medicaid-coverage-weight-loss-drugs-washington-post-reports-2025-08-01)