WASHINGTON — A trio of high-stakes policy shifts by the Trump administration has officially taken effect this month, marking a radical departure from previous federal oversight of the nation’s elderly. By simultaneously rescinding nursing home staffing mandates, introducing artificial intelligence (AI) as a primary “referee” for traditional Medicare coverage, and narrowing the scope of telehealth, the administration is betting on deregulation and technology to curb costs—a move critics call a “perfect storm” for vulnerable seniors.
1. The Nursing Home Staffing Rollback
The most controversial of these moves is the full revocation of the 2024 federal staffing mandate. The rule would have required nursing homes to provide at least 3.48 hours of care per resident daily and maintain a registered nurse on-site 24/7.
A recent investigation by The New York Times linked the repeal to a massive industry lobbying effort. “About 40 corporate entities associated with nursing homes across the country donated nearly $4.8 million to MAGA Inc., a pro-Trump super PAC,” the Times reported, noting that the donations occurred shortly before the administration ceased its legal defense of the rule.
Industry groups celebrated the repeal, arguing the mandate was an impossible standard during a historic labor shortage. However, patient advocates cite research suggesting the mandate could have prevented 13,000 deaths annually.
2. Medicare’s “AI Referee”: The WISeR Model
In a historic shift for traditional Medicare, the administration has launched the Wasteful and Inappropriate Service Reduction (WISeR) pilot program. For the first time, traditional Medicare beneficiaries in six states—Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington—must seek prior authorization for 17 specific medical procedures.
Unlike the human-led reviews of the past, these decisions are now guided by artificial intelligence and machine learning. The program aims to “root out waste” in services that CMS identifies as high-risk for inappropriate use.
The “WISeR 17” List:
If you are in a pilot state, the following procedures now require AI-assisted pre-approval:
- Spinal & Nerve Procedures: Cervical fusion, Percutaneous vertebral augmentation (for fractures), Deep brain stimulation (for Parkinson’s/Tremor), and Epidural steroid injections.
- Joint & Mobility: Arthroscopic lavage and debridement for the osteoarthritic knee.
- Neurostimulators: Electrical nerve stimulators, Vagus nerve stimulation, and Hypoglossal nerve stimulation (for Sleep Apnea).
- Wound Care: Application of bioengineered skin and tissue substitutes for non-healing wounds.
- Other Services: Sacral nerve stimulation (incontinence), Phrenic nerve stimulators, and treatments for impotence.
Under WISeR, the tech companies conducting the reviews receive a “share of averted expenditures,” creating what critics call a financial incentive to deny care.
3. The Narrowing of Telehealth Flexibility
The third pillar is the expiration of pandemic-era telehealth flexibilities. Effective early 2026, most Medicare beneficiaries must once again be located in a physical medical facility in a rural area to have telehealth services covered.
While exceptions remain for behavioral health, the “hospital-at-home” convenience that millions of seniors relied on for routine check-ups has been largely dismantled. The administration argues this return to strict geographic requirements is necessary to prevent billing fraud.
A Growing Divide in Care Quality
The convergence of these three policies has created a polarized landscape. To the administration, these are “common-sense” reforms that protect the solvency of the Medicare Trust Fund. To advocates, they represent a retreat from the government’s responsibility to protect the aged.
The New York Times report highlighted a 2024 study by the National Bureau of Economic Research showing that many nursing home chains hide profits through complex corporate structures. The study argued that if these “hidden profits” were spent on staff, nearly 76% of facilities could have met the 24-hour RN requirement without federal help.
As the WISeR pilot begins its six-year run, the primary question remains: Will the savings from AI and deregulation come at the expense of senior safety?
Source: The New York Times
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