Week in Washington 06/05/24

MA STARS Lawsuit

A federal judge ruled in favor of SCAN Health Plan’s suit against CMS. The suit argued that CMS violated the Administrative Procedures Act (APA) through its application of CMS star ratings calculation, specifically around the Tukey outlier methodology. The ruling could void some of the methodological changes made in 2023. CMS must now decide whether to appeal the ruling or settle. Given that the ruling could impact recently filed Medicare Advantage rates for 2025, CMS would be under pressure to decide sooner than later.  

ARP Extension

The Center for Budget and Policy Priorities released new analysis on the effects of the expiration of the enhanced premium subsidies. Currently, the enhanced subsidies that went into effect, initially, as part of the American Rescue Plan, are set to expire at the end of 2025. The CBO recently released analysis that extending the enhanced subsidies would increase enrollment in the individual market by about 7.1 million relative to a baseline of the enhanced subsidies ending. While no action is expected until next year, both insurers and consumer advocates are increasingly their lobbying efforts to try to make the enhanced subsidies permanent.

MA Transparency

As part of CMS’ request for information (RFI) around data to make Medicare Advantage plans more transparent. As part that process, several provider groups included comments around increasing prior authorization reporting requirements. Insurer lobbying groups, such as AHIP, have pushed against increasing reporting requirements. Given the pressure from Congress on this issue, CMS is expected to use the RFI to release a proposed rule on this issue.

MDMA Treatment

A panel of experts advising the FDA voted against approving using MDMA-assisted therapy in treating PTSD. Panels vote is not binding on the FDA however the FDA typically does follow the panels advice.

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