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Week in Washington
The Supreme Court heard oral arguments surrounding two cases that involved the Chevron deference. The Chevron deference emerged from a ruling in the 1980s that gave agencies latitude to interpret and implement laws. Without such latitude, the judiciary will gain significantly more power to restrict and strike down regulations. Existing and future CMS regulations could be dramatically different if the Supreme Court rules against the Chevron deference. A ruling is expected in June.
At the time of writing this blog (Thursday morning), Congress is expected to pass a continuing budget resolution that would fund the government until early March. If a continuing resolution cannot be passed by end of Friday then the government will have a partial shutdown.
- Prior Authorization- CMS released the final interoperability and prior authorization rule this week. The rule affects Medicare Advantage, MCOs, and QHPs. The rule sets forth standards around electronic records as well as it places time limits on prior authorization responses for payers. The rule does not impact Commercial insurers that are not QHPs.
- Drug Coupon - The Biden Administration decided not to appeal a court ruling that struck down a regulation that would prevent Commercial insurers from counting coupons for drug makers towards enrollees’ deductibles/MOOPs.
Humana reported higher than expected medical utilization during the third quarter in its Medicare Advantage business. The higher costs are expected to increase benefit ratios for that book of business. This finding appears not to be isolated to Humana.
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