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Week in Washington
The Senate is expected to move forward on passing a gun control/mental health bill this week. The bill cleared a procedural hurdle this week. Congress will be going on recess at the end of the week so there is a strong push to vote on it before the recess.
The Senate is also discussing two other pieces of legislation. This week Senators Shaheen and Collins introduced a bill that would limit cost sharing expenses on insulin. As the bill would likely shift these costs to premiums, it would reduce government revenue. It’s unclear what level of support the bill has at the moment.
Additionally, Senate Democrats are considering their own drug reform acts as part of a potential reconciliation bill. Discussions by key Senators are ongoing and no firm bill has yet to emerge. Senator Manchin floated the potential compromise of having enhanced ACA subsidies for lower income individuals without the ARP subsidy increases for those above 400% FPL.
A busy week for the Supreme Court and Medicare. A few quick updates.
- SCOTUS rejected UnitedHealth Group’s case to overturn the rule that requires MA insurers to return overpayments (RADV audits) and ruled in favor of HHS. We don’t have information on the RADV protocols yet so the full implications are not yet known.
- SCOTUS ruled in favor of a hospital in Marietta v. DaVita. The case centered around the Medicare Secondary Payer act as to where group plans are allowed to take into account that plan participation with end stage renal disease is eligible for Medicare benefits. DaVita had sued the hospital for allegedly being reimbursed at low levels (essentially DaVita alleged that Marietta’s plan incentivized patients to switch to Medicare to avoid higher copays). The ruling potentially makes it easier for other private insurer plans to incentivize enrollees to switch to Medicare for ESRD or other types of treatment.
The Supreme Court has not yet issued several major/controversial cases but is expected to over the next week or so.
- A major CMS regulation reached OMB. While the exact details are unclear, the regulation focuses on advanced explanation of benefits that is required under the Consolidated Appropriations Act of 2021. The legislation requires issuers to provide information on potential costs for certain procedures BEFORE they happen.
- CMS announced that it will be delaying the release of the 2019 and 2020 benefit year RADV adjustments to individual/small group risk adjustment transfers. Consequently, issuers should reflect these adjustments in their 2022 MLR reports.
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