Week in Washington 090723

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.

Week in Washington

09/07/2023

Court Cases against HHS

• RADV Rule – Humana is suing HHS over the finalized Medicare Advantage RADV rule. They’re asking for the entire rule to be invalidated. The rule would reduce payments to Medicare Advantage plans. It should be noted that the case has been assigned to Judge O’Connor, who historically has been hostile to the current Administration. You can track the litigation here:
• Drug Negotiation Cases – As a reminder, there are a number of outstanding lawsuits against the Administration to block implementation of the drug negotiation provisions of the Inflation Reduction Act. The cases are expected to pick up in the near term.

Congress

• Budget – Congress returned from recess this week. The biggest issue facing Congress is passing a budget. There is increasing concern of a potential government shutdown.
• PBMs – A bill expected to be released soon that would make major changes to Pharmacy Benefit Managers. The bill is expected to include provisions that would require PBMs to publish data on their fees and rebates as well as prohibit spreading pricing in Medicaid. The bill is expected to be voted on this month and has a good chance of advancing.

North Carolina Medicaid Expansion Delay

North Carolina’s Medicaid expansion is unlikely to happen in 2023 due to delays in state funding. The current expectation is that Medicaid expansion will happen sometime in 2024.

Virginia

CMS announced this week that it had determined that the state of Virginia had failed to enforce certain provisions of the ACA. This determination means that CMS can directly level fines on Virginia’s issuers if CMS determines that an issuer is not following federal regulations. CMS can also review rate filings and conduct market conduct examinations if necessary.

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