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
A federal judge in Texas ruled that large portions of the ACA preventative services requirements that provide certain test and drugs to be offered by private insurance without cost-sharing were unconstitutional. The ruling ruled against the HIV prevention medication (PrEP drugs) as well as preventative services added by the US Preventative Services Task Force were also unconstitutional.
It’s unclear what happens next as the judge did not note the scope of ruling or remedy (how HHS can fix). The government is expected to appeal whenever the ruling is final. The ruling is currently only applicable to individual and group insurance.
A major Medicare Advantage regulation hit OMB last week. The regulation “Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024” is on pace for being released earlier than normal. Typically this means publication in 2-4 weeks.
News and Notes
- HHS’ OIG found low rates of telehealth fraud during the pandemic. HHS relaxed some of the telehealth requirements during the pandemic, which raised concerns of potential gaming and fraud. However, OIG only found 0.2% of claims posed a high risk.
- AHIP analysis found that approximately 82% of premium dollars were spent on drugs and medical costs.
- MCO - New research on the effect of Medicaid managed care on utilization management.
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