News

Following Up on Issues with Medicare Advantage (MA) Plan Star Ratings, CMS Releases Updated Scores

• On July 2, CMS released updated star ratings for the Medicare Advantage (MA) plans. The revisions follow two court rulings finding the agency’s computation methods confusing and unfair to payers. The new star rankings have identified seven more MA plans with a five-star rating, increasing the number of plans to 38 from the previous 31. SCAN Health, Elevance Health, and Cigna are among the companies that had their scores recalculated and will be awarded bonuses based on their improved ratings (Health Payer Specialist, July 3; CMS, July 2).

Congress Grapples with Moving Forward Post-Chevron Overturn

• Following the U.S. Supreme Court’s decision overturning Chevron agency deference principles in the case of Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce on June 28, some lawmakers are suggesting Congress should begin writing more prescriptive laws and increase their regulatory oversight of federal agencies. The Government Accountability Office (GAO) has also presented ideas to address the new regulatory landscape, such as changing the rulemaking process to require agencies to publish information about the writing of rules published in the Federal Register and requiring agencies to conduct retrospective reviews of substantial rules. The GAO is also floating the idea of lawmakers establishing a new regulatory agency to help implement new bills should and oversee agencies’ regulatory actions (Inside Health Policy, July 5).

Health Insurance Companies Concerned About Potential Burden of Gene Therapies on Risk-Adjustment System

• CMS plans to reveal amounts that insurance companies owe or will receive based on the revised risk-adjustment system later in July. While CMS initially updated the system to account for higher cost members, insurers are concerned that new, costly gene therapies will negatively impact the system even with these adjustments. Providers have expressed concern that because of the cost of the new treatments, insurers might react by reducing services and other benefits and decreasing the size of provider networks (Modern Healthcare, July 5).

Federal Litigation

Federal Court Grants Stay for Gender Non-Discrimination Rule in 15 States

• Following lawsuits filed by 15 states to halt implementation of a rule interpreting Section 1557 of the Affordable Care Act (ACA) that prohibits discrimination in medical coverage and treatment on the basis of gender identity, a federal district court in Mississippi granted a nationwide preliminary injunction and stay two days before the rule was set to go into effect. The states that filed the lawsuits argue that because the rule does not define sex, HHS cannot say what is meant by discrimination on the basis of sex. The District Court Judge, Louis Guirola Jr, based his decision on the likely compliance costs and federal funding losses states would face and burden on providers if the rule was to go into effect. LGBTQ+ advocates note the devastating effects the stay can have on the population, as this new rule would have aided in the protection of both equitable and nondiscriminatory standards of care (Modern Healthcare, July 3).

Federal Studies and Reports

Urban Institute Study Shows Fewer Adults Skipping Medical Care Because of Cost

• A new Urban Institute study found that fewer people delayed medical care in 2022 than in 2019-2021. Researchers concluded that the following outcomes are the result of the Medicaid continuous coverage requirements and enhanced tax credits.
  • 75 million non-elderly individuals neglected to receive necessary medical care in 2022, dropping from 12.1% in 2019 to 9.7%;
  • Adults below 138% of the federal poverty level (FPL) saw a 27% reduction in cost barriers, and
  • A 19% cost barrier reduction was seen for families between 138% and 249% FPL.