Biden No Surprises Act Interpretation Wins At Appellate Level
After being struck down at the federal district level several times, the 5th Circuit Court of Appeals sided with the Biden administration’s original interpretation of the No Surprises Act in determining how a key metric in billing disputes is calculated. The court said that insurers can use a wider variety of rates in calculating the key qualifying payment amount (QPA) metric that helps arbitrators determine fair payment amounts.
Now, the law remains heavily skewed to providers, who win three in four cases thus far in arbitration. The law itself favors providers in that it is baseball-style arbitration. The Biden administration wanted to tell arbitrators to give deference to the QPA, but this remains struck down by the courts. But the QPA determination is at least a small win that could begin to change things for the better.
#nosurprisesact #nsa #surprisebilling #providers #healthplans
Election Day Articles On Healthcare Policy
A number of healthcare articles today on what would happen in healthcare policy under either a Harris or Biden White House. Nothing radically new discussed. Topics include:
- Obamacare, including the future of the enhanced premium subsidies
- Drug price negotiations
- Medicare
- Medicaid
Additional articles: https://www.statnews.com/2024/11/04/kamala-harris-election-win-could-bring-health-care-policy-changes/ and https://www.statnews.com/2024/11/04/donald-trump-health-care-policy-medicaid-abortion-aca-transgender/ and https://insidehealthpolicy.com/health-insider/obamacare-medicare-medicaid-fda-drug-pricing-health-tech-paths-hinge-election-outcome and https://www.fiercehealthcare.com/payers/its-election-day-2024-where-do-harris-and-trump-stand-health-policy
(Some articles may require a subscription.)
#healthcare #healthcarereform #election2024 #harris #trump
https://kffhealthnews.org/news/article/health-policies-pivotal-changes-election-results-6-issues/
Medicaid Director Survey Finds Major Concerns
The annual Kaiser Family Foundation (KFF) survey of Medicaid directors finds the executives are worried about financial and policy uncertainty in the year ahead due to lower revenue collections, the end of enhanced pandemic funding, among other issues.
Enrollment is expected to drop, while spending will increase. The spending increase is primarily due to a drop in federal aid as well as drug trends.
(Article may require a subscription.)
#medicaid #managedcare
GoodRx and PBMs Accused Of Suppressing Payments To Independent Pharmacies
In three class-action lawsuits, drug coupon aggregator GoodRx and pharmacy benefit managers (PBMs) are being accused of working together to suppress reimbursements to small pharmacies for generic prescription drugs.
#drugpricing #pbms
— Marc S. Ryan
