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January 19, 2024

Washington Roundup

Roll Call tells us

  • “House and Senate leaders have agreed to extend temporary government funding in two batches, through March 1 and March 8, according to a source familiar with the plan.
  • “The decision comes as lawmakers face a Friday, Jan. 19 deadline to clear a temporary spending bill for four of the dozen annual appropriations bills — Agriculture, Energy-Water, Military Construction-VA and Transportation-HUD. The remaining eight bills’ stopgap funds expire after Feb. 2 under the most recent interim spending law.”

The Wall Street Journal reports,

  • The Biden administration on Wednesday, January 17, finalized requirements to streamline the process for doctors and patients seeking health insurance approval for medical care and treatments.
  • “The rule aims to shorten the timeline for the so-called prior authorization process to as little as 72 hours for many of the tens of millions of people who get their health insurance through Medicare Advantage, Medicaid or an Affordable Care Act health plan by automating some of the processing of the requests.
  • “Plans would also have to share more information with doctors about the status of decisions and information on denials, with a turnaround time of seven calendar days for non-urgent requests.”

Here is a link to the CMS fact sheet on the final rule.

  • “Impacted payers must implement certain operational provisions, generally beginning January 1, 2026. In response to public comment on the proposed rule, impacted payers have until compliance dates, generally beginning January 1, 2027, to meet the API development and enhancement requirements in this final rule. The exact compliance dates vary by the type of payer.”

STAT News reports that the federal government dismissed its appeal of a D.C. district court decision vacating a Trump Administration rule favoring the use of copay accumulators by health plans. “Insurers can still use the copay accumulators when patients use brand drugs that do have generic competition.”

Bloomberg informs us about lawsuits that air ambulance companies have brought against health insurers who allegedly refused to pay No Surprises Act arbitration awards. The insurers have asked the federal district court in Houston to dismiss the cases for lack of subject matter jurisdiction and improper venue.

Twin Cities Business reports about a U.S. Labor Department ERISA prohibited transaction / fiduciary breach complaint filed against Blue Cross of Minnesota on January 12, 2024. The allegedly illegal act was to reimburse network providers for a MinnesotaCares gross receipts tax.

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