News Briefs: Texas Court Ruling Delays New Agent and Broker Restrictions in MA
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Jul 05, 2024
Just days after the Supreme Court issued rulings overturning a longstanding legal framework that gives federal agencies the benefit of the doubt when interpreting ambiguous legislation, the U.S. District Court for the Northern District of Texas granted plaintiffs’ request for a stay to prevent CMS from implementing new agent and broker provisions in Medicare Advantage this fall. Since CMS finalized the 2025 MA and Part D rule that included new caps on administrative payments to agents and brokers by MA organizations and a ban on anticompetitive terms in MAO contracts with agents, brokers and third-party marketing organizations, at least three complaints have been filed challenging CMS’s implementation of the new provisions that take effect Oct. 1. According to a July 3 opinion signed by U.S. District Judge Reed O’Connor, the court agreed to stay the effective date of the fixed-fee and contract-terms restriction in the final rule until the issues can be fully briefed and heard by the court. The parties must submit a joint schedule for summary judgment briefing by no later than July 17. “Of note, the Court declined to grant a stay with respect to the regulatory changes on the sharing of beneficiary information,” Helaine Fingold, partner at the law firm Epstein Becker & Green, P.C., tells AIS Health, a division of MMIT. “Keep in mind that this does not mean that the plaintiffs will definitely win (or definitely lose, as to the sharing of beneficiary information provision) upon the Court’s full consideration of the issues. It does, however, indicate that the plaintiffs were able to convince the Court that they are likely to prevail (or not) on the merits.” Read more
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