Trump 2.0 Faces Lingering Legal Questions Regarding RADV Audits, Stars, Broker Pay
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Jan 16, 2025
As field marketing organizations and Medicare Advantage insurers filed multiple legal challenges to federal rulemaking, 2024 was a particularly litigious year for program stakeholders. Now, with the return of Donald Trump to the White House, the new administration must contend with critical questions about MA plan payments to agents and brokers, the calculation of Part C and Part D Star Ratings and the recoupment of overpayments to MA plans. Two leading managed care attorneys tell AIS Health, a division of MMIT, that the resolution to these questions may depend on the administration’s appetite to defend the rulemaking of the prior administration.
It also depends on the preferences of Trump’s respective leadership picks for HHS and CMS, Robert F. Kennedy, Jr., and Mehmet Oz, M.D. CMS on Jan. 10 proposed an estimated rate increase of 4.3% for MA plans, and it will be up to the new administration to finalize rates for 2026. Given that the rate increase is more favorable than the last two years — when the Biden administration began phasing in a new risk adjustment model — a vocal MA supporter like Oz could be inclined to “not rock the boat” and let what’s already been set in motion play out, suggests Lindsey Fetzer, member of the law firm Bass Berry & Sims.
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