RISE summarizes recent regulatory-related headlines and reports.
Judge vacates CMS regulation to limit MA broker and agent pay caps
A federal judge this week vacated a regulation introduced during the Biden administration that would have limited how much Medicare Advantage insurers can pay brokers or agents for steering consumers to their plans.
In July 2024, U.S. District Judge Reed O’Connor of the Northern District of Texas Fort Worth Division placed a stay on the Centers for Medicare & Medicaid Services’ (CMS) plans to cap administrative payments and restrict contract terms after marketing trade groups sued the federal agency to block the rule. On Monday, he vacated the fixed fee and contract terms restriction in the final rule, according to Modern Healthcare, which first reported the decision.
In the ruling, O’Connor said that CMS can only regulate how to use compensation and not how insurers pay marketers for administrative costs, according to the publication. However, he upheld a requirement that prevents third-party marketers from distributing the personal information of Medicare enrollees to marketing organizations without their consent.
Elevance Health loses Star ratings case
Judge Mark Pittman of the U.S. District Court for the Northern District of Texas in Fort Worth this week sided with the Centers for Medicare & Medicaid Services (CMS) over a Star rating dispute with Elevance Health, according to Reuters.
The insurer sued the U.S. Department of Health and Human Services (HHS) and CMS in October over reducing its quality rating for one of its contracts in 2025, which Elevance Health claimed led to the company losing at least $375 million in bonus payments. The organization said one of its contracts received a score of 3.749 but was assigned 3.5 stars, and the plan should have been rounded up to 4 stars.
Elevance argued that CMS didn’t follow its own regulations to calculate the ratings, but the government said that its methodology is sound and if the court allowed the challenge to move forward, it would open the door to insurers who missed the cutoff for higher ratings.
HHS launches platform to show MAHA progress
HHS announced it has launched MAHA in Action—a new platform that showcases the federal initiatives and state-led reforms advancing the Trump administration’s Make America Healthy Again (MAHA) agenda.
“Make America Healthy Again” isn’t just a slogan—it’s a mission statement, and we’re delivering results, fast,” HHS Secretary Robert F. Kennedy Jr. said in the announcement. “The MAHA in Action tracker puts the wins on the map. It gives the public, the press, and policymakers real-time visibility into how we’re restoring health, integrity, and accountability to every corner of our public health agency.”
The site features federal reforms being implemented across HHS agencies and a growing list of newly enacted state policies aligned with MAHA priorities.
MA study: Medication compliance may reduce health care costs
A new study published in BMC Health Services Research found that better medication adherence among Medicare Advantage plan members is associated with lower health care costs.
The observational study, conducted by researchers from the University of Mississippi School of Pharmacy, analyzed data from more than one million beneficiaries across three adherence quality measures for blood pressure medications, cholesterol-lowering medication, and diabetes medications. Medication adherence was measured in year one, and payer medical costs were measured in year two.
Better adherence was associated with lower payer medical costs, with the greatest cost savings found in adherence to diabetes medication. Researchers said targeting interventions to improve compliance with medications can improve patient outcomes and reduce health care costs.