RISE summarizes recent regulatory-related headlines.
High court rules in favor of HHS in Medicare DSH formula dispute
The Supreme Court on Tuesday ruled 7-2 in favor of the Department of Health and Human Services (HHS) in a case that challenged the formula used to calculate Medicare Disproportionate Share Hospital (DSH) payments, which are designed to compensate hospitals for treating low-income patients. Justices Ketanji Brown Jackson and Sonia Sotomayor dissented.
In the case, Advocate Christ Medical Center v. Kennedy, more than 200 hospitals argued that Supplemental Security Income (SSI) in the calculation. The Supreme Court rejected the argument and sided with the federal government’s position that the formula should include only patients who are eligible to receive a cash SSI payment during the month they were hospitalized.
Sutter Health to settle antitrust lawsuit for $228M
Sutter Health of California has agreed to settle claims it violated antitrust and unfair competition laws by forcing health plans to enter contracts that prevented them from steering patients to lower cost hospitals that weren’t affiliated with Sutter. The $228.5 million settlement resolves a case brought in 2012 by more than three million small businesses and individuals who said they overpaid for health care for years and sought more than $400 million in damages. Although the plaintiffs lost the case during a jury trial in 2020, the case had been set for retrial this spring. In a statement, Sutter Health said the “settlement is what’s best for the parties, for patients and for the class, and the prospect of additional litigation is not in anyone’s interest. There is no admission of liability, and the settlement is subject to court approval."
HHS reportedly planning a $20M ‘Take Back Your Health’ ad campaign
NBC News reports that HHS Secretary Robert F. Kennedy Jr. is planning a four-year public relations campaign that will cost tens of millions of dollars. The “Take Back Your Health” campaign, which comes during widespread job and budget cuts at HHS, aims to address the country’s chronic health problems, urging Americans to “take control of their health” and pledge to adopt healthier habits, according to the article. HHS will measure the success of the campaign based on audience reach, engagement, shift in perception, and behavior change, NBC News said.
Democratic Senators urge HHS to halt plans to dismantle ACL
A group of 24 senators this week sent a letter to Kennedy, criticizing the decision to dismantle the Administration for Community Living (ACL) as part of the agency’s budget and job cuts. ACL provides home-delivered and congregate meals for older adults, Medicare enrollment assistance, peer support, community living activities, and support for family caregivers, among other functions. In the letter, lawmakers urged Kennedy to halt what they describe as a “shortsighted effort that will cause tangible and enduring harm to older adults and people with disabilities.”
“For over a decade, ACL and its expert staff have coordinated services across federal, state, and local governments to ensure that older adults and people with disabilities live healthy, connected, independent lives in the community,” the senators wrote in the letter. “In fact, ACL saves the federal government and taxpayers money by keeping older adults and people with disabilities out of institutions; for example, it costs less to feed a senior for an entire year through the Older Americans Act than it does for a senior to spend one night in a hospital.”
Trade group concerned over Elevance Health’s decision to cut MA marketing
The National Association of Benefits and Insurance Professionals (NABIP), an organization that represents health insurance and employee benefits professionals, said in a statement that it is deeply concerned over Elevance Health’s recent decision to withdraw nearly all its plans from digital agent-accessible platforms, mandate manual submissions via PDFs, and suspend enrollment kit fulfillment. The company plans to remove its Medicare Advantage plans from online marketing platforms beginning May 1, Modern Healthcare reports.
“This decision directly harms Medicare beneficiaries by limiting their access to essential healthcare options and support during Medicare’s enrollment period,” said NABIP CEO Jessica Brooks-Woods in the announcement. “By removing digital tools and shifting to manual processes, Elevance Health is making it harder for seniors to make informed decisions. And these changes eliminate the trusted guidance seniors rely on, creating unnecessary barriers at a time when making informed healthcare decisions is most critical for them.”
“This is not just about policy; it’s about the well-being of seniors who depend on agents for guidance,” added Brooks-Woods. “We stand with Medicare beneficiaries and agents to ensure that they have fair access to health care options and the support they need to make informed choices.”