MHA Today | December 2, 2024

Staff Contact: Jane Drummond

Following a nine-day trial, the Cole County Circuit Court denied a challenge to a 2023 law prohibiting medical providers from performing gender transition surgeries or prescribing hormone therapies for the same purpose for individuals less than 18 years of age.

After analyzing a substantial amount of evidence and expert testimony from both sides, the court concluded there was insufficient agreement among worldwide medical experts on the appropriate treatment for gender dysphoria. Therefore, the plaintiffs’ claims that the statute was facially unconstitutional failed because they could not prove that the legislature lacked a rational basis for enacting the law.

Staff Contact: Andrew Wheeler

CMS released a proposed rule to “hold Medicare Advantage and Part D plans more accountable for delivering high-quality coverage so that people with Medicare are connected to the care they need when they need it.”

CMS is proposing to permit coverage of anti-obesity medications and enhance Medicare Advantage prior authorization and utilization management guardrails. The proposed guardrails include the following.

• refining the definition of internal coverage criteria
• changing the reopening rules to eliminate the discretion of a Medicare Advantage organization to reopen an approved authorization for an inpatient hospital admission
• using artificial intelligence
• requiring Medicare Advantage organizations to make a provider directory available to CMS for inclusion in the Medicare Plan Finder online tool
• ensuring equitable access to behavioral health benefits

CMS will accept comments about the proposed rule until 4 p.m., Monday, Jan. 27, 2025. MHA published an issue brief with additional details.

CMS released a final rule that establishes a new, six-year mandatory model intended to increase access to kidney transplants while improving quality of care for people seeking kidney transplants.

The Increasing Organ Transplant Access Model participants now will have a financial incentive to perform more transplants and encourage participating transplant hospitals to identify their underserved populations and address gaps in care for donors and transplant recipients.

Hospitals located within the St. Louis donation service area will be included as IOTA participants. MHA will soon publish an issue brief with additional details.