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Plaintiffs Seek Supreme Court Review in Federal Circuit Tucker Act Case

Client Alert | 1 min read | 02.12.19

On February 4, several health plans (including C&M client Maine Community Health Options) filed petitions for certiorari at the U.S. Supreme Court, seeking review of the Federal Circuit’s opinion in the ACA “risk corridors” cases, which held that while the risk corridors program contained a mandatory payment obligation on the part of the Government, that payment obligation was temporarily suspended by appropriations riders that restricted HHS funds available to satisfy the obligation, even though the riders did not amend or repeal the statutory payment obligation and even though the health plans had already performed their own reciprocal obligations under the statute. The petitioners are seeking review of the Federal Circuit’s opinion on several grounds, including (i) the restriction of funds to an agency via appropriations rider does not extinguish a statutory payment obligation of the United States, (ii) a rider that does not by its terms repeal or amend a money-mandating statute cannot impliedly and retroactively extinguish the Government’s payment obligation. The Maine petition is linked here. 

Insights

Client Alert | 6 min read | 04.29.26

CMS Seeks to Expand Interoperability Requirements to Drug Pre-Authorization (FAQ)

On April 10, 2026, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (2026 CMS Interoperability Standards and Prior Authorization for Drugs, or CMS-0062-P) outlining the agency’s plans to impose new interoperability requirements on payors participating in certain Medicare and Medicaid programs. As described by the agency in a recent press release, the proposed rule “builds on” prior rulemaking by clarifying and enhancing interoperability requirements for payors’ prior authorization processes, specifically those associated with coverage requests for pharmaceutical therapies....