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Regulatory Pathways to Promote Treatment for Substance Use Disorder or Other Under-Treated Conditions Using Risk Adjustment

Published online by Cambridge University Press:  01 January 2021

Abstract

This commentary provides a legal analysis of the extent to which changes proposed by scholars to promote care for substance use disorder or other under-treated illnesses through risk adjustment could be implemented administratively, without legislation, in federal risk adjustment systems: Medicare's privatized component, Medicare's pharmaceutical component, and the individual and small group market. As the article explains, federal laws governing risk adjustment provide broad discretion to regulators and can reasonably be interpreted to permit (or in the case of Part C even compel) full and final implementation through the administrative process of almost all of the changes that scholars have proposed.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

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42 U.S.C. § 1395w-115(c)(1).Google Scholar
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42 U.S.C. § 1315a.Google Scholar
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Cf. Minuteman Health Inc. v. Burwell, 191 F. Supp. 3d 174, 198-99 (D. Ma. 2018) (recognizing agency discretion to consider values other than actuarial risk); New Mexico Health Connections v. HHS, 2018 WL 1136901, *28 (D. N.M. 2018) (same).Google Scholar

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Regulatory Pathways to Promote Treatment for Substance Use Disorder or Other Under-Treated Conditions Using Risk Adjustment
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