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Supreme Court Grants Certiorari in Tucker Act Case Regarding ACA Payments

Client Alert | 1 min read | 06.24.19

On June 24, the U.S. Supreme Court granted certiorari in Maine Cmty. Health Options v. United States (a C&M case), on appeal from the U.S. Court of Appeals for the Federal Circuit. Maine, along with two companion cases, seeks review of the Federal Circuit’s opinion in the Affordable Care Act “risk corridors” cases, in which the Court held that while the ACA’s risk corridors program contained a mandatory payment obligation on the part of the Government, that payment obligation was suspended by appropriations riders that restricted HHS funds available to satisfy the obligation. The Federal Circuit reached this conclusion notwithstanding the fact that 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 sought review of the Federal Circuit’s opinion on several grounds, including (i) that the restriction of funds to an agency via appropriations rider does not extinguish a statutory payment obligation of the United States, and (ii) that 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. 

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Client Alert | 4 min read | 03.25.26

NAIC Intensifies AI Regulatory Focus: What Health Insurance Payors Need to Know

The National Association of Insurance Commissioners (NAIC) is intensifying its oversight of how insurers use AI — and the pace of regulatory activity shows no signs of slowing. Over the past several months, the NAIC has published a formal Issue Brief staking out its position on federal AI legislation, launched a multistate AI Evaluation Tool pilot aimed at examining insurers’ AI governance programs, and continued to expand adoption of its AI Model Bulletin across state lines. These developments continue a trend towards enhancing regulation; the NAIC adopted AI Principles in 2020 and a Model Bulletin in 2023 clarifying that existing insurance laws apply to AI systems and establishing expectations for governance, documentation, testing, and third-party oversight. That Model Bulletin has now been adopted in approximately 24 states....