This RCD discusses a recent decision by the United States Court of Appeals for the First Circuit that struck down Puerto Rico’s Act 90-2019, which aimed to regulate pay structures for Medicare Advantage insurers in Puerto Rico. The court found that the provision in Act 90, known as the “Mandated Price Provision,” is preempted by federal law. However, the author argues that the court’s decision did not adequately consider the congressional intent of the Medicare Advantage Act in weighing the public health crisis in Puerto Rico. The RCD provides background on the Medicare Advantage program and Act 90 and explains how Act 90 aimed to eliminate insurers’ practice of paying providers at rates below the CMS’s minimum reimbursement rates under the traditional Medicare program. The article concludes that the court’s decision inadequately considered the larger purpose of the Medicare Advantage Act and the relevant public health crisis in Puerto Rico.

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波多黎各解决公共卫生危机的努力被美国第一巡回上诉法院驳回

本 RCD 讨论了美国第一巡回上诉法院最近的一项裁决，该裁决推翻了波多黎各的第 90-2019 号法案，该法案旨在规范波多黎各 Medicare Advantage 保险公司的薪酬结构。法院发现第 90 号法案中被称为“强制价格条款”的条款被联邦法律取代。然而，提交人争辩说，法院的判决没有充分考虑国会在权衡波多黎各公共卫生危机时使用《医疗保险优势法案》的意图。RCD 提供了 Medicare Advantage 计划和第 90 号法案的背景，并解释了第 90 号法案如何旨在消除保险公司在传统 Medicare 计划下以低于 CMS 最低报销率的费率向提供者付款的做法。