CMS Marketplace Rule Under Legal Scrutiny: Final vs. Proposed Standards, Enforcement Risks, and ACA Litigation Ahead

Christine Burke Worthen
Christen Linke Young
Zachary L. Baron
Christine Burke Worthen | Epstein Becker & Green P.C.
Christen Linke Young | The Brookings Institution
Zachary L. Baron | Georgetown University Law Center
Live Video-Broadcast: June 26, 2025

2 hour CLE

Tuition: $195.00
Subscribe to myLawCLEs All-Acces Pass...
Get this course, plus over 1,000+ of live webinars.
Learn More
Training 5 or more people?

Sign-up for a law firm subscription plan and each attorney in the firm receives free access to all CLE Programs

Program Summary

Session I - What’s Ahead for the Health Insurance Marketplace: Understanding CMS’s 2025 Proposed Rule – Christine Burke Worthen and Christen Linke Young

This session will provide a synopsis of the Marketplace Integrity and Affordability Proposed Rule that was issued by the Centers for Medicare and Medicaid Services on March 10, 2025. We will discuss the proposed standards for the Health Insurance Marketplace, and additional safeguards to protect consumers from improper enrollments by brokers and agents.

The proposed standards include revisions to the income verification process, changes to eligibility redeterminations and pre-enrollment verification for special enrollment periods, changes to essential health benefits, and changing the annual Open Enrollment Period, among other items covered in the Proposed Rule. We will also look at ongoing work on Capitol Hill and how that may impact the Final Rule. If the final Rule is issued, we will review what is finalized.

Key topics to be discussed:

  • General summary of proposed rule
  • Issues that prompted the Proposed Rule
  • What may/may not be finalized
  • Takeaways from ongoing discussions on the Hill that may impact the Final Rule

Session II - Legal Trends and Recent ACA Policy Actions – Zachary L. Baron

This session will provide a synopsis of legal and enforcement issues related to the Marketplace Integrity and Affordability Proposed Rule (and Final Rule if applicable) issued by the Centers for Medicare and Medicaid Services (CMS).

I will discuss the statutory authorities offered by CMS to support its policy changes under the Affordable Care Act and how such private insurance provisions are generally enforced. I will also highlight various legal issues raised by commenters in response to the proposed rule. I will also cover past and current litigation regarding regulations issued under the Affordable Care Act and how broader administrative law trends could inform future litigation to this Rule. I will also highlight how congressional oversight, and debates can interact with ongoing regulatory activity.

Key topics to be discussed:

  • Legal issues raised by the rule
  • Past ACA litigation
  • Broader administrative law trends
  • Intersections between congressional oversight and litigation

Date / Time: June 26, 2025

  • 1:00 pm – 3:10 pm Eastern
  • 12:00 pm – 2:10 pm Central
  • 11:00 am – 1:10 pm Mountain
  • 10:00 am – 12:10 pm Pacific

Closed-captioning available

Speakers

Speaker_Christine Burke WorthenChristine Burke Worthen | Epstein Becker & Green P.C.

Health care providers, payers, digital health companies, and investors call on attorney Christine Burke Worthen for legal and strategic advice as they navigate complex regulatory and business challenges in the continuously evolving health care delivery and reimbursement landscape.

Her practical guidance enables clients across the health care ecosystem—health systems, hospitals, physician practices, digital health companies, behavioral health providers, third-party administrators, health plans, and investors—to implement both short- and long-term strategies that align with their organizational goals.

Christine possesses a wealth of experience working on matters concerning Medicare reimbursement, Medicare Advantage, participation in CMS Innovation Center payment models, managed Medicaid, managed care contract negotiations, and value-based payment arrangements with commercial payers, self-insured employers, and Medicare Advantage plans. She provides counsel on the regulatory, operational, and financial considerations necessary for maneuvering through the changing payment environment, including various forms of risk-based payment models, price transparency, revenue cycle and payment integrity, clinically integrated network development and value-based enterprise models, risk adjustment, and provider compensation arrangements.

New market entrants rely on Christine for assistance in establishing compliant care delivery models across markets, whether through traditional brick-and-mortar models, home-based models, or virtual models of care, and transforming innovative ideas into reimbursable strategies. Investors rely on Christine for assistance with evaluating the opportunities for optimizing payer contracts and network relationships to achieve sustainable financial performance and regulatory due diligence in transactions.

Christine also advises on other areas of concern for payers, investors, and providers, such as health care fraud and abuse compliance, HIPAA/Part 2 compliance, licensing, mental health parity compliance, and payer disputes.

Beyond her health care practice, Christine provides ERISA counsel to employers regarding their defined benefit and defined contribution retirement plans, as well as self-insured and fully insured welfare benefits plans. She has represented clients in government audits conducted by the IRS and the U.S. Department of Labor.

Before joining Epstein Becker Green, Christine was a partner in the health care practice of a national law firm. She previously served as Vice President and Senior Counsel at a health system in Maine. Earlier in her career, Christine was a partner and chair of the Healthcare Services Practice Group in a regional law firm’s Portland (Maine) and Boston offices.

 

Speaker_Christen Linke YoungChristen Linke Young | The Brookings Institution

Christen Linke Young is a visiting fellow with Brookings’ Center on Health Policy. She is a health policy expert with 15 years of service in federal and state government, most recently serving in the Biden White House as the Deputy Assistant to the President for Health and Veterans Affairs.

Christen works on a wide range of health policy issues, including pricing of prescription drugs, expanding access to health insurance coverage, and supporting our public health institutions to prevent disease and promote population health.

She previously served as the Deputy Secretary of Health and Human Services in North Carolina and held several health policy roles in the Obama administration. She holds a J.D. from Yale Law School and B.S. from Stanford University and resides in Washington, D.C. with her husband and two young children.

 

Speaker_Zachary L. BaronZachary L. Baron | Georgetown University Law Center

Zachary Baron is a director of the Center for Health Policy and Law at the O’Neill Institute and is an adjunct professor at the McCourt School of Public Policy. He has also served as an adjunct professor at Georgetown Law. He focuses on providing technical assistance for policymakers and public education on health policy legal issues with an emphasis on access to coverage, affordability, transparency, and equity.

Prior to joining the O’Neill Institute, Baron served as health counsel for the Committee on Ways and Means in the U.S. House of Representatives, where his portfolio included health and tax matters, such as coverage provisions under the Affordable Care Act (ACA), surprise billing, and the private health insurance market. He also led congressional investigations on discrimination in the child welfare system, the coronavirus pandemic, and private equity’s expansion in the health care system.

Baron previously served as senior counsel for the Energy and Commerce Committee concerning legal and policy issues related to access to reproductive health care, and as special counsel to the Ranking Member of the Senate Judiciary Committee during a pending Supreme Court nomination. His additional past government experience includes working on regulations and guidance implementing provisions of the ACA at the Centers for Medicare & Medicaid Services.

Baron also served as an attorney in private practice, handling high profile litigation disputes as well as health regulatory and antitrust matters.

Baron received his J.D. from the University of California, Berkeley, School of Law, and his B.A. from the University of California, Los Angeles.

Agenda

Session I – What’s Ahead for the Health Insurance Marketplace: Understanding CMS’s 2025 Proposed Rule | 1:00pm – 2:00pm

  • General summary of proposed rule
  • Issues that prompted the Proposed Rule
  • What may/may not be finalized
  • Takeaways from ongoing discussions on the Hill that may impact the Final Rule

Break | 2:00pm – 2:10pm

Session II – Legal Trends and Recent ACA Policy Actions | 2:10pm – 3:10pm

  • Legal issues raised by the rule
  • Past ACA litigation
  • Broader administrative law trends
  • Intersections between congressional oversight and litigation

Credits

Alaska

Approved for CLE Credits
2 General

Our programs are CLE-eligible through Alaska’s recognition of multi-jurisdictional reciprocity.
Alabama

Pending CLE Approval
2 General

Arkansas

Approved for CLE Credits
2 General

Arizona

Approved for CLE Credits
2 General

California

Approved for CLE Credits
2 General

Colorado

Pending CLE Approval
2 General

Connecticut

Approved for CLE Credits
2 General

District of Columbia

No MCLE Required
2 CLE Hour(s)

Delaware

Pending CLE Approval
2 General

Florida

Approved via Attorney Submission
2.5 General Hours

Receive CLE credit in Florida via attorney submission.
Georgia

Pending CLE Approval
2 General

Hawaii

Approved for CLE Credits
2.4 General

Iowa

Pending CLE Approval
2 General

Idaho

Pending CLE Approval
2 General

Illinois

Pending CLE Approval
2 General

Indiana

Pending CLE Approval
2 General

Kansas

Pending CLE Approval
2 Substantive

Kentucky

Pending CLE Approval
2 General

Louisiana

Pending CLE Approval
2 General

Massachusetts

No MCLE Required
2 CLE Hour(s)

Maryland

No MCLE Required
2 CLE Hour(s)

Maine

Pending CLE Approval
2 General

Michigan

No MCLE Required
2 CLE Hour(s)

Minnesota

Pending CLE Approval
2 General

Missouri

Approved for CLE Credits
2.4 General

Mississippi

Pending CLE Approval
2 General

Montana

Pending CLE Approval
2 General

North Carolina

Pending CLE Approval
2 General

North Dakota

Approved for CLE Credits
2 General

Our programs are CLE-eligible through North Dakota’s recognition of multi-jurisdictional reciprocity. Section 1, Policy 1.14
Nebraska

Pending CLE Approval
2 General

myLawCLE reports attendance to Nebraska on each attorney’s behalf for all programs. Please do not self-report.
New Hampshire

Approved for CLE Credits
120 General minutes

As of July 1, 2014, the NHMCLE Board no longer provides pre- or post-approval of courses. Attendees must self-determine whether a program is eligible for credit, and self-report their attendance online at www.nhbar.org, based on qualification provisions of Rule 53.
New Jersey

Approved for CLE Credits
2.4 General

Our programs are CLE-eligible through New Jersey’s recognition of multi-jurisdictional reciprocity, except for the courses required under BCLE Reg. 201:2
New Mexico

Approved for CLE Credits
2 General

Nevada

Pending CLE Approval
2 General

New York

Approved for CLE Credits
2.4 General

Our programs are CLE-eligible through New York’s Approved Jurisdiction Group “B”.
Ohio

Pending CLE Approval
2 General

Oklahoma

Pending CLE Approval
2.5 General

Oregon

Pending CLE Approval
2 General

Pennsylvania

Approved for CLE Credits
2 General

Rhode Island

Pending CLE Approval
2.5 General

South Carolina

Pending CLE Approval
2 General

South Dakota

No MCLE Required
2 CLE Hour(s)

Tennessee

Pending CLE Approval
2 General

Texas

Approved for CLE Credits
2 General

Utah

Pending CLE Approval
2 General

Virginia

Not Eligible
2 General Hours

Vermont

Approved for CLE Credits
2 General

Washington

Approved via Attorney Submission
2 Law & Legal Hours

Receive CLE credit in Washington via attorney submission.
Wisconsin

Pending CLE Approval
2.4 General

West Virginia

Pending CLE Approval
2.4 General

Wyoming

Pending CLE Approval
2 General

#1 CLE Access Program

  • Over 1,000 Live CLE Webinars each year
  • All CLE webinars broadcasted in last 12 months
  • Programs covering over 35 practice areas
  • Hot topics & changes in the law
  • All formats: Live, Replay, and On-demand
  • Accreditation in every state

Access every CLE webinar,
every format, all year long!

myLawCLE All-Access Pass

only $395 yearly


Register Now

#1 CLE Access Program

  • Over 1,000 Live CLE Webinars each year
  • All CLE webinars broadcasted in last 12 months
  • Programs covering over 35 practice areas
  • Hot topics & changes in the law
  • All formats: Live, Replay, and On-demand
  • Accreditation in every state

Access every CLE webinar,
every format, all year long!

myLawCLE All-Access Pass

only $395 yearly


More CLE Webinars
Trending CLE Webinars
Upcoming CLE Webinars
Gun Trust 101 (2025 Edition)
Gun Trust 101 (2025 Edition) Mon, June 9, 2025
On-Demand
Live Replay
Abating Tax Penalties (2025 Edition)
Abating Tax Penalties (2025 Edition) Thu, June 12, 2025
On-Demand
Live Replay
Notable False Claims Act Developments
Notable False Claims Act Developments Tue, June 17, 2025
Live Webcast
Inherited IRAs in Estate Planning (2025 Edition)
Inherited IRAs in Estate Planning (2025 Edition) Tue, June 17, 2025
On-Demand
Live Replay
House v. NCAA: Shaping the Future of Student-Athlete Rights
House v. NCAA: Shaping the Future of Student-Athlete Rights Fri, June 20, 2025
On-Demand
Live Replay
Annual Mini-Medical School (2025 Edition)
Annual Mini-Medical School (2025 Edition) Mon, June 23, 2025
On-Demand
Live Replay
Single Member LLCs: Avoiding Risks and Seizing Opportunities
Single Member LLCs: Avoiding Risks and Seizing Opportunities Mon, June 23, 2025
On-Demand
Live Replay
PTSD 101: What attorneys should know (2024 Edition)
PTSD 101: What attorneys should know (2024 Edition) Tue, June 24, 2025
On-Demand
Live Replay
Contract Negotiation Fundamentals
Contract Negotiation Fundamentals Wed, June 25, 2025
Live Webcast
1031 Exchanges 101 (2025 Edition)
1031 Exchanges 101 (2025 Edition) Wed, June 25, 2025
On-Demand
Live Replay
The Probate Process from A-Z
The Probate Process from A-Z Wed, June 25, 2025
On-Demand
Live Replay