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Trump’s Drug-Discount Cards Expected to Reach Medicare Recipients After Election

President Trump’s plan to send 33 million Medicare beneficiaries a card that can be used to help pay for as much as $200 in prescription drug costs won’t be completed until after the election, according to a person familiar with the plan.

The cards will be mailed in phases, with some likely going out later in October but most not until after the Nov. 3 presidential election, the person said. The Centers for Medicare and Medicaid Services is spending an estimated $20 million for administrative costs to print and send letters to Medicare beneficiaries informing them that they will be getting cards, the person said.

Plans for the overall drug-discount program have been sent to the Office for Management and Budget, the person said. It is unclear if or when the office will approve the program, which could cost $8 billion, the person said. The Centers for Medicare and Medicaid Services, which oversees Medicare designed for people 65 and older, is unable to say exactly when the cards will go out because the proposal is still at OMB. Beneficiaries will have two years to use the discount cards, the person said.

Low-income beneficiaries who don’t already get financial assistance for medications would likely get the cards, according to the person familiar with the planning, rather than everyone in Medicare Part D, which helps cover prescription drug costs for people 65 and older.

Mr. Trump surprised his own health-administration leaders on Sept. 24 when he announced the plan to mail out prescription drug cards. The discount cards were proposed by White House chief of staff Mark Meadows, said an administration official.

CMS officials rushed to figure out how the program could be structured and designed, according to two people familiar with the planning.

The proposed plan calls for funding the cards from two Medicare trust funds, according to the administration official. It would run out of a CMS office that tests new models for providing or paying for health care.

The program lets officials waive Medicare’s laws or standards to test if new initiatives increase efficiency and “economy of programs” without adversely affecting quality, according to CMS. These waiver programs have generally been required to show they won’t increase federal spending beyond what would have occurred without the test.

The drug-discount-card plan, for example, could be designed to test if people are more adherent to medications if they are given a discount, according to the administration official.

Democrats and other critics have said providing discounts doesn’t fit with the parameters or goals of the program, and they say it is unwise to tap the Medicare trust funds at the same time one of the funds is facing insolvency concerns.

Medicare is funded by two trust funds held by the U.S. Treasury. The trusts pay for hospital care and to administer the federal health-insurance program for people 65 and older and the disabled. They are funded through payroll taxes, income taxes paid on Social Security benefits and other sources.

The Medicare trust

Biden’s claim that Trump is ‘pushing to slash Medicare benefits’

The explanation from the Biden campaign was also surprising, So let’s explore this claim in detail. It’s an interesting and complex story.

The Facts

The Biden campaign explained that this line hinged on the fact that President Trump is backing a lawsuit that would nullify the Affordable Care Act, also known as Obamacare. The Trump administration filed a legal brief on June 25 asking the Supreme Court to strike down the entire law, joining with a group of GOP state attorneys general who argue that the ACA is unconstitutional. The court will hear arguments in the case, known as California v. Texas, on Nov. 10.

The case hinges on the fact that Trump’s 2017 tax law in effect eliminated the ACA’s individual mandate penalty by reducing it to zero. Without the mandate, the whole law should fall, rather than just individual portions, the plaintiffs argue. Trump decided to embrace that argument, rather than say that if one part of the law was unconstitutional, the other parts of the law could survive.

In an effort to reduce the number of people in the United States without health insurance, the ACA set up an insurance-market exchange and provided subsidies to help people buy individual insurance. The law also greatly expanded Medicaid, the health-care program for the poor. To help pay for this, the law also made adjustments to Medicare, mostly big cuts in payments to Medicare providers and a hike in the payroll tax for wealthy taxpayers.

Separately, the law added a handful of additional benefits for people on Medicare, primarily a gradual closing of the coverage gap — “the doughnut hole” — in the Medicare Part D program when coverage ceased for prescription drugs once a limit was reached.

The law also provided some free or reduced cost-sharing for some preventive services, such as mammograms and colonoscopies, as well as a free annual wellness visit. Private insurance plans known as Medicare Advantage also could no longer charge higher cost-sharing amounts than traditional fee-for-service Medicare for certain services, including skilled-nursing facility care, chemotherapy and kidney dialysis.

A Supreme Court amicus brief by AARP, the interest group for the elderly, cited an estimate that 40.1 million people took advantage of at least one Medicare preventive service with no co-pays or deductibles in 2016, while more than 10.3 million Medicare beneficiaries took advantage of an annual wellness visit.

The Biden campaign argues that it’s fair to say that Medicare benefits would be slashed because if the whole law fell, these benefits would disappear, as would every other part of the law.

First of all, the Bipartisan Budget Act of 2018, signed by Trump, sped up closure of the doughnut hole and, as of 2020, there is no longer a coverage gap. Four experts, both inside and outside Congress, told us that even if the ACA was repealed, the doughnut-hole closure is done and cannot be reversed.

(A discordant note was offered by Juliette Cubanski, deputy director of the Program on Medicare Policy at

Alignment Healthcare Adds MemorialCare Hospitals and Doctors to 2021 Medicare Advantage Provider Network

Nationally ranked nonprofit health system and Medicare Advantage insurance provider sign agreement to expand access to care for Medicare-eligible beneficiaries in Southern California

MemorialCare, a leading nonprofit health system in Southern California with hundreds of primary care and specialty providers, four top hospitals and 200 locations, is joining Alignment Healthcare’s Medicare Advantage provider network starting Jan. 1, 2021, expanding its scope of coverage to 2 million Medicare-eligible residents in Los Angeles and Orange counties.1

This means that Medicare beneficiaries who enroll in select plans from Alignment – named one of four 2020 Best Insurance Companies for Medicare Advantage in California by U.S. News & World Report – will have access to MemorialCare’s hospitals, health centers and urgent care locations and may seek “in-network” care from physicians associated with MemorialCare Medical Foundation. Medicare’s annual enrollment period for the 2021 plan year begins Oct. 15.

“As part of Alignment’s network, we will ensure that more people will have increased access to MemorialCare’s renowned services,” said Mark Schafer, M.D., CEO, MemorialCare Medical Foundation, which includes MemorialCare Medical Group, Greater Newport Physicians, and Edinger Medical Group. “MemorialCare has a long, 113-year history of providing quality care to Southern California communities, and joining Alignment’s network allows us to continue delivering on that commitment.”

Alignment Healthcare continues to grow and recently announced in August that it plans to expand its Medicare Advantage plans into several new markets across California, Nevada, and North Carolina starting in 2021. Alignment’s health care delivery model – powered by its proprietary command center technology AVA™ – and ACCESS On-Demand Concierge program, launched in 2019, offers its Medicare Advantage members white-glove service such as round-the-clock access to a doctor by phone or video, a dedicated concierge team, and a black benefits card that can be used like a debit card – all at no additional cost. Depending on their plan, members receive a monthly allowance automatically loaded onto their black card to purchase eligible over-the-counter and grocery benefit items at more than 50,000 retailers nationwide.

“At Alignment Healthcare, we are always looking for ways to make our members happy, and we hope they will be pleased with having access to MemorialCare’s top-rated doctors, hospitals and services,” said Dawn Maroney, president of consumer and markets, Alignment Healthcare. “This announcement is also an important consideration for Southern Californians who are making a decision about their 2021 Medicare coverage during this year’s Medicare Annual Election Period – to know what health care providers will be available to them in their health plan’s network when they need it in 2021.”

MemorialCare’s Long Beach Medical Center, Orange Coast Medical Center, Saddleback Medical Center and Miller Children’s & Women’s Hospital Long Beach have been recognized by U.S. News & World Report as one of America’s Best Hospitals and “high performing” in numerous clinical categories since the rankings began. In addition, MemorialCare Medical Foundation comprises more than 350 primary care physicians and 2,250 specialists in the areas of internal medicine, family medicine, pediatrics, geriatric medicine, pulmonology,

The Best Time to Switch From a Medicare Advantage Plan to a Medigap Plan

Last of a three-part series.

Medicare’s annual election period runs from Oct. 15 through December 7.

And that’s the best time to switch from a Medicare Advantage plan to a Medigap plan, according to Jae Oh, author of Maximize Your Medicare.

According to Oh, it’s critical that your Medigap carrier your application before you switch out of your Medicare Advantage and sign up for a standalone Part D plan. The worst outcome, he says, would be to have your Medigap application denied and choose a Part D plan. That would “eject” the Medicare Advantage plan that you may have in place and leave you without additional health benefits, said Oh.

Watch Oh’s videos on the topics on YouTube. Also read Buying your Medigap policy.

So, why might you switch from a Medicare Advantage plan to a Medigap plan?

There are a few reasons, according to Oh. The annual contracts are subject to change every year. And those changes could include premiums, copays, deductibles and doctors. By contrast, under Medigap, there is no concept of network. Every health care provider accepts a Medigap plan. To be sure, the premiums might cost more. But buying a Medigap plan could be one way to manage and mitigate the risk of unexpected health care costs in retirement,

So, what’s the best way to search for and select a Medigap policy?

1. Start with Medicare’s Plan Finder tool. One drawback with the tool, according to Oh, is this: The transparency of Medigap premiums is not very good. “The prices don’t accurately reflect the most updated premiums from carrier to carrier,” he says.

And as a result, it can be too high in certain instances. And that can be a disincentive; people might look at the list and think it’s too expensive when in fact the actual price in the marketplace is much lower. “It’s just been my general observation that the prices are not exactly at the razor’s edge of where the market sits at that time,” said Oh.

One bit of good news, according to Medicare.gov, is this: Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.

When selecting a plan, Oh said the two most important factors to consider are the type of plan that best suits your needs and the carrier. And it’s really important to get the carrier right. You shouldn’t choose just any carrier, he says. Since underwriting is involved, there are certain instances where oh might suggest one carrier that is more likely to accept an applicant versus another.

2. Your local State Health Insurance Assistance Program (SHIP) will provide you in-depth, one-on-one insurance counseling and

Medicare vs. Medicaid: What Is the Difference? | Health Insurance

ALTHOUGH THEY WERE BORN ON THE SAME DAY, Medicare and Medicaid are not identical twins. And even though they have been around for 55 years, many people still confuse these government-backed two healthcare programs.

On July 30, 1965, President Lyndon Johnson signed the laws that created Medicare and Medicaid as part of his Great Society programs to address poverty, inequality, hunger and education issues. Both Medicare and Medicaid offer health care support, but they do so in very different ways and mostly to different constituencies.

According to the Medicare Rights Center:

  • Medicare is a federal program that provides health coverage to those age 65 and older, or to those under 65 who have a disability, with no regard to personal income.
  • Medicaid is a combined state and federal program that provides health coverage to those who have a very low income, regardless of age.

Some people may be eligible for both Medicare and Medicaid, known as dually eligible, and can qualify for both programs. The two programs work together to provide health coverage and lower costs, the MRC says. And although Medicare and Medicaid are both health insurance programs administered by the government, there are differences in the services they cover and in the ways costs are shared.

Medicare is a federal health insurance program. According to the Department of Health and Human Services, the program pays medical bills from trust funds that working people have paid into during their employment. It offers essentially the same coverage and costs everywhere in the United States and is overseen by the Centers for Medicare & Medicaid Services (CMS), an agency of the federal government.

Medicare is designed primarily to serve people over 65, whatever their income, and younger disabled people and dialysis patients who are diagnosed with end-stage renal disease (permanent kidney failure requiring dialysis or transplant). Patients pay a portion of their medical costs through deductibles for hospital and other services. They also pay small monthly premiums for non-hospital coverage.

Medicare has two parts. Part A covers hospital care, and Part B covers other services like doctor’s appointments, outpatient treatment and other medical expenses. HHS says you are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

  • You receive retirement benefits or are eligible to receive benefits from Social Security or the Railroad Retirement Board.
  • You or your spouse had Medicare-covered government employment.

If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

HHS says that most people do not have to pay a premium for Part A, but everyone must pay a premium for Part B. This is deducted monthly from your Social Security, railroad

Health Groups Turn Up Heat on 2021 Medicare Fee Schedule

WASHINGTON — Physician groups and other healthcare providers continued expressing their dissatisfaction with the 2021 Medicare physician fee schedule proposed rule from the Centers for Medicare & Medicaid Services (CMS).

“While we support the CPT coding revisions and revaluations of office and outpatient evaluation and management (E/M) services recommended by the AMA/Specialty Society RVS Update Committee [RUC], we strongly oppose the proposed budget neutrality reduction proffered by CMS for these and other physician fee schedule changes proposed for 2021,” said a letter sent Monday to CMS Administrator Seema Verma from 47 medical and health specialty groups including the American College of Surgeons, the American College of Radiology, and the American Academy of Ophthalmology. The groups represent 1.4 million providers, including physicians, social workers, and speech-language pathologists.

If adopted as proposed, the fee schedule would “reduce Medicare payment for services provided in patients’ homes, physician offices, non-physician practices, therapy clinics, skilled nursing facilities, hospitals and rehabilitation agencies — at a time when the spread of COVID‐19 remains unchecked,” the letter said.

The proposed fee schedule, which was announced in early August, includes “simplified coding and billing requirements for E/M visits [that] will go into effect January 1, 2021, saving clinicians 2.3 million hours per year in burden reduction,” CMS said. “As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.”

However, the proposed rule also lists (on p. 50375) the estimated impacts of the rule’s payment changes for each specialty, which includes losers as well as winners.

Three specialties fare the best: endocrinology, with a 17% increase; rheumatology, with a 16% increase; and hematology/oncology, with a 14% increase. At the bottom are nurse anesthetists and radiologists, both with an 11% decrease; chiropractors, with a 10% decrease; and interventional radiology, pathology, physical and occupational therapy, and cardiac surgery, all with a 9% decrease. Surgical specialties in general took some of the biggest hits, with cuts in every category ranging from 5% to 9%.

The proposed rule also lists the fee schedule’s final conversion factor — the amount that Medicare’s relative value units (RVUs) are multiplied by to arrive at a reimbursement for a particular service or procedure under Medicare’s fee-for-service system. Due to budget neutrality changes required by law, the proposed 2021 conversion factor is $32.26, a decrease of $3.83 from the 2020 conversion factor of $36.09, CMS said. Comments on the proposed rule were due by 5 p.m. on Monday.

American Medical Group Association (AMGA), which represents group practices, also weighed in on the proposed rule. “AMGA is concerned that the CMS proposed 2021 Physician Fee Schedule rule would inadvertently exacerbate the financial situation facing our membership that is a result of the ongoing novel coronavirus 2019 (COVID-19) pandemic,” the association said in a statement. “While appreciative of the effort to increase support for primary care services, the Physician Fee Schedule’s budget neutrality requirements effectively

Does Medicare cover bladder cancer care? Screening and more

Medicare covers a wide range of services for the treatment and diagnosis of bladder cancer when received on either an inpatient and outpatient basis.

When a person receives a cancer diagnosis, it can be a challenging time. Aside from medical and emotional care, financial support can be vitally important.

Medicare has a comprehensive range of cancer-related benefits available, with additional support options to help with out-of-pocket expenses.

In this article, we discuss bladder cancer, how Medicare covers treatments and services, and resources that may provide more help.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

Medicare covers medically necessary treatment options for bladder cancer, including:

  • surgery
  • chemotherapy
  • radiation
  • targeted therapy
  • intravesical therapy
  • immunotherapy

Sometimes, a doctor may plan treatment more often than Medicare will approve, or they may order services that Medicare does not cover.

In these cases, a person may have to pay some or all of the costs out of pocket.

For someone with an average risk of developing bladder cancer, there are currently no preventive screenings that would increase an individual’s chance of survival.

Some healthcare providers screen people who have a high risk of bladder cancer. These include people who:

  • have had bladder cancer before
  • have an irregularity in the bladder that has been present since birth
  • are exposed to certain chemicals at work

Screening can include examining a person’s urine under a microscope to look for blood and cancer cells.

Some tests also look for tumor markers. These tests look for substances in the urine that indicate there may be cancer cells present.

Medicare Part A covers medically necessary cancer treatments that take place while a person is admitted to the hospital. This includes surgical procedures, chemotherapy, and radiation treatments.

Part A also covers necessary skilled nursing facility care, hospice, and home health care. If a person is enrolled in an eligible clinical study, Part A covers some inpatient costs.

Medicare Part B covers tests and treatments when a person is not required to stay in the hospital. The treatments must be medically necessary and they must be standard medical treatments.

These can include:

  • doctor visits
  • durable medical equipment (DME)
  • many intravenous chemotherapy drugs
  • radiation
  • outpatient surgery
  • nutritional counseling
  • mental health services
  • feeding pumps

Surgical options

Several different types of surgeries may help treat bladder cancer, and which type a doctor chooses depends on the type and spread of cancer.

Transurethral resection of bladder tumor (TURBT)

This surgery may be used for diagnostic testing. It can also

Health Insurers Lay Groundwork For Biden And ‘Medicare Advantage At 60’

Health insurance companies are expanding Medicare Advantage health plan offerings to seniors in hundreds of new counties for 2021 as new regulations allow for new benefits and the program becomes more popular.

But these health plans could also be establishing a beachhead for perhaps an even bigger draw of seniors if a Joe Biden White House successfully convinces Congress to lower the eligibility of Medicare to 60.

As the presidential campaign heats up in its final month, Biden is stepping up talk about his healthcare proposal that includes allowing Americans between the ages of 60 and 64 the option of buying into Medicare, the federal health insurance program for the elderly. The proposal is considered less costly than earlier versions proposed by Democrats in the U.S. Senate to lower Medicare eligibility to as young as 55 or even 50 and is expected to allow private insurers to offer Medicare Advantage at a younger age just as they do now for existing eligible Medicare beneficiaries.

Meanwhile, the Trump administration supports Medicare Advantage but doesn’t have a plan to lower the age of eligibility. Health insurers aren’t weighing in on a general election presidential endorsement, but advocates and lobbies to expand Medicare Advantage see potential to expand if eligibility widens to more Americans.

“With Medicare Advantage’s steady growth in enrollment and the increasing evidence of its value through better costs and better outcomes for beneficiaries, it would be our expectation that any proposal to extend Medicare to more beneficiaries would include a strong role for Medicare Advantage,” says Allyson Y. Schwartz, who is president and CEO of the Better Medicare Alliance, which includes an array of business, community, health groups and insurers like Humana, CVS Health, parent of Aetna, and UnitedHealth Group.

Insurers began last week announcing their expansions in new regions ahead of the annual open enrollment period when seniors eligible for Medicare can choose new benefits or stay with their existing plans. Such changes can be made during Medicare’s open enrollment, which runs Oct. 15 through Dec. 7.

Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some also offering vision, dental care and wellness programs.

Every state in the U.S. offers Medicare Advantage and choices of plans are soaring with practically every major plan offering options that include “$0 Medicare Advantage 2021 premiums.” 

Among those that have already announced their Medicare Advantage expansions include Cigna, Humana, UnitedHealth Group and newer companies like Alignment Healthcare, which said last week it is offering 36 Medicare Advantage options

Trump Signs Medicare Loan Relief Bill Delaying Repayments

President Trump on Thursday morning signed a bill to keep the federal government running through December 11. This “continuing resolution” (CR), which was approved by the Senate Wednesday on an 84-10 vote, according to The New York Times, includes provisions to delay repayment by physicians of pandemic-related Medicare loans and to reduce the loans’ interest rate.

In an earlier news release, the American Medical Association (AMA) reported that Congress and the White House had agreed to include the provisions on Medicare loans in the CR.

Under the Medicare Accelerated and Advance Payments (AAP) program, the Centers for Medicare & Medicaid Services (CMS) advanced money to physicians who were financially impacted by the pandemic. The program, created in March, was suspended in late April.

Physicians who received the Medicare loans were supposed to start paying them back 120 days after they were made. CMS planned to recoup the advances by offsetting them against Medicare claims payments due to physicians. Practices had up to 210 days (7 months) to repay the loans through this process before being asked to repay them directly with interest of 10.25%.

For the practices that received these advances, that meant their Medicare cash flow was scheduled to dry up, starting in August. However, CMS quietly abstained from collecting these payments when they came due, according to Modern Healthcare.

New Terms

Under the new loan repayment terms in the CR, recoupment of the disbursed funds is postponed until 365 days after the date on which a practice received the money. The balance is due by September 2022.

The amount to be recouped from each claim is reduced from 100% to 25% of the claim for the first 11 months and to 50% of claims withheld for an additional 6 months. If the loan is not repaid in full by then, the provider must pay the balance with interest of 4%.

More than 80% of the $100 billion that CMS loaned to healthcare providers through May 2 went to hospitals, Modern Healthcare calculated. Of the remainder, specialty or multispecialty practices received $3.5 billion, internal medicine specialists got $24 million, family physicians were loaned $15 million, and federally qualified health centers received $20 million.

In the AMA’s news release, AMA President Susan Bailey, MD, who assumed the post in June, called the original loan repayment plan an “economic sword hanging over physician practices.”

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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Rural Hospitals Teeter on Financial Cliff as COVID Medicare Loans Come Due

David Usher is sitting on $1.7 million he’s scared to spend.

The money lent from the federal government is meant to help hospitals and other health care providers weather the COVID-19 pandemic. Yet some hospital administrators have called it a payday loan program that is now, brutally, due for repayment at a time when they still need help.

Coronavirus cases have “picked up recently and it’s quite worrying,” said Usher, chief financial officer at the 12-bed Edwards County Medical Center in rural western Kansas. Usher said he would like to use the money to build a negative-pressure room, a common strategy to keep contagious patients apart from those in the rest of the hospital.

But he’s not sure it’s safe to spend that cash. Officially, the total repayment of the loan is due this month. Otherwise, according to the loan’s terms, federal regulators will stop reimbursing the hospitals for Medicare patients’ treatments until the loan is repaid in full.

The federal Centers for Medicare & Medicaid Services has not yet begun trying to recoup its money, with the coronavirus still affecting communities nationwide, but hospital leaders fear it may come calling for repayment any day now.

Hospital leaders across the country said there has been no communication from CMS on whether or when they will adjust the repayment deadline. A CMS spokesperson had not responded to questions by press time.

“It’s great having the money,” Usher said. “But if I don’t know how much I get to keep, I don’t get to spend the money wisely and effectively on the facility.”

Usher took out the loan from Medicare’s Accelerated and Advance Payments program. The program, which existed long before the pandemic, was generally used sparingly by hospitals faced with emergencies such as hurricanes or tornadoes. It was expanded for use during the coronavirus pandemic — part of billions approved in federal relief funds for health care providers this spring.

A full repayment of a hospital’s loan is technically due 120 days after it was received. If it is not paid, Medicare will stop reimbursing claims until it recoups the money it is owed — a point spelled out in the program’s rules. Medicare reimburses nearly $60 billion in payments to health care providers nationwide under Medicare’s Part A program, which makes payments to hospitals.

More than 65% of the nation’s small, rural hospitals — many of which were operating at a deficit before the pandemic — jumped at the Medicare loans when the pandemic hit because they were the first funds available, said Maggie Elehwany, former vice president of government affairs for the National Rural Health Association.

CMS halted new loan applications to the program at the end of April.

“The pandemic has simply gone on longer than anyone anticipated back in March,” said Joanna Hiatt Kim, vice president of payment policy and analysis for the American Hospital Association. The trade association sent a letter to CMS in late July asking for a delay in the recoupment.

On Monday, the