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A 'paradigm shift' in weight loss drug coverage
Wegovy is now approved to be used to reduce the risk of heart attack, stroke and cardiovascular death, which could lead to broader payer coverage of the drug. -
Maryland could open ACA exchange to undocumented immigrants
Maryland legislators are considering a bill that would allow people to purchase insurance on Maryland's health insurance exchange, regardless of their immigration status. -
Single payer still a tough sell in California
California legislators are putting a single-payer system back on the table, but it still faces long odds of becoming a reality, the Los Angeles Times reported Feb. 21. -
Friday Health collapse spurs consumer protection bill in Colorado
Colorado lawmakers are considering a bill that would prevent customers from incurring extra out-of-pocket costs if their insurer goes bankrupt in the middle of the year. -
Payers urge 'stability' from CMS on Medicare Advantage
CMS needs to do more to account for rising utilization rates in Medicare Advantage, the Better Medicare Alliance argued. -
Nebraska lawmakers mull Medicaid coverage of weight loss drugs
Nebraska lawmakers are considering requiring the state's Medicaid program to cover GLP-1 drugs, the Omaha World-Herald reported Feb. 15. -
The two-midnight rule and Medicare Advantage: 7 updates
In 2024, Medicare Advantage plans must provide coverage for an inpatient admission when the admitting physician expects the patient to require hospital care for at least two midnights, otherwise known as the two-midnight rule. -
Virginia lawmakers eye insurance coverage for undocumented minors
A Virginia lawmaker has proposed new legislation that would expand health insurance coverage to undocumented residents under the age of 19. The bill passed in the Virginia Senate Feb. 13. -
CMS issues AI guidance for Medicare Advantage plans
Algorithms and artificial intelligence-powered software tools can be used to support Medicare Advantage plans in making coverage decisions for members, but payers are still bound by CMS' internal benefits requirements and nondiscrimination rules under the ACA, the agency said in guidance to insurers regarding its final 2024 MA rule. -
Payer execs sweat proposed Medicare Advantage rates
Payer executives are not happy with CMS' proposed Medicare Advantage rates for 2025. -
Florida sues HHS over CHIP eligibility requirements
Florida is challenging rules from CMS that require states keep eligible children enrolled in Medicaid and CHIP for a full 12 months, even if their families do not pay premiums. -
$12M Medicaid expansion campaign launches in Florida
A campaign to put a Medicaid expansion proposal to Florida voters is underway, the Tallahassee Democrat reported Feb. 1. -
CMS proposes Medicare Advantage rate cut
CMS proposed a slight decrease in Medicare Advantage benchmark payments for 2025. -
No big changes to Medicare Advantage, 61 senators urge
A bipartisan group of lawmakers is urging CMS to maintain "payment and policy" stability in Medicare Advantage. -
New Jersey signs prior authorization reform bill into law
New Jersey has signed the nation's most comprehensive prior authorization reform bill into law. -
CMS looks to tackle Medicare Advantage's 'black box'
CMS is seeking input on improving transparency in the Medicare Advantage program. -
BCBS Massachusetts pauses GI anesthesia policy
Blue Cross Blue Shield of Massachusetts is pausing a controversial policy that went into effect Jan. 1 that limited coverage for the use of monitored anesthesia for certain gastrointestinal patients undergoing endoscopic, bronchoscopic or interventional pain procedures, including colonoscopies. -
Senator accuses Medicare Advantage marketers of 'race to the bottom'
Medicare Advantage's annual enrollment period is over, but the marketing tactics used to sell older adults on the plans are still under scrutiny in Washington. -
Georgia lawmaker files bill to ban AI use for health coverage decisions
A Georgia state lawmaker filed legislation Jan. 9 that would prohibit the use of artificial intelligence technology to determine insurance, health coverage, or public assistance award decisions. -
HHS reaffirms payers' role in reproductive health access
HHS announced several new actions to protect and expand access to reproductive health services and reaffirmed the insurance industry's responsibility in maintaining that access.
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