Michigan reforms prior authorization: The Michigan Legislature passed a bill March 24 that requires payers to publish prior authorization requirements on their website, including aggregated information about prior authorization approval and denials. Individuals with a financial stake in the outcome of prior authorization decisions are banned from the decision-making process. Urgent and nonurgent prior authorization requests must be acted upon in a timely manner. Clinicians and patients must be properly notified of new or amended prior authorization requirements. Payers must base their prior authorization requirements on clinical, evidence-based criteria established with input from practicing physicians.
California bans payer abortion fees: Gov. Gavin Newsom signed legislation March 22 that bans payers from charging any out-of-pocket costs for abortion services, including copays, deductibles or other cost-sharing requirements. The also prohibits payers from imposing utilization management practices on covered abortion and abortion-related services.
U.S. House passes insulin cap: A bill capping the consumer cost of insulin at $35 per month passed the House of Representatives March 31. Senate Majority Leader Chuck Schumer is proposing a compromise bill that would roll back insulin costs to 2006 levels and ban rebate payments for insulin to pharmacy benefit managers.
Congress extends telehealth flexibilities: A March 10 omnibus spending bill allows employers to continue offering telehealth coverage to employees with health savings accounts before they meet an annual deductible. The bill also allows Medicare-enrolled providers to bill for telehealth services and cover telehealth visit costs for adults 65 and older and those that occur within a patient’s home and in healthcare facilities.
Georgia enforces mental health parity: Gov. Brian Kemp signed a bill April 4 that increases enforcement of mental healthcare parity from payers and requires parity reports to the state.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 17–19 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
