Policy Updates

Virginia Democratic Gov. Abigail Spanberger signed HB736 into law April 6, furthering prior authorization reform in the state. Effective in 2027, the law establishes a minimum duration requirement. Prior authorizations must be in effect for at least six months for…

West Virginia and New Mexico are both launching Medigap “birthday rules” within the next year. Federal law does not include ongoing protections for beneficiaries who want to switch Medicare supplement coverage beyond the established one-time, six-month window. However, these state…

Elevance Health is bringing its out-of-network provider penalty policy to New York on July 1, continuing a state-by-state expansion that has drawn legislative backlash and opposition from hospitals and physician groups. Under the policy, in-network facilities in New York that…

The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative.  Seven BCBSA recommendations: 1. CMS should notify…

The Congressional Budget Office estimated the CMS Innovation Center spent $7.9 billion from 2011 through 2020, a March 27 report from the Government Accountability Office said. While some models have been expanded beyond testing, the Innovation Center has seen mixed…

CMS published its final 2027 Medicare Advantage and Part D rule on April 2, enacting changes to star ratings, supplemental benefits administration, Part D coverage, and a series of deregulatory provisions. The rule is effective June 1 and applies to…

Health savings accounts have become one of the more active areas of federal health policy over the past year, with GOP lawmakers pushing to expand eligibility and use the tax-advantaged accounts as a vehicle for broader consumer-driven healthcare reform.  Four…

Cost Plus Drugs’ Mark Cuban recently voiced his support for the “Break Up Big Medicine Act,” introduced by Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo. Proposed in February, the bill would prevent companies from simultaneously owning a health insurer…

This month, Alabama enacted HB300, a law that requires health plans to cover breast exams without a deductible, copay or coinsurance. Diagnostic breast exams include mammography, MRIs, ultrasounds and molecular imaging used for detecting and understanding abnormalities. Health plans must…

Iowa Republican Gov. Kim Reynolds signed a bill March 25, originally introduced March 13, that would tax HMOs 0.95% on money flowing through the plan to build out a healthcare fund. The tax will encompass HMOs, including Medicaid managed care…