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CMS: Medicare will cover Alzheimer's drugs with full FDA approval
Medicare will cover drugs to treat Alzheimer's disease if they receive full FDA approval, the agency said June 1. -
UnitedHealthcare backs off controversial GI prior authorization policy
UnitedHealthcare is not implementing a gastroenterology endoscopy prior authorization policy set to take effect June 1 and instead will set up an advance notification process for non-screening GI procedures. -
North Carolina legislators OK Blue Cross Blue Shield reorganization
North Carolina legislators approved a bill that would allow Blue Cross Blue Shield of North Carolina to reorganize, adding a new nonprofit parent company. -
CMS: 'Substantial' portion of Medicaid terminations due to red tape
With Medicaid redeterminations underway nationwide, CMS is urging states to ensure they do not terminate coverage for eligible individuals. -
Illinois passes bill creating state-run ACA exchange
Illinois lawmakers have passed legislation to create a state-run health insurance exchange. -
7 key CMS policy updates in the first half of 2023
CMS has finalized or proposed several policy changes in 2023, including stricter audits of Medicare Advantage plans, changes to prior authorization and regulations aimed at drug prices. -
Minnesota passes preventive care requirements law
Minnesota Gov. Tim Walz signed legislation requiring insurers to cover preventive services after a Texas judge struck down some requirements for payers to cover preventive care at no cost to members under the ACA. -
CMS proposes rule to improve Medicaid and PBM price transparency
CMS is proposing a new rule for drug manufacturers, pharmaceutical benefit managers and managed care plans to increase drug price transparency in Medicaid. -
Cigna delays implementation of modifier 25 policy again
The Cigna Group is again delaying implementation of a policy that would have required the submission of medical records when using modifier 25 for all evaluation and management claims billed with CPT codes 99212-99215 and a minor procedure. -
175 groups urge UnitedHealthcare to halt GI prior authorization policy
A coalition of 175 organizations have signed a letter urging UnitedHealthcare not to implement a new gastroenterology endoscopy prior authorization policy that is set to go into effect June 1. -
Medicaid redeterminations are going worse than expected, experts say
After a three-year period of continuous Medicaid/CHIP enrollment under the COVID-19 public health emergency, states could begin terminating coverage for ineligible residents in April. With redeterminations underway, health policy experts say too many people in some states are losing health coverage for the wrong reasons. -
Florida terminates Medicaid coverage for 250,000
Florida has disenrolled nearly 250,000 individuals from its Medicaid program over the last month, the Tampa Bay Times reported May 17. -
Sanders reintroduces single-payer Medicare bill with record sponsors
Sen. Bernie Sanders, along with Rep. Pramila Jayapal and Rep. Debbie Dingell, introduced the Medicare for All Act of 2023 on May 17 to create a federally administered single-payer healthcare system. -
Appeals court pauses Texas ruling against ACA preventive care coverage
The U.S. 5th Circuit Court of Appeals has temporarily blocked a Texas court's ruling earlier this year that struck down an ACA provision requiring payers and employers to provide coverage for preventive services. -
Medicaid work requirements would have 'negligible effect on employment,' CBO says
The Congressional Budget Office said a proposal to add work requirements for Medicaid eligibility would have "a negligible effect on employment status or hours worked by people who would be subject to the work requirements." -
CMS proposes rate transparency rules for Medicaid
CMS proposed two new rules April 27 that would establish national standards of care provided through fee-for-service Medicaid/CHIP and managed care plans, along with a requirement to publicly disclose provider payment rates online. -
AMA leads push against Cigna modifier 25 policy
The American Medical Association and more than 100 physician and healthcare organizations are asking Cigna to reconsider a policy they say will add administrative costs and burdens and potentially negatively affect patients. -
600,000 would be kicked off Medicaid under work requirement proposal: CBO
House Republicans' Medicaid work requirement proposal would result in an estimated 600,000 people losing coverage, the Congressional Budget Office said in an April 25 report. -
HHS releases proposed rule to expand Medicaid, ACA access to DACA recipients
HHS unveiled its proposed rule that, if finalized, would expand healthcare coverage access to an estimated 129,000 previously uninsured Deferred Action for Childhood Arrivals program recipients. -
CMS to limit non-standard ACA plans, add special enrollment periods: 5 notes
CMS is upping its proposed number of non-standard ACA plans payers can offer in each region from two to four.
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