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Payers prep for the great 2023 shuffle from Medicaid to ACA coverage
The nation's uninsured rate is at a record low thanks in part to continuous Medicaid enrollment since early 2020. But with the federal public health emergency expected to come to a close in 2023, payers are prepping for a major disenrollment of beneficiaries nationwide. -
HHS renews COVID-19 PHE for 11th time — here's why
When President Joe Biden declared the COVID-19 pandemic "over" Sept. 18, his message divided the medical community and sent a clear message: the nation is moving on from COVID-19. -
Inflation Reduction Act Medicare Part B biosimilar provisions take effect
Increased Medicare payment for biosimilars took effect Oct. 3, one of the first Medicare provisions of the Inflation Reduction Act to kick in. -
The White House wants CMS and private insurers to address food insecurity: 5 things to know
The Biden Administration unveiled a five-point plan to address hunger, nutrition and health Sept. 27. The White House wants Medicare, Medicaid and private insurers to play a role in solving food insecurity and food related illness. Here are five things to know about the proposal: -
How the pandemic shaped BCBS North Carolina's new telehealth policy
Blue Cross Blue Shield of North Carolina is expanding its telehealth policy to include more services based on two years of telehealth claims data from the COVID-19 pandemic released Sept. 20. -
Aetna: Aduhelm is medically necessary
Aetna considers Aduhelm to be medically necessary and said Sept. 13 it will cover the controversial Alzheimer's drug if certain criteria are met. -
CMS: COVID-19 vaccines, including updated boosters, still free
Updated COVID-19 boosters designed to target the omicron variant will be provided at no cost, regardless of insurance status, CMS said Sept. 12. -
Postpartum Medicaid coverage to expand in West Virginia, Indiana
CMS approved extending Medicaid and Children's Health Insurance Program coverage for a full year after pregnancy for women in Indiana and West Virginia. -
Federal judge awards partial victory to ACA opponents, rules against HIV drug coverage
A federal judge in Texas awarded a partial victory Sept. 7 to opponents of the ACA who challenged a key provision that requires payers and employers to cover preventive services. -
Biden administration proposes rule to overhaul Medicaid, CHIP enrollment process
The Biden-Harris Administration proposed a new CMS rule Aug. 31 to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program, and Basic Health Programs. -
Lawmaker investigating Medicare Advantage marketing tactics
Senate Finance Committee Chairman Ron Wyden has launched a probe into potentially deceptive marketing tactics used by Medicare Advantage plans. -
Inflation Reduction Act may help ease payers' Medicaid losses if public health emergency ends, Fitch says
Payers with large Medicaid operations are expected to face negative pressure on revenues if the federal public health emergency ends in October, but the total impact on profits is likely to be small because of coverage alternatives offered by the Inflation Reduction Act, according to an Aug. 11 analysis Fitch Ratings shared with Becker's. -
Massachusetts governor signs law to overhaul mental health coverage, reform prior authorization
Massachusetts Gov. Charlie Baker signed legislation Aug. 10 that overhauls the state's mental/behavioral healthcare delivery system and reforms prior authorization practices within the specialty. -
HHS releases guidance reminding payers of ACA contraception coverage requirement
HHS, the Labor Department and Treasury Department put payers on notice that they are required to cover birth control and family planning counseling under the Affordable Care Act in every state. -
Democrats reach deal to give Medicare price negotiation powers, extend ACA subsidies
Senate Democrats reached a deal June 27 on a major healthcare and energy reform bill that will extend Affordable Care Act tax credits to 2025, empower Medicare to negotiate the cost of some drugs and put the U.S. on a path toward 40 percent lower carbon emissions by 2040, according to CNN. -
Federal government approves Maine's plan to merge individual and small group markets
CMS has approved Maine's plan to improve health insurance for small businesses and tackle rising premiums by merging its individual and small group markets under the ACA into a single, pooled market, starting in 2023. -
Illinois health system blocks fertility coverage for LGBTQ employees
Peoria, Ill.-based OSF HealthCare will only cover fertility treatment for employees in opposite-sex marriages, Bloomberg Law reported July 18. -
Aetna drops noncoverage policy for cardiac PET/CT scans at behest of medical groups
Aetna has dropped its policy to not cover cardiac PET/CT scans following a joint letter from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine and Molecular Imaging. -
Senate Democrats advance plan to give Medicare drug price negotiation powers: 6 notes
U.S. Senate Democrats reached a legislative agreement June 6 that would allow Medicare to negotiate the cost of prescription drugs starting next year. -
Aetna drops prior authorization for cataract surgeries
Aetna will no longer require pre-approval for member's cataract surgeries starting July 1.
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