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UnitedHealthcare's commercial plan prior authorization cuts by category
UnitedHealthcare is cutting 20 percent of its prior authorizations in two waves. The first cuts take effect Sept. 1 and the second phase goes into effect Nov. 1. -
3 payers halting policies after pushback
Humana, UnitedHealthcare and Cigna changed or paused policies this year after receiving criticism from medical groups and other organizations. -
UnitedHealthcare's prior authorization cuts to begin Sept. 1
The first wave of UnitedHealthcare's previously announced 20 percent reduction in prior authorization requirements takes effect Sept 1. -
AHA, AMA, payers urge CMS not to implement new electronic prior authorization standards
The American Hospital Association, American Medical Association, AHIP and the Blue Cross Blue Shield Association are urging CMS not to move forward with implementing electronic transaction standards for healthcare attachments during prior authorization they say would create "costly burdens" across the healthcare industry. -
Lawmakers introduce bill incentivizing value-based care in Medicare
Lawmakers are proposing legislation that would extend incentives for value-based care in Medicare. -
6 states with price transparency requirements for payers
Though federal price transparency requirements for payers have been in effect since July 2022, several states moved faster to enact their own requirements and add additional regulations, according to a July 21 analysis from the National Conference of State Legislatures. -
University of Texas dropping weight loss drug coverage for employees
The University of Texas System is planning to drop coverage for weight loss drugs such as Wegovy under its employee and retiree health plans, citing high costs and low adherence rates. -
Biden administration pitches tougher mental health parity standards for payers
The White House is proposing stronger standards for insurers' coverage of mental health services. -
Ascension drops weight loss drug coverage for employees
St. Louis-based Ascension has dropped coverage for weight loss drugs such as Wegovy from its employee health plan. -
'An industry-shifting moment': Employers, payers tussle over claims data
As insurance premiums continue to rise nationwide, lawsuits from large, self-insured employers are being filed against health insurers in an effort to access complete medical claims data and fulfill fiduciary duties under federal law. -
New bill aims to overturn ban on Medicare coverage of weight loss drugs
A new bill filed in the Senate July 20 aims to lift the ban on Medicare coverage of weight loss drugs such as Ozempic and Wegovy. -
CMS approves mobile crisis services for Medicaid enrollees in California, Kentucky
CMS has approved proposals from California and Kentucky for community-based mobile intervention teams to provide behavioral crisis services to Medicaid enrollees. -
CMS pitches expanded coverage of PET scans for Alzheimer's disease
CMS is proposing broader coverage of PET scans for patients with Alzheimer's disease, which can help determine if patients are eligible for newly-approved drugs to treat the disease. -
8 recent CMS moves
From requiring hospitals to post the cost of services in more consumer-friendly formats to proposing complete coverage of HIV prevention drugs for Medicare enrollees, these are eight CMS updates Becker's has reported since June 22: -
CMS wants Medicare to cover PrEP without cost-sharing
CMS is proposing new coverage guidelines for HIV prevention drugs in Medicare, requiring the program to cover the drugs without cost sharing for beneficiaries. -
Oregon removes immigration status as Medicaid coverage obstacle
Medicaid coverage in Oregon is available to all adults and children who meet eligibility criteria — regardless of immigration status — as of July 1. -
Medicare will cover Alzheimer's drug Leqembi: 5 things to know
Medicare will provide broader coverage of Leqembi, a drug that has been shown to slow the progression of Alzheimer's disease, now that the drug has received full FDA approval. -
White House taking aim at surprise medical bills, 'junk' insurance
President Joe Biden announced a series of actions aimed at addressing surprise medical billing, unfair medical debt and "junk" short-term insurance plans. -
CMS updates Medicare drug price negotiation guidelines
CMS published updated guidance for the Medicare Drug Price Negotiation program, based on feedback from more than 7,500 public comments. -
Government watchdog wants CMS to up auditing of Medicaid managed care
The Government Accountability Office is urging CMS to consider adding Medicaid managed care programs to the scope of its recovery audit program.
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