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As payers prep for a PHE wind down, most Medicaid beneficiaries don't know coverage will end
The expiration of the federal COVID-19 public health emergency will trigger a nationwide Medicaid redetermination process, but most Medicaid members are unaware their health coverage could eventually end — and payers largely aren't getting the word out. -
OptumRx will keep Humira available as competitors hit the market
UnitedHealth Group's OptumRx will keep Humira in its drug formulary, in addition to three biosimilar competitors, Bloomberg reported Nov. 15. -
Senate Democrats push for more Medicare Advantage marketing regulations
U.S. Senate Democrats are urging CMS to continue its oversight of Medicare Advantage marketing practices and introduce additional regulations to protect consumers from deceptive tactics. -
Medicare plan finder won't include $35 insulin cap for 2023
Newly capped insulin prices for Medicare beneficiaries at $35 won't show up in Medicare Plan Finder this year. -
HHS to maintain COVID-19 public health emergency past January
The U.S. will extend the COVID-19 public health emergency past January 11, 2023, CNBC reported Nov. 11. -
4 states aiming to stop Medicaid churn for kids under 6
Four states are moving toward policies to keep children continuously enrolled in Medicaid to prevent coverage gaps, Kaiser Health News reported Nov. 10. -
CMS doubles down on value-based payments for specialty care: 4 things to know
CMS wants all traditional Medicare beneficiaries and most Medicaid beneficiaries in accountable care organizations by 2030. In a strategy report published Nov. 7, CMS detailed its plans to reach this goal. -
CMS rule change adds Medicare special enrollment periods
A CMS rule finalized Oct. 28 will reduce gaps in Medicare enrollment for new enrollees and adds special enrollment periods for extenuating circumstances. -
CMS cracks down on Medicare Advantage TV marketing
CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first. -
Choosing the right partner for MRF compliance
The Transparency in Coverage (TiC) final rule went into effect July 1, 2022, and requires insurers to include provider-negotiated rates, as well as allowed billable amounts for all out-of-network providers. -
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.
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