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CMS proposes rule to further overhaul Medicare Advantage marketing, prior authorization
CMS issued a proposed rule Dec. 14 to continue its efforts to overhaul prior authorization and marketing practices around Medicare Advantage and Part D plans, along with adding health equity measures to star ratings and boosting behavioral health network adequacy requirements. -
CMS proposes new rule for ACA plans: 5 things to know
CMS is proposing a new rule to streamline options on the ACA marketplace and add more provider network requirements. -
Bloomberg: It's time to end the public health emergency
The number of powerful voices calling for an end to the nation's COVID-19 public health emergency is growing larger. -
MyChart message fees live on unstable ground
When Cleveland Clinic said it would begin billing for certain Epic MyChart messages this November, it set off a fiery debate across the healthcare industry around hospital finances, patient access and physician burnout. -
Cigna adds Humira biosimilars to formulary
Cigna will add Humira biosimilars to its pharmacy formulary, giving the new, cheaper alternative products hitting the market next year the same position as the drug. -
New Jersey looks to require some payers to cover abortions
New Jersey is likely to soon become the eighth state to require state-regulated health plans to cover abortion services, Bloomberg reported Dec. 1. -
'A disaster scenario': Payers, providers urge Congress to extend HDHP telehealth flexibilities as expiration looms
The Connected Health Initiative, a coalition of medical groups, payers, universities and technology companies, wrote to congressional leaders Nov. 28 urging them to extend telehealth coverage for people with high deductible health plans before they hit their deductible, a policy that expires at the end of this year. -
New ACA customers up nearly 40%
Nearly 3.4 million people have signed up for ACA coverage since the open enrollment period began Nov. 1, or a 17 percent increase in enrollment since last year. -
Bernie Sanders poised to lead Senate health committee
Sen. Bernie Sanders' office said Nov. 17 that he is looking to become chair of the Senate's Health, Education, Labor and Pensions Committee, according to The Hill. -
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.
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