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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. -
The 2-midnight rule and Medicare Advantage: 6 things to know
There are major changes afoot for Medicare Advantage plans and when they are required to cover inpatient services in hospitals for their members. The changes are likely to present challenges for hospitals and how physicians document inpatient care. -
California lawmakers reach deal on largest-ever Medicaid investment
California lawmakers and healthcare stakeholders have reached a major deal that represents the largest-ever investment in Medi-Cal, the state's Medicaid program, Politico reported June 24. -
CMS pitches Medicare coverage pathway for new medical devices
CMS is proposing a new pathway for Medicare coverage of new treatments designated as breakthrough devices. -
13 recent CMS moves
From proposed price transparency requirements under Medicaid to a new No Surprises Act website, these are 13 CMS moves reported by Becker's since April 1: -
CMS to states: Slow down Medicaid redeterminations
CMS officials are urging states to double-down on efforts to prevent people from unnecessarily losing Medicaid coverage. -
HHS secretary 'deeply concerned' about procedural Medicaid losses
HHS Secretary Xavier Becerra is urging states to do more to prevent people from losing Medicaid coverage for procedural reasons. -
North Carolina governor approves Blue Cross Blue Shield reorganization
North Carolina Gov. Roy Cooper signed a bill allowing Blue Cross Blue Shield of North Carolina to reorganize as a nonprofit holding company. -
25 more drugs subject to Inflation Reduction Act rebates
HHS has added 25 drugs to its list of products eligible for Inflation Reduction Act rebates. -
FDA commissioner: Agency, CMS discussing Medicare weight loss drug coverage
The FDA and CMS are discussing how to handle obesity drugs in Medicare, Bloomberg Law reported June 7. -
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.
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