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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. -
Payers must post negotiated prices starting today: 8 things to know
CMS' Transparency in Coverage final rule took effect July 1, requiring payers nationwide to publish the cost of nearly every healthcare service they've negotiated with providers. -
CMS rule limiting 3rd-party Medicare Advantage, Part D marketing now in effect
A CMS rule revising Medicare Advantage and Part D marketing and communication regulations went into effect June 28 to increase oversight over third-party marketing organizations. -
California will become first state to offer Medicaid to all eligible residents
California is set to become the first state to allow any eligible resident to enroll in Medi-Cal regardless of immigration status, according to The Sacramento Bee. -
CMS to launch new oncology payment model under Medicare
The Biden administration will launch the next phase of its Cancer Moonshot initiative next July with a new value-based oncology payment model through Medicare that aims to improve cancer care outcomes and lower costs nationwide. -
CMS to cover COVID-19 vaccinations for children 5 and younger
CMS said June 22 it will pay for COVID-19 vaccinations for children aged six months to five years who are covered under Medicaid and the Children's Health Insurance Program without cost-sharing. -
FTC warns PBMs about unlawful drug rebate practices through new enforcement policy
The Federal Trade Commission has voted unanimously to put pharmacy benefit managers and drugmakers "on notice" about a new enforcement policy against illegal bribes and rebate schemes that can block patient access to competing lower-cost drugs. -
Hawaii looks to expand gender-affirming health insurance coverage
A bill was passed May 5 in the Hawaii State Legislature that would ban payers from applying "categorical cosmetic or blanket exclusions" for transgender individuals with prescribed gender confirmation treatments or procedures. -
Biden administration considering requirement for Medicaid to primarily fund direct care in nursing homes
The Biden administration may look to require nursing homes to spend a majority of their Medicaid funding on direct care for residents and place a limit on using funds for operations, maintenance, capital improvements or profits, according to Kaiser Health News. -
Members’ satisfaction relies on convenience for your members
In today’s world, convenience is a big element of our lifestyles. Why do healthcare benefits still seem so inconvenient? -
UnitedHealthcare to roll out prior authorization changes for radiation therapy in June
Effective June 7, United Healthcare will require and Optum will manage prior authorization for the following outpatient radiation therapies: -
Anthem Blue Cross ends payment of consultation services
Anthem Blue Cross is halting reimbursement of consultation services for its commercial plans. -
BCBS of Georgia to end 'avoidable ER' program
Blue Cross Blue Shield Healthcare Plan of Georgia plans to end its "avoidable emergency room" program on March 18. -
UnitedHealthcare to roll out coverage changes for obstetrical ultrasounds
UnitedHealthcare is rolling out a new obstetrical ultrasound policy for commercial members starting June 1, the payer said March 1.
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