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CMS pitched prior authorization overhaul, but timeline remains uncertain
In December 2022, CMS pitched a rule it said would streamline the prior authorization process. But 10 months after closing public comment, it remains uncertain when — or if — the proposal will be finalized, KFF Health News reported Jan. 9. -
Virginia eliminates tobacco use surcharge under ACA plans
Virginia has banned payers offering coverage on the ACA marketplace from including a surcharge for tobacco use, effective Jan. 1. -
Hospitals, payers get behind key points of CMS' Medicare Advantage proposed rule
Hospital and payer groups were broadly supportive of proposed changes to Medicare Advantage prior authorization and broker compensation regulations. -
New CMS prior authorization rule takes effect
A new CMS rule aiming to streamline Medicare Advantage and Part D prior authorizations took effect Jan. 1. -
New payer price transparency rules take effect in 2024
New requirements for payers under CMS' Transparency in Coverage rule took effect Jan. 1. -
California expands Medicaid to all eligible undocumented individuals
Starting Jan. 1, California will become the first state to offer Medicaid coverage to all eligible undocumented individuals, Cal Matters reported Dec. 28. -
Senators concerned Medicare Advantage plans deny long-term care
A pair of senators are asking CMS to require Medicare Advantage plans to cover stays in long-term care facilities at the same rate as traditional Medicare. -
5 Medicare Advantage changes coming in 2024
CMS will implement new risk adjustment payment rates, prior authorization requirements and network standards for Medicare Advantage plans in 2024. -
3 Inflation Reduction Act Medicare changes taking effect in 2024
The federal government will cap drug copays and premiums for Medicare beneficiaries and expand eligibility for financial assistance for medications in 2024. -
Massachusetts Medicaid to add doula coverage
Massachusetts' Medicaid program, MassHealth, is expanding coverage of doula services to pregnant, birthing and postpartum beneficiaries beginning in spring 2024. -
Medicare bills pass House committee: 3 things to know
The House Energy and Commerce Committee advanced 19 pieces of legislation Dec. 7, including bills aimed at increasing Medicare Advantage transparency. -
Senators urge CMS to collect more Medicare Advantage data
A bipartisan group of senators say lawmakers don't have enough data on Medicare Advantage to properly oversee the program. -
How BCBS plans are putting price transparency data to work
It's been nearly two years since payers have been required to publish the costs of their in-network provider rates for covered items and services, and now Blue Cross Blue Shield plans are using that data to create actionable insights for stakeholders across the healthcare system. -
Medical groups push back on Cigna policy change
Medical societies representing 95,000 members have expressed their "profound objection" to Cigna's characterization of closed-loop spinal cord stimulation therapy as "experimental, investigational, and/or unproven." -
CMS to crack down on Medicaid redetermination compliance
CMS has laid out how it will sanction states that do not comply with Medicaid redetermination requirements. -
Presidential candidates are setting their sights on the ACA. Are voters?
The Affordable Care Act is back in the political spotlight, but few voters have the future of the law at the top of their lists of issues to address, according to a KFF poll published Dec. 1. -
UnitedHealthcare updates home health prior authorization review process
UnitedHealthcare is updating its prior authorization and concurrent review process for home health services that are delegated to Home & Community Care, the payer's home care division. -
Bipartisan anger over Medicare Advantage denials on the rise
Concerns about Medicare Advantage denials are on the rise in Washington, Politico reported Nov. 24. -
CMS pitches new regulations for state-run exchanges: 5 things to know
CMS is proposing several new regulations for the ACA marketplace in 2025, including tighter regulation of state-based marketplaces. -
House subcommittee passes Medicare bills: 3 things to know
The Health Subcommittee of the Energy and Commerce Committee passed 21 health bills on to the full committee, including bills aimed at increasing Medicare Advantage transparency.
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