Elevance Health plans to require hospitals to identify the physical location where care was provided on billing forms and adjust payments for off-campus services accordingly. The insurer said Sept. 29 the new policies will apply across its commercial, Medicare Advantage…
Policy Updates
Sen. Mark Warner, D-Va., has introduced a bill that would roll back most of the healthcare cuts under HR 1, add a public option to the ACA exchanges and apply Medicare drug pricing rules to commercial health plans. 10 things…
House Democrats have drafted an 84-page health policy agenda outlining what the party would pursue if it wins a House majority in November, according to a Sept. 25 report from Politico, which first obtained the document. The new agenda follows…
Health systems are not the only groups pushing back against a CMS proposal to restrict remote patient monitoring. In July, CMS pitched banning Medicare payments for remote patient monitoring services carried out by third-party companies. As proposed, starting Jan. 1,…
The American Medical Association is urging CMS to maintain its Jan. 1, 2027, electronic prior authorization deadline. CMS broadened prior authorization reform efforts — and built upon payers’ existing commitments — to include providers and EHR vendors. Application programming interface…
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Connecticut Comptroller Sean Scanlon is establishing AI safeguards for the State Employee Health Plan and Partnership Plan. The protections, announced Sept. 16, will cover more than 270,000 members on the plan Mr. Scanlon oversees. The policy prevents adverse determinations and…
CMS will add four condition tracks to its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model starting in spring 2027, the agency said in a Sept. 15 news release. Four things to know: 1. The expansion adds heart failure,…
Pharmacies have been seeing compelling interest in Medicare’s GLP-1 Bridge program since its July launch, NPR first reported. The demonstration, designed to give eligible Medicare Part D beneficiaries access to certain GLP-1s at a fixed monthly cost, will run through…
So far, 2026 has been a year defined by insurer retrenchment, including market exits across product lines and other strategic realignments. A slew of policy changes has reshaped markets: the expiration of enhanced premium tax credits and tighter prior authorization…
Anthem is now covering three surgical meshes for breast reconstruction, according to a clinical guideline published Aug. 27. DuraSorb Monofilament Mesh, GalaFLEX and TIGR Matrix Surgical Mesh “are considered medically necessary when used for breast reconstruction surgery,” the guidance said.…