On Dec. 15, CMS published 24 quality and efficiency measures under consideration for adoption in Medicare programs. HHS employs this pre-rulemaking process to decide on measures for Medicare programs and releases a public list of the pitched measures each year.…
Payer Policy Updates
New Hampshire legislators have introduced two bills that would impose new requirements on health insurers operating in the state, with both measures set to take effect in 2027 if enacted. HB 1406 would prohibit insurers from using artificial intelligence to…
Insurers are updating reimbursement policies that include new rules surrounding remote monitoring and inpatient reimbursement. Here’s a look at some of the most recent notable updates.
New York Gov. Kathy Hochul has signed legislation requiring insurers to cover follow-up screening and diagnostic services for lung cancer without imposing cost sharing on members. The law takes effect Jan. 1, 2027, and amends state insurance law governing individual,…
New Jersey has finalized rules requiring state-regulated insurers to cap out-of-pocket costs on insulin, asthma inhalers and epinephrine auto-injectors. The state published the final regulations Dec. 1, implementing legislation Gov. Phil Murphy signed that made New Jersey the second state…
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CMS published its 2027 Medicare Advantage and Part D proposed rule on Nov. 25 that includes an overhaul of how star ratings are calculated, new enrollment flexibilities, and rollbacks of Biden-era health equity requirements. The proposed rule is subject to…
Legally residing refugees and asylees will face new challenges with accessing health insurance coverage. The 2025 budget law will cut Medicaid spending by about $1 trillion over 10 years, and Medicaid data usage by Immigration and Customs Enforcement is slated…
U.S. Reps. Kathy Castor, D-Fla., Brian Fitzpatrick, R-Pa., and Debbie Wasserman Schultz, D-Fla., have reintroduced a bill to widen access to lung cancer screenings, according to a Nov. 20 news release. The bill prevents Medicaid, traditional Medicare, Medicare Advantage, and…
Thirteen Democrats in the U.S. House of Representatives introduced eight bills aimed at reforming Medicare Advantage and solidifying traditional Medicare, according to a Nov. 19 news release from Rep. Mark Pocan, D-Wis. Each piece of legislation falls into one of…
The Wasteful and Inappropriate Service Reduction initiative from CMS will take effect next year, adding prior authorization requirements to traditional Medicare. Providers in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma will pilot the new protocol. Here are eight things…