Policy Updates

An Illinois Senate bill introduced in February would ban payers from using automated tools, including AI, to downcode physician claims and would require that any downcoding decision be made by a licensed physician of the same or similar specialty as…

The Georgia Senate has passed a bill that would ban AI tools from being used independently to make coverage decisions. The bill, which passed the chamber unanimously in February, would require a clinician to make the final decision on coverage…

The Iowa House passed legislation on Feb. 25 that would ban health insurers from denying coverage for a service solely because the referring primary care provider is out of network. Under the legislation, insurers would also be barred from imposing…

Anthem Blue Cross of California is bringing its controversial out-of-network penalty policy to California on June 1, a move that has already drawn legislative backlash in the insurer’s home state of Indiana. Under the policy, participating hospitals and facilities in…

CMS issued requests for applications from Medicare Part D plans and state Medicaid agencies to join the voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth,” known as BALANCE, model. Under the model, CMS will negotiate with manufacturers on…

West Virginia lawmakers proposed a bill in January that would require payers covering cancer chemotherapy to also cover scalp cooling. Scalp cooling can help prevent or limit hair loss during chemotherapy. Under HB 4089, along with the mandate, insurers would…

Washington state lawmakers pitched a bill in January that would prompt health insurance carriers on its benefit exchange to contribute to an abortion savings program. SB 6182 seeks to establish a fund to assist those who face barriers to abortion…

Blue Shield of California nonprofit parent company Ascendiun launched a national healthcare reform movement focused on value-based care, cost and tech advancement — and is calling on the government to help — according to a news release. The campaign, called…

Sen. Bernie Sanders, I-Vt., and Rep. Ro Khanna, D-Calif., introduced legislation March 2 that would reverse the Medicaid and ACA changes enacted under the One Big Beautiful Bill Act and expand Medicare to cover dental, vision and hearing services for…

Indiana lawmakers have passed legislation banning health insurers from penalizing hospitals for using out-of-network providers, a direct rebuke of Elevance Health in its home state. The bill received final legislative approval on Feb. 26 and now heads to Gov. Mike…