CMS is implementing a final rule that will shorten the open enrollment period on the ACA exchange and create stricter eligibility verifications for enrollees. In a June 20 news release, the agency said the changes will lower individual premiums by…
Payer Policy Updates
The Trump administration and insurers appear to have their own changes to reimbursement practices in store, with announcements expected next week — adding to funding changes outlined in Congress’ budget reconciliation bills. The Wall Street Journal reported June 20 that…
A group of Democratic lawmakers has introduced legislation to create a public insurance option for individuals and employers. The Choose Medicare Act was introduced by Reps. Jimmy Gonzalez, Jared Huffman, LaMonica McIver and Eleanor Holmes Norton, and Sens. Jeff Merkley…
Three states that offer health coverage to undocumented immigrants are sunsetting or limiting those benefits. House Republicans’ proposed budget reconciliation package also includes provisions to penalize states financially if they provide Medicaid benefits to noncitizen residents by reducing their ACA…
HHS officials ordered CMS to provide the personal data of Medicaid enrollees to the Department of Homeland Security in June, according to an exclusive report from the Associated Press. The shared data includes the immigration status of Medicaid enrollees in…
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Proposed changes to Medicare Advantage are unlikely to be included in a final budget deal, The Hill reported June 11. Senators had floated adding provisions of the No UPCODE Act, which targets overpayments in the program, to the massive federal…
Groups representing insurers are pushing back on proposed tighter regulations on Medicare Advantage coding. Senate Republicans are considering targeted changes to Medicare Advantage as part of the sweeping “One Big Beautiful Bill.” Lawmakers are considering adding provisions of the No…
Nebraska Gov. Jim Pillen has signed the Ensuring Transparency in Prior Authorization Act, which aims to overhaul the prior authorization process in the state by making prior auth requirements publicly available on insurers’ websites and ensuring that providers are given…
Vermont Gov. Phil Scott has signed legislation that grants the Green Mountain Care Board new powers to manage the financial health of hospitals and insurers in the state. The GMCB, an independent state agency in Vermont responsible for overseeing the…
Arizona Gov. Katie Hobbs recently signed a bill into law that requires a licensed medical professional to have the final say in claims denials and prior authorization decisions. The new law prohibits insurers from using AI as the final decision-maker…