Payer Policy Updates

Lawmakers are pushing CMS to do more to prevent misuse of artificial intelligence by Medicare Advantage plans. 

A federal court kept the ACA preventive care mandate in place for now but raised questions about its constitutionality. 

Washington state opened applications for its Medicaid-like health insurance program for  undocumented adult immigrants on June 20.

Three states recently passed legislation reforming the prior authorization process:

In 2025, Minnesota's Medicaid program will no longer award managed care contracts to for-profit HMOs.

The Illinois General Assembly has passed a pair of health insurance reform bills, which Gov. JB Pritzker has indicated he will sign.

In 2024, Medicare Advantage plans must provide coverage for an inpatient admission when the admitting physician expects the patient to require hospital care for at least two midnights, otherwise known as the two-midnight rule.

CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. 

Federal lawmakers are proposing allowing Medicaid reimbursement of doulas and midwives in every state. 

Illinois is expanding coverage of weight-loss drugs to state employees, a move Gov. JB Pritzker's office estimates could cost up to $210 million annually, WBEZ reported April 30.