Payer Policy Updates

CMS needs to do more to account for rising utilization rates in Medicare Advantage, the Better Medicare Alliance argued. 

Nebraska lawmakers are considering requiring the state's Medicaid program to cover GLP-1 drugs, the Omaha World-Herald reported Feb. 15. 

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.

A Virginia lawmaker has proposed new legislation that would expand health insurance coverage to undocumented residents under the age of 19. The bill passed in the Virginia Senate Feb. 13.

Algorithms and artificial intelligence-powered software tools can be used to support Medicare Advantage plans in making coverage decisions for members, but payers are still bound by CMS' internal benefits requirements and nondiscrimination rules under the ACA, the agency said in…

Payer executives are not happy with CMS' proposed Medicare Advantage rates for 2025. 

Florida is challenging rules from CMS that require states keep eligible children enrolled in Medicaid and CHIP for a full 12 months, even if their families do not pay premiums. 

A campaign to put a Medicaid expansion proposal to Florida voters is underway, the Tallahassee Democrat reported Feb. 1. 

CMS proposed a slight decrease in Medicare Advantage benchmark payments for 2025. 

A bipartisan group of lawmakers is urging CMS to maintain "payment and policy" stability in Medicare Advantage.