Payer Policy Updates

The Biden Administration is doubling down on a proposal to create "Medicaid-like" coverage for low-income adults in states that have not expanded the program. 

Wegovy is now approved to be used to reduce the risk of heart attack, stroke and cardiovascular death, which could lead to broader payer coverage of the drug. 

Maryland legislators are considering a bill that would allow people to purchase insurance on Maryland's health insurance exchange, regardless of their immigration status. 

California legislators are putting a single-payer system back on the table, but it still faces long odds of becoming a reality, the Los Angeles Times reported Feb. 21. 

Colorado lawmakers are considering a bill that would prevent customers from incurring extra out-of-pocket costs if their insurer goes bankrupt in the middle of the year. 

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…