Payer Policy Updates

Humana CEO Jim Rechtin is putting his support behind federal legislation aimed at reforming the Medicare Advantage prior authorization process. 

North Carolina will cover GLP-1 drugs for weight loss through its Medicaid program. 

CMS has issued new policies aimed at blocking "unauthorized changes" from brokers when enrolling individuals on the state and federal health insurance exchanges.

A federal judge rejected Georgia's request to extend its Medicaid work requirement program, the Georgia Recorder reported July 16. 

Eight payers have signed an agreement to promote value-based payment models in Washington state. 

Illinois Gov. JB Pritzker has signed a pair of health insurance reform bills into law.

A federal judge has paused implementation of CMS regulations capping the amount Medicare Advantage companies can pay brokers that sell their plans. 

CMS has approved requests from five states to provide Medicaid coverage to incarcerated people before they are released. 

Oregon has launched a program to provide Medicaid benefits to individuals earning up to 200% of the federal poverty level, the Oregon Capital Chronicle reported July 1. 

Blue Cross and Blue Shield of Rhode Island is eliminating nearly 65% of prior authorization requirements for primary care providers by early 2025.