Payer Policy Updates

In December 2022, CMS pitched a rule it said would streamline the prior authorization process. But 10 months after closing public comment, it remains uncertain when — or if — the proposal will be finalized, KFF Health News reported Jan.…

Virginia has banned payers offering coverage on the ACA marketplace from including a surcharge for tobacco use, effective Jan. 1.

Hospital and payer groups were broadly supportive of proposed changes to Medicare Advantage prior authorization and broker compensation regulations. 

A new CMS rule aiming to streamline Medicare Advantage and Part D prior authorizations took effect Jan. 1.

New requirements for payers under CMS' Transparency in Coverage rule took effect Jan. 1.

Starting Jan. 1, California will become the first state to offer Medicaid coverage to all eligible undocumented individuals, Cal Matters reported Dec. 28.

A pair of senators are asking CMS to require Medicare Advantage plans to cover stays in long-term care facilities at the same rate as traditional Medicare. 

CMS will implement new risk adjustment payment rates, prior authorization requirements and network standards for Medicare Advantage plans in 2024. 

The federal government will cap drug copays and premiums for Medicare beneficiaries and expand eligibility for financial assistance for medications in 2024. 

Massachusetts' Medicaid program, MassHealth, is expanding coverage of doula services to pregnant, birthing and postpartum beneficiaries beginning in spring 2024.