Elevance Health has shared plans to potentially penalize hospitals and other contracted facilities that use care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans in 11 states. Under the policy, finalized Oct. 1 and…
Payer Policy Updates
California Gov. Gavin Newsom vetoed a state bill that would have required health insurance policies with outpatient prescription drug benefits to cover up to a year of hormone therapy, according to an Oct. 13 update to the legislation. Current law…
Michigan Gov. Gretchen Whitmer signed legislation Oct. 7 that aims to preserve the state’s Medicaid funding by maintaining its Insurance Provider Assessment tax. The new law instructs the state to request a waiver from CMS to continue the tax on…
California Gov. Gavin Newsom signed a law that aims to curb inflated drug pricing by pharmacy benefit managers on Oct. 11. The legislation restricts “spread pricing,” wherein PBMs charge a plan or insurer more than the total paid to the…
Republican lawmakers are reviving proposals that failed to make it into the sweeping One Big Beautiful Bill Act, turning their focus to a trio of measures that could reshape how employers offer health benefits through Individual Coverage Health Reimbursement Arrangements,…
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Pennsylvania lawmakers introduced a bill in October to regulate AI use in health insurance, joining a wave of states attempting to add guardrails in the payer space, especially after an early draft of the One Big Beautiful Bill Act included…
Despite Cigna launching its downcoding policy on Oct. 1, the insurer is temporarily holding off on implementing it for California HMO plans, according to the California Medical Association and Cigna. The policy allows Cigna to adjust some higher-level evaluation and…
The American Hospital Association is encouraging HHS Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, MD, and insurers to follow through on prior authorization reforms. In a letter to the CMS and HHS leaders, the AHA emphasized that 95%…
Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program should remain relatively stable next year, CMS said in a Sept. 26 news release. But MA enrollment is projected to decrease 900,000 in…
Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. Not all of the introduced bills have been heard in committee. Here are eight proposals introduced in 2025…