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…
Payer Policy Updates
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…
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CMS has finalized a rule requiring Medicare Advantage plans to submit provider directory data for inclusion in the Medicare Plan Finder. The change, aimed at improving transparency and beneficiary decision-making, takes effect January 1, 2026. Under the rule, MA plans…
The Congressional Budget Office found permanently expanding ACA enhanced premium tax credits prior to the federal government’s Sept. 30 fiscal year end would boost the insured population by 3.8 million people over the next decade, while increasing the deficit by…
A group of Republican lawmakers is pressing the Trump administration to step up enforcement of the No Surprises Act, citing ongoing problems with implementation and the IDR process. “We request the departments finalize clear and consistent QPA calculation methodology, accelerate…
Reps. Jan Schakowsky, D-Ill., and Mark Pocan, D-Wis., introduced a resolution opposing a Trump administration initiative that they said would “force recipients of traditional Medicare to receive prior authorization, including through the use of artificial intelligence, before being able to…
Two prior authorization reform bills have passed the California legislature and are headed to Gov. Gavin Newsom’s desk. The California Medical Association, which supported the legislation, said in a Sept. 11 news release the bills “aim to dramatically streamline the…