Payer Policy Updates

The House Energy and Commerce Committee advanced 19 pieces of legislation Dec. 7, including bills aimed at increasing Medicare Advantage transparency. 

A bipartisan group of senators say lawmakers don't have enough data on Medicare Advantage to properly oversee the program. 

It's been nearly two years since payers have been required to publish the costs of their in-network provider rates for covered items and services, and now Blue Cross Blue Shield plans are using that data to create actionable insights for…

Medical societies representing 95,000 members have expressed their "profound objection" to Cigna's characterization of closed-loop spinal cord stimulation therapy as "experimental, investigational, and/or unproven." 

CMS has laid out how it will sanction states that do not comply with Medicaid redetermination requirements. 

The Affordable Care Act is back in the political spotlight, but few voters have the future of the law at the top of their lists of issues to address, according to a KFF poll published Dec. 1. 

UnitedHealthcare is updating its prior authorization and concurrent review process for home health services that are delegated to Home & Community Care, the payer's home care division. 

Concerns about Medicare Advantage denials are on the rise in Washington, Politico reported Nov. 24. 

CMS is proposing several new regulations for the ACA marketplace in 2025, including tighter regulation of state-based marketplaces. 

The Health Subcommittee of the Energy and Commerce Committee passed 21 health bills on to the full committee, including bills aimed at increasing Medicare Advantage transparency.