Payer Policy Updates

A bipartisan group of senators is introducing legislation that would require Medicare Advantage plans to report more encounter data. 

From October to December, airwaves are flooded with advertisements for Medicare Advantage plans, urging beneficiaries to call and review their options. 

It's been more than seven months since the first states began the process of unwinding the continuous Medicaid enrollment period in place for three years during the pandemic, resulting in state agencies and beneficiaries reporting major operational challenges and exacerbated…

Blue Cross Blue Shield of Massachusetts' plan to remove 14,000 prior authorization requirements for home care services is a response to the capacity crisis in the state's hospitals, the payer's chief medical officer Sandhya Rao, MD, told NPR affiliate WBUR…

CMS is proposing a standard appeals process for risk adjustment data validation audits in Medicare Advantage. 

CMS is proposing a set of new Medicare Advantage rules, including new standards that would impose more limits on plans' payments to brokers and limit the role of third-party marketers. 

CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. 

Blue Cross Blue Shield of Massachusetts is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1. 

The second and final wave of UnitedHealthcare's prior authorization cuts began Nov. 1. 

Payers' negotiated prices for office visits and medical services can vary widely from county to county, according to a price transparency study published Oct. 27 in JAMA Health Forum.