Payer Policy Updates

Payers and providers don't agree on much when it comes to the No Surprises Act dispute resolution process. 

New Mexico's superintendent of insurance has ordered payers operating in the state to expand access to behavioral health services, the Albuquerque Journal reported Sept. 19.

Updated COVID-19 boosters have started rolling out to pharmacies nationwide, but some individuals are reporting a high price tag associated with getting a shot.

Oregon is asking CMS to approve a basic health program for lower-income individuals who make too much to qualify for Medicaid, a move that could raise premiums prices on the state's individual insurance market. 

Hawaii is pausing Medicaid disenrollments for all Hawaii residents for the remainder of 2023 in the wake of the Maui wildfires. 

As prior authorizations have come under the regulatory and legislative microscope, several payers have announced cuts to their requirements. 

Blue Cross Blue Shield of Michigan is the latest payer to announce it is scaling back its prior authorization requirements.

The first wave of UnitedHealthcare's prior authorization cuts began Sept. 1.

CMS is urging states to correct an issue that could result in eligible people being removed from Medicaid. 

UnitedHealthcare is cutting 20 percent of its prior authorizations in two waves. The first cuts take effect Sept. 1 and the second phase goes into effect Nov. 1.