Payer Policy Updates

CMS is proposing new coverage guidelines for HIV prevention drugs in Medicare, requiring the program to cover the drugs without cost sharing for beneficiaries. 

Medicaid coverage in Oregon is available to all adults and children who meet eligibility criteria — regardless of immigration status — as of July 1.  

Medicare will provide broader coverage of Leqembi, a drug that has been shown to slow the progression of Alzheimer's disease, now that the drug has received full FDA approval. 

President Joe Biden announced a series of actions aimed at addressing surprise medical billing, unfair medical debt and "junk" short-term insurance plans. 

CMS published updated guidance for the Medicare Drug Price Negotiation program, based on feedback from more than 7,500 public comments. 

The Government Accountability Office is urging CMS to consider adding Medicaid managed care programs to the scope of its recovery audit program. 

There are major changes afoot for Medicare Advantage plans in 2024 and when they are required to cover inpatient services in hospitals for their members. The changes are likely to present challenges for hospitals and how physicians document inpatient care.

California lawmakers and healthcare stakeholders have reached a major deal that represents the largest-ever investment in Medi-Cal, the state's Medicaid program, Politico reported June 24.

CMS is proposing a new pathway for Medicare coverage of new treatments designated as breakthrough devices. 

From proposed price transparency requirements under Medicaid to a new No Surprises Act website, these are 13 CMS moves reported by Becker's since April 1: