Payer Policy Updates

Anonymous employees with Texas HHS have filed a whistleblower complaint against the agency over "numerous and growing system issues" they say are leading to incorrectly terminated health coverage during the Medicaid redeterminations process, according to an Aug. 24 Nexstar report.

CMS published draft guidance for a new program that will allow Medicare Part D beneficiaries to spread out their out-of-pocket prescription costs over an entire year. 

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. 

CMS will make several tweaks to the ACO REACH model in 2024, designed to make payments from the model more predictable for participants and adjust equity benchmarks. 

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. 

Humana, UnitedHealthcare and Cigna changed or paused policies this year after receiving criticism from medical groups and other organizations. 

The first wave of UnitedHealthcare's previously announced 20 percent reduction in prior authorization requirements takes effect Sept 1. 

The American Hospital Association, American Medical Association, AHIP and the Blue Cross Blue Shield Association are urging CMS not to move forward with implementing electronic transaction standards for healthcare attachments during prior authorization they say would create "costly burdens" across…

Lawmakers are proposing legislation that would extend incentives for value-based care in Medicare. 

Though federal price transparency requirements for payers have been in effect since July 2022, several states moved faster to enact their own requirements and add additional regulations, according to a July 21 analysis from the National Conference of State Legislatures.