CMS shared plans Dec. 23 for its voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. The announcement comes weeks following the White House’s agreements with Eli Lilly and Novo Nordisk to apply most-favored-nation…
Payer Policy Updates
The American Hospital Association and Federation of American Hospitals are calling on Elevance Health to rescind a new policy that would penalize hospitals for using out-of-network providers. In a Dec. 17 letter to Elevance President and CEO Gail Boudreaux, AHA…
UnitedHealthcare is delaying a coverage policy that would have sharply restricted remote physiologic monitoring services for most chronic conditions. The policy, which had been scheduled to take effect Jan. 1, will now be implemented later next year, the insurer confirmed…
The National Council of Insurance Legislators adopted the Prior Authorization Reform Model Act sponsored by a Mississippi state senator at the group’s annual meeting. “The model will protect the provider-patient relationship from unnecessary third-party interference, prevent programs from hindering the…
U.S. Democratic Sens. Patty Murray of Washington, Ron Wyden of Oregon and Kirsten Gillibrand of New York introduced a bill that would block the CMS Wasteful and Inappropriate Service Reduction model. The six-year WISeR pilot, set to kick off next…
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On Dec. 15, CMS published 24 quality and efficiency measures under consideration for adoption in Medicare programs. HHS employs this pre-rulemaking process to decide on measures for Medicare programs and releases a public list of the pitched measures each year.…
New Hampshire legislators have introduced two bills that would impose new requirements on health insurers operating in the state, with both measures set to take effect in 2027 if enacted. HB 1406 would prohibit insurers from using artificial intelligence to…
Insurers are updating reimbursement policies that include new rules surrounding remote monitoring and inpatient reimbursement. Here’s a look at some of the most recent notable updates.
New York Gov. Kathy Hochul has signed legislation requiring insurers to cover follow-up screening and diagnostic services for lung cancer without imposing cost sharing on members. The law takes effect Jan. 1, 2027, and amends state insurance law governing individual,…
New Jersey has finalized rules requiring state-regulated insurers to cap out-of-pocket costs on insulin, asthma inhalers and epinephrine auto-injectors. The state published the final regulations Dec. 1, implementing legislation Gov. Phil Murphy signed that made New Jersey the second state…