Democratic senators introduced legislation June 25 that would cap out-of-pocket costs for traditional Medicare beneficiaries. The Medicare Cost Cap Act would install a $5,000 annual cap for Parts A and B cost-sharing — including deductibles, copays and coinsurance — beginning…
Policy Updates
Thirty-one House Democrats are seeking more information on CMS’ Wasteful and Inappropriate Service Reduction model. The lawmakers sent a letter to CMS Administrator Mehmet Oz, MD, June 22, requesting data on the pilot by July 15. WISeR harnesses AI to bring prior…
The House Appropriations Committee moved forward with an amendment that would block funding for a CMS pilot that brings prior authorization requirements to traditional Medicare. The lawmakers adopted the amendment by voice vote June 9 during their 2027 spending bill markup. Under the…
CMS has logged nearly 40,000 complaints alleging potential violations of federal health insurance law since the agency began tracking them in 2022, with the vast majority of closed complaints related to the No Surprises Act, according to an enforcement report…
Prior authorization reforms in Massachusetts went into effect June 5. Democratic Gov. Maura Healey finalized the regulations in May, following through on her earlier plan to tackle prior authorization. Here are six things to know about the reforms: 1. The…
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Federal employees will soon need to verify the eligibility of any dependent they add to their health plan under a new rule finalized by the Office of Personnel Management. The rule, published June 2, implements the FEHB Protection Act of…
Colorado Democratic Gov. Jared Polis signed a bill in early June to move forward with funding for the state’s health insurance affordability efforts. Colorado’s health insurance affordability enterprise — which collects fees from health plan carriers and hospitals to support…
The Trump administration has finalized an overhaul of the No Surprises Act’s independent dispute resolution process, establishing a centralized disputes gateway, creating a new federal payer registry, and reducing administrative fees. The final rule, issued jointly by HHS, the Labor…
Seventeen Democratic senators are proposing to add home care coverage to Medicare for the first time, along with an expansion of Medicaid home- and community-based services. The proposed framework, published May 20, centers on creating a Medicare “home care guarantee,”…
Massachusetts will impose the strictest limits on health insurance cost-sharing in the country beginning in 2027, Gov. Maura Healey said May 18. Payers will be required to limit increases in member cost-sharing, including deductibles and copays, to no more than…