Federal lawmakers have introduced a handful of bills aimed at speeding up prior authorization and cracking down on upcoding in Medicare Advantage. Not all of the introduced bills have been heard in committee. Here are eight proposals introduced in 2025…
Payer Policy Updates
CMS has finalized a rule requiring Medicare Advantage plans to submit provider directory data for inclusion in the Medicare Plan Finder. The change, aimed at improving transparency and beneficiary decision-making, takes effect January 1, 2026. Under the rule, MA plans…
The Congressional Budget Office found permanently expanding ACA enhanced premium tax credits prior to the federal government’s Sept. 30 fiscal year end would boost the insured population by 3.8 million people over the next decade, while increasing the deficit by…
A group of Republican lawmakers is pressing the Trump administration to step up enforcement of the No Surprises Act, citing ongoing problems with implementation and the IDR process. “We request the departments finalize clear and consistent QPA calculation methodology, accelerate…
Reps. Jan Schakowsky, D-Ill., and Mark Pocan, D-Wis., introduced a resolution opposing a Trump administration initiative that they said would “force recipients of traditional Medicare to receive prior authorization, including through the use of artificial intelligence, before being able to…
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Two prior authorization reform bills have passed the California legislature and are headed to Gov. Gavin Newsom’s desk. The California Medical Association, which supported the legislation, said in a Sept. 11 news release the bills “aim to dramatically streamline the…
Sen. Richard Blumenthal is urging Cigna to rescind a new policy he said will create “onerous administrative burdens for physicians, needlessly raises costs for healthcare providers and jeopardizes patient care.” Beginning Oct. 1, Cigna’s new Evaluation and Management Coding Accuracy…
Massachusetts’ Division of Insurance and Department of Public Health has issued a bulletin Sept. 3 requiring insurance carriers to cover vaccines as outlined by the state, not just the CDC. “We won’t let Donald Trump and Robert Kennedy get between…
Montana has submitted an application to HHS to add work requirements and enhanced cost-sharing to its Medicaid expansion program. Under the proposal, “working-age, able-bodied adults” with incomes up to 138% of the federal poverty level will be required to complete…
The House Committee on Oversight and Government Reform is investigating CVS Health over reports of the company using confidential patient information to lobby against a bill under consideration by the Louisiana legislature. Chairman James Comer, R-Ky., and Subcommittee on Federal…