Payer Policy Updates

AHIP, the trade association representing the insurance industry, is opposed to some of CMS' proposed changes to the Medicare Advantage star ratings program. 

Provider groups are applauding CMS' proposed rule overhauling prior authorization in Medicare Advantage. 

As the U.S. prepares to end the COVID-19 public health emergency, hospitals are facing a major cut in Medicare payments used to treat patients diagnosed with the disease.

New York state legislators and stakeholders are debating a bill that would overhaul the state's health system and establish a single-payer system, Spectrum News reported Feb. 9. 

Traditional Medicare and Medicare Advantage beneficiaries could begin seeing lower copays for certain Part B drugs beginning April 1, according to new guidance from HHS. 

Payer executives are expecting to lose members in their Medicaid managed care contracts as states begin the redetermination process, but some are hopeful to convert some of these members to other lines of business. 

As Medicare Advantage insurance companies continue to grow in popularity, it’s important for our nation’s health policy leaders to ensure that MA enrollees have access to the same level of medically-necessary coverage as traditional Medicare. Fortunately, CMS has proposed a…

Payer executives are still taking stock of tougher Medicare Advantage auditing standards CMS unveiled Jan. 31.  

A federal judge in Texas has handed another win to the Texas Medical Association and medical providers nationwide against HHS over a challenge to the arbitration process between out-of-network providers and payers that was established under the No Surprises Act.

Proposed Medicare Advantage plan rates introduced by CMS could have some impacts on revenue, but it's too early to see the full scope, Cigna CEO David Cordani told investors on a Feb. 3 call transcribed by Seeking Alpha.