Payer Policy Updates

The American Medical Association and more than 100 physician and healthcare organizations are asking Cigna to reconsider a policy they say will add administrative costs and burdens and potentially negatively affect patients.  

House Republicans' Medicaid work requirement proposal would result in an estimated 600,000 people losing coverage, the Congressional Budget Office said in an April 25 report.

HHS unveiled its proposed rule that, if finalized, would expand healthcare coverage access to an estimated 129,000 previously uninsured Deferred Action for Childhood Arrivals program recipients.

CMS is upping its proposed number of non-standard ACA plans payers can offer in each region from two to four. 

HHS has removed seven drugs from its initial list of 27 drugs subject to inflation rebates. 

CMS issued a final rule April 5 that, among other things, aims to streamline Medicare Advantage and Part D prior authorizations and clamp down on misleading marketing practices. 

Two Senators are introducing legislation aimed at reducing Medicare Advantage overpayments. 

CMS will move ahead with Medicare Advantage risk adjustment changes payers and some provider groups opposed, but the agency will phase in the model over three years. 

After more than three years, the nation's continuous Medicaid enrollment policy has come to an end, setting off a pivotal redetermination period that will present unprecedented challenges for payers, health systems, and state Medicaid agencies alike.

Clear data collection standards will help advance health equity, the Blue Cross Blue Shield Association says.