Payer Policy Updates

Up to 6.7 million children nationwide are at risk of losing their CHIP coverage when Medicaid redeterminations begin this spring, according to a new analysis from the Georgetown University Center for Children and Families.

Blue Cross Blue Shield of Massachusetts will continue reimbursing telehealth at the same rate as in-person services for primary and chronic care for now. 

Connecticut lawmakers are considering a proposal to reduce premiums by reimbursing insurers for the most costly claims, CT News Junkie reported Feb. 16. 

West Virginia lawmakers are considering adding a Medicaid "buy-in" program to provide insurance to low-income workers making too much to qualify for the program, the News and Sentinel reported Feb. 16. 

Medicare Advantage audits are "unequivocally not cuts" in funding, HHS says. 

Proposed changes to Medicare Advantage payments could cut benefits for members, according to a report commissioned by the Better Medicare Alliance. 

In January, CMS said it will implement stricter auditing practices around Medicare Advantage plans, but payers and policy experts say they have a lot of questions about the next steps forward.

President Joe Biden has vowed to strike down any law that cuts Medicare spending — but cutting spending can come in many forms.

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.