Payer Policy Updates

CMS has approved Maine's plan to improve health insurance for small businesses and tackle rising premiums by merging its individual and small group markets under the ACA into a single, pooled market, starting in 2023.

Peoria, Ill.-based OSF HealthCare will only cover fertility treatment for employees in opposite-sex marriages, Bloomberg Law reported July 18. 

Aetna has dropped its policy to not cover cardiac PET/CT scans following a joint letter from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine and Molecular Imaging.

U.S. Senate Democrats reached a legislative agreement June 6 that would allow Medicare to negotiate the cost of prescription drugs starting next year.

Aetna will no longer require pre-approval for member's cataract surgeries starting July 1.

CMS' Transparency in Coverage final rule took effect July 1, requiring payers nationwide to publish the cost of nearly every healthcare service they've negotiated with providers.

A CMS rule revising Medicare Advantage and Part D marketing and communication regulations went into effect June 28 to increase oversight over third-party marketing organizations.

California is set to become the first state to allow any eligible resident to enroll in Medi-Cal regardless of immigration status, according to The Sacramento Bee.

The Biden administration will launch the next phase of its Cancer Moonshot initiative next July with a new value-based oncology payment model through Medicare that aims to improve cancer care outcomes and lower costs nationwide.

CMS said June 22 it will pay for COVID-19 vaccinations for children aged six months to five years who are covered under Medicaid and the Children's Health Insurance Program without cost-sharing.