Payer Policy Updates

Senate Finance Committee Chairman Ron Wyden has launched a probe into potentially deceptive marketing tactics used by Medicare Advantage plans. 

Payers with large Medicaid operations are expected to face negative pressure on revenues if the federal public health emergency ends in October, but the total impact on profits is likely to be small because of coverage alternatives offered by the…

Massachusetts Gov. Charlie Baker signed legislation Aug. 10 that overhauls the state's mental/behavioral healthcare delivery system and reforms prior authorization practices within the specialty. 

HHS, the Labor Department and Treasury Department put payers on notice that they are required to cover birth control and family planning counseling under the Affordable Care Act in every state.

Senate Democrats reached a deal June 27 on a major healthcare and energy reform bill that will extend Affordable Care Act tax credits to 2025, empower Medicare to negotiate the cost of some drugs and put the U.S. on a…

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.