Payer Policy Updates

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. 

The Federal Trade Commission has voted unanimously to put pharmacy benefit managers and drugmakers "on notice" about a new enforcement policy against illegal bribes and rebate schemes that can block patient access to competing lower-cost drugs. 

A bill was passed May 5 in the Hawaii State Legislature that would ban payers from applying "categorical cosmetic or blanket exclusions" for transgender individuals with prescribed gender confirmation treatments or procedures.

The Biden administration may look to require nursing homes to spend a majority of their Medicaid funding on direct care for residents and place a limit on using funds for operations, maintenance, capital improvements or profits, according to Kaiser Health…

In today’s world, convenience is a big element of our lifestyles. Why do healthcare benefits still seem so inconvenient?

Effective June 7, United Healthcare will require and Optum will manage prior authorization for the following outpatient radiation therapies:

Anthem Blue Cross is halting reimbursement of consultation services for its commercial plans.