Payer Policy Updates

President Joe Biden's administration is no longer allowing several states to charge premiums to newly-eligible Medicaid enrollees — an undoing of Obama and Trump-era allowances, according to NPR. 

California's Health Care Services Department issued a notice Feb. 6 that removed prior authorization requirements for most drugs Under Medi-Cal, the state's Medicaid program. 

Two U.S. senators have introduced a bill that would temporarily extend pandemic-era policies that expanded Medicare's coverage of telehealth services.

The American Medical Association sent statements to two congressional committees claiming that payers are rampantly disregarding mental parity law due to a lack of enforcement. 

There's no such thing as free, even when it comes to free COVID-19 testing, writes Cameron Kaplan, PhD, economist and assistant professor of medicine at the University of Southern California’s Keck School of Medicine, in a Feb. 3 Wall Street…

COVID-19 test price gouging is still a "significant problem," America's Health Insurance Plans said in a statement submitted to Congress.

CMS is seeking input on an Advanced Notice that includes proposed changes to Medicare Advantage capitation rates and Part D payment policies.

Medicare will cover up to eight at-home COVID-19 tests for beneficiaries beginning in early spring, CMS announced Feb. 3. 

States are anticipating that the federal government will end the COVID-19 public health emergency sometime in 2022, which would require them to potentially unenroll upwards of 15 million people from Medicaid programs, according to Politico. 

UnitedHealthcare has reprocessed 1.6 million COVID-19 vaccination claims that shortchanged providers, according to a Jan. 20 congressional report from Sen. Bob Casey, D-Pa.