Payer Policy Updates

CMS wants all traditional Medicare beneficiaries and most Medicaid beneficiaries in accountable care organizations by 2030. In a strategy report published Nov. 7, CMS detailed its plans to reach this goal. 

A CMS rule finalized Oct. 28 will reduce gaps in Medicare enrollment for new enrollees and adds special enrollment periods for extenuating circumstances. 

CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first.

The Transparency in Coverage (TiC) final rule went into effect July 1, 2022, and requires insurers to include provider-negotiated rates, as well as allowed billable amounts for all out-of-network providers. 

The nation's uninsured rate is at a record low thanks in part to continuous Medicaid enrollment since early 2020. But with the federal public health emergency expected to come to a close in 2023, payers are prepping for a major…

When President Joe Biden declared the COVID-19 pandemic "over" Sept. 18, his message divided the medical community and sent a clear message: the nation is moving on from COVID-19.

Increased Medicare payment for biosimilars took effect Oct. 3, one of the first Medicare provisions of the Inflation Reduction Act to kick in. 

The Biden Administration unveiled a five-point plan to address hunger, nutrition and health Sept. 27. The White House wants Medicare, Medicaid and private insurers to play a role in solving food insecurity and food related illness. Here are five things…

Blue Cross Blue Shield of North Carolina is expanding its telehealth policy to include more services based on two years of telehealth claims data from the COVID-19 pandemic released Sept. 20.

Aetna considers Aduhelm to be medically necessary and said Sept. 13 it will cover the controversial Alzheimer's drug if certain criteria are met.