Payer Policy Updates

America's Health Insurance Plans supported CMS' preliminary guidance on covering Aduhelm, Biogen's Alzheimer's disease treatment, calling its decision "the right approach."

Mississippi's House of Representatives passed an amendment to a bill that would bar the state from contracting Medicaid services to entities that have settled with the state for over $50 million — a move specifically targeting Centene — according to…

CMS released additional guidance Feb. 4 on how payers should best cover at-home COVID-19 tests. 

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.