A Colorado law equalizing behavioral and physical health in insurance coverage went into effect Jan. 1, preventing carriers in the state from limiting the “medically necessary treatment” of behavioral, mental health and substance use disorders. The law was passed in…
Policy Updates
An Arkansas law has expanded coverage for bariatric surgery, but not weight-loss drugs. Under Act 628, the state’s Medicaid program and commercial plans must cover bariatric surgery — along with its preoperative and post-operative care — for individuals with “severe…
Health insurers face a wave of regulatory and policy changes in 2026, from the expiration of enhanced ACA premium tax credits to tighter prior authorization rules and new state coverage mandates. Here’s a rundown of major federal and state payer…
Fourteen House lawmakers are calling on federal officials to investigate Elevance Health’s new policy that will penalize hospitals that use out-of-network providers, arguing the approach is anti-competitive and undermines the No Surprises Act. On Dec. 18, the bipartisan group of…
CMS shared plans Dec. 23 for its voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model. The announcement comes weeks following the White House’s agreements with Eli Lilly and Novo Nordisk to apply most-favored-nation…
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The American Hospital Association and Federation of American Hospitals are calling on Elevance Health to rescind a new policy that would penalize hospitals for using out-of-network providers. In a Dec. 17 letter to Elevance President and CEO Gail Boudreaux, AHA…
UnitedHealthcare is delaying a coverage policy that would have sharply restricted remote physiologic monitoring services for most chronic conditions. The policy, which had been scheduled to take effect Jan. 1, will now be implemented later next year, the insurer confirmed…
The National Council of Insurance Legislators adopted the Prior Authorization Reform Model Act sponsored by a Mississippi state senator at the group’s annual meeting. “The model will protect the provider-patient relationship from unnecessary third-party interference, prevent programs from hindering the…
U.S. Democratic Sens. Patty Murray of Washington, Ron Wyden of Oregon and Kirsten Gillibrand of New York introduced a bill that would block the CMS Wasteful and Inappropriate Service Reduction model. The six-year WISeR pilot, set to kick off next…
On Dec. 15, CMS published 24 quality and efficiency measures under consideration for adoption in Medicare programs. HHS employs this pre-rulemaking process to decide on measures for Medicare programs and releases a public list of the pitched measures each year.…