Twelve Democratic senators signed a March 19 letter detailing their plan for health insurance reforms. The letter said Senate Finance Committee Democratic staff will design policies to elevate affordability, break down barriers to accessing insurance and rein in insurance companies.…
Policy Updates
Louisiana lawmakers are advancing a bill that would restrict how payers use AI and automated decision systems when making coverage determinations, requiring human clinical judgment before any denial and giving enrollees new rights to challenge AI-influenced denials. If passed, the…
The Association for Community Affiliated Plans, Alliance of Community Health Plans, America’s Essential Hospitals, AHIP and the Federation of American Hospitals are asking CMS to pull back on its proposal to permit non-network plans to receive qualified health plan certification,…
Rhode Island Gov. Dan McKee, a Democrat, issued an executive order March 12 to address healthcare affordability in the wake of losing ACA enhanced subsidies. He plans to model other states’ approaches to maximizing federal financial assistance and lowering premiums…
An Illinois Senate bill introduced in February would ban payers from using automated tools, including AI, to downcode physician claims and would require that any downcoding decision be made by a licensed physician of the same or similar specialty as…
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The Georgia Senate has passed a bill that would ban AI tools from being used independently to make coverage decisions. The bill, which passed the chamber unanimously in February, would require a clinician to make the final decision on coverage…
The Iowa House passed legislation on Feb. 25 that would ban health insurers from denying coverage for a service solely because the referring primary care provider is out of network. Under the legislation, insurers would also be barred from imposing…
Anthem Blue Cross of California is bringing its controversial out-of-network penalty policy to California on June 1, a move that has already drawn legislative backlash in the insurer’s home state of Indiana. Under the policy, participating hospitals and facilities in…
CMS issued requests for applications from Medicare Part D plans and state Medicaid agencies to join the voluntary “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth,” known as BALANCE, model. Under the model, CMS will negotiate with manufacturers on…
West Virginia lawmakers proposed a bill in January that would require payers covering cancer chemotherapy to also cover scalp cooling. Scalp cooling can help prevent or limit hair loss during chemotherapy. Under HB 4089, along with the mandate, insurers would…