Payer Policy Updates

The Biden administration may look to require nursing homes to spend a majority of their Medicaid funding on direct care for residents and place a limit on using funds for operations, maintenance, capital improvements or profits, according to Kaiser Health…

In today’s world, convenience is a big element of our lifestyles. Why do healthcare benefits still seem so inconvenient?

Effective June 7, United Healthcare will require and Optum will manage prior authorization for the following outpatient radiation therapies:

Anthem Blue Cross is halting reimbursement of consultation services for its commercial plans. 

Blue Cross Blue Shield Healthcare Plan of Georgia plans to end its "avoidable emergency room" program on March 18.

UnitedHealthcare is rolling out a new obstetrical ultrasound policy for commercial members starting June 1, the payer said March 1.  

Georgia lawmakers are pitching a bill that would require families to be rescreened for possible eligibility if they lose their health insurance — a failsafe as states brace for an ACA enrollment cliff — according to the Augusta Chronicle. 

The FTC is requesting large, vertically-integrated players in the pharmacy benefit management industry share insights on their influence over drug pricing and access. 

Two Iowa lawmakers are calling on CMS to extend the eligibility for transitional health plans through 2023. 

Maine is the first state to combine its individual and small group insurance markets under the ACA, according to the Press Herald.