UnitedHealthcare has released the specific procedure codes it will exempt from prior authorization as part of the insurer’s previous pledge to reduce requirements by 30% before the end of 2026. The code lists cover 1,700 procedure codes for a range…
Policy Updates
The Labor Department is proposing a rule that would set criteria for employer associations to sponsor association health plans that qualify as employee welfare benefit and group health plans under the Employee Retirement Income Security Act. Received by the Office…
The Pharmaceutical Care Management Association and its members committed to sharing TrumpRx’s cash prices for drugs through their real-time benefit tools and other cost transparency platforms. An Aug. 13 news release said the association coordinated with the Trump administration and…
When President Trump signed the No Surprises Act into law in 2020, the straightforward premise was that patients should not be blindsided by massive emergency care bills from out-of-network physicians they never chose. On that front, the law has largely…
UnitedHealthcare is rolling out new reimbursement limits on five categories of lab tests across its commercial, ACA, Medicare Advantage and Medicaid plans. The five policies cover allergen testing, liver fibrosis testing, in vitro chemotherapy sensitivity assays, testosterone blood tests and…
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CMS on July 31 finalized its Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule for fiscal 2027, setting a 2.3% payment increase for acute care and long-term care hospitals and locking in the first mandatory, nationwide…
Payer policy changes that are not reflected in contracts are the leading source of revenue leakage for providers, according to a July 29 report from Trek Health in partnership with the Healthcare Financial Management Association. The report is based on…
Senate Democrats want more information on how to enact private health insurance reforms, including feedback on establishing a federal public option. The 86-page RFI, published July 30, asks stakeholders and policy experts for their input on dozens of potential policy…
CMS will discontinue the Part D premium stabilization program at the end of this year, returning the standalone prescription drug plan market to what the agency called “traditional market conditions.” CMS said July 28 its analysis of 2027 bids indicated…
As HHS hosts payers and medical associations in Washington, D.C., it will introduce a pledge July 29 to advance mental health and addiction care nationwide. Optum CEO Patrick Conway, MD, told Becker’s on July 27 that his company will be…