The Alliance of Community Health Plans formed a patient advisory council — including those with diabetes, caregivers and community advocates — to guide research. The council strives to include patient perspectives in chronic disease research and initiatives, a July 9…
Policy Updates
Vermont Republican Gov. Phil Scott signed an executive order July 8 to kick off a state initiative focused on healthcare affordability. The order prompts state agencies to act within their existing authority and develop statutory reform recommendations for the 2027…
Sens. Kirsten Gillibrand, D-N.Y., and Eric Schmitt, R-Mo., sent a letter June 26 to Defense Secretary Pete Hegseth urging the Defense Department to act on a report regarding Tricare’s autism program. A September National Academies of Sciences, Engineering, and Medicine…
Prior authorization reform is moving on multiple fronts in 2026 — through Congress, state capitals, federal courtrooms and the exam rooms where physicians spend an average of 13 hours per week on PA paperwork alone. Here are 10 recent updates…
Democratic senators introduced legislation June 25 that would cap out-of-pocket costs for traditional Medicare beneficiaries. The Medicare Cost Cap Act would install a $5,000 annual cap for Parts A and B cost-sharing — including deductibles, copays and coinsurance — beginning…
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Thirty-one House Democrats are seeking more information on CMS’ Wasteful and Inappropriate Service Reduction model. The lawmakers sent a letter to CMS Administrator Mehmet Oz, MD, June 22, requesting data on the pilot by July 15. WISeR harnesses AI to bring prior…
The House Appropriations Committee moved forward with an amendment that would block funding for a CMS pilot that brings prior authorization requirements to traditional Medicare. The lawmakers adopted the amendment by voice vote June 9 during their 2027 spending bill markup. Under the…
CMS has logged nearly 40,000 complaints alleging potential violations of federal health insurance law since the agency began tracking them in 2022, with the vast majority of closed complaints related to the No Surprises Act, according to an enforcement report…
Prior authorization reforms in Massachusetts went into effect June 5. Democratic Gov. Maura Healey finalized the regulations in May, following through on her earlier plan to tackle prior authorization. Here are six things to know about the reforms: 1. The…
Federal employees will soon need to verify the eligibility of any dependent they add to their health plan under a new rule finalized by the Office of Personnel Management. The rule, published June 2, implements the FEHB Protection Act of…