A March analysis from KFF aims to shed light on CMS’ upcoming BALANCE model for GLP-1 coverage — highlighting financial requirements, operational mandates and unresolved policy questions — ahead of its 2027 launch. The model, announced in December, builds on the…
Policy Updates
CMS approved New York’s efforts to roll back Essential Plan coverage for New Yorkers with incomes between 200% and 250% of the federal poverty level, according to a March 23 news release from New York State of Health, the state’s…
New York Attorney General Letitia James reported $1.53 million in restitution and savings in 2025 through her office’s healthcare helpline, according to a March 23 news release. The helpline acts as a resource for New Yorkers seeking clarity on bills,…
CMS has finalized a rule to phase out faxing and mailing for healthcare claims documentation, which it estimates will save the healthcare industry $781 million annually. Four things to know: 1. The Administrative Simplification; Adoption of Standards for Health Care…
A Democrat-led bill that would create a $200 million trust fund for health coverage cleared a Connecticut state Senate committee, according to a March 19 news release. The money would move from the state’s emergency federal response fund into the…
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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.…
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…