Payer Policy Updates

Medicare Advantage companies are bringing in billions in "questionable" payments found during in-home visits and chart-reviews, HHS' Office of Inspector General claimed in a new audit. 

The Biden administration is proposing rules that would require insurers to cover the costs of over-the-counter contraceptives without a prescription. 

Vice President Kamala Harris has proposed expanding Medicare coverage for home healthcare, NPR reported Oct. 8. 

CMS is proposing new regulations on the ACA marketplace in 2026, which include some aimed at cracking down on fraud. 

The federal government will spend $5 billion to keep Medicare Part D premiums stable in 2025, according to an Oct. 2 report from the Congressional Budget Office. 

Over the last month, California Gov. Gavin Newsom has signed 17 bills pertaining to the deployment and regulation of generative AI technology, including legislation that will require health insurers to ensure that physicians supervise the use of AI tools that…

A new bill will require some forms of insurance in California to pay for IVF. 

Average Medicare Advantage premiums and Medicare Part D premiums will decrease in 2024, CMS said Sept. 27. 

CMS is providing states new guidance to ensure states comply with required Medicaid services for children. 

States must be in full compliance with all of CMS' Medicaid renewal requirements by the end of 2026.