Health plans are backing a proposal from Connecticut Gov. Ned Lamont to cap the rates hospitals can charge for out-of-network services, the CT Mirror reported May 9. The measure would bar providers from charging more than 240% of Medicare rates…
Payer Policy Updates
HHS will not enforce mental health parity regulations opposed by some large employers and insurers. In a May 9 court filing, attorneys for HHS said the department intends to reconsider the rules and may issue a proposed rule rescinding or…
Alabama Gov. Kay Ivey has signed legislation that will allow nonprofit agricultural organizations to offer health benefits in a format that would be exempt from the state’s insurance regulations, a move highly criticized by BCBS Alabama. While not classified as…
Arizona lawmakers have passed legislation that mandates health insurers to have a medical director independently review all claims denials based on medical necessity. The bill, passed May 6, requires the medical director to exercise independent medical judgment and bans relying…
Health insurers face “relatively modest short-term effect from tariffs,” according to an April 28 brief from Fitch Ratings. The short-term effects could change though depending on how long tariffs last and the industries they apply to, and insurers could face…
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CMS is considering proposals that would cut the number of procedures that are subject to prior authorization, Bloomberg reported April 29. Five things to know: 1. People familiar with the discussions told Bloomberg that CMS is exploring making prior authorization…
A federal judge has dismissed a proposed class-action lawsuit that aimed to require insurers in New Mexico to cover medical cannabis as a behavioral health treatment. The complaint was originally filed in June 2022. On April 23, U.S. District Judge…
UnitedHealth Group is feeling “better than pretty good” about the potential for pharmaceutical tariffs and the resulting possible impact on its businesses. President Donald Trump has threatened tariffs on pharmaceutical imports, with U.S. Commerce Secretary Howard Lutnick saying April 13…
CMS’ payment increase of 5.03% in 2026 “will likely significantly support the recovery” of Medicare Advantage plans as they continue to face rising medical costs, according to Fitch Ratings. Increased government scrutiny, reduced base payments and rising utilization in the…
Medicare Advantage plans spent $38 billion on non-Medicare benefits in 2024, according to a Medicare Payment Advisory Commission report. The group, which advises Congress on Medicare issues, held a meeting April 10. According to a presentation, MA plans received $83…