Groups representing insurers are pushing back on proposed tighter regulations on Medicare Advantage coding. Senate Republicans are considering targeted changes to Medicare Advantage as part of the sweeping “One Big Beautiful Bill.” Lawmakers are considering adding provisions of the No…
Payer Policy Updates
Nebraska Gov. Jim Pillen has signed the Ensuring Transparency in Prior Authorization Act, which aims to overhaul the prior authorization process in the state by making prior auth requirements publicly available on insurers’ websites and ensuring that providers are given…
Vermont Gov. Phil Scott has signed legislation that grants the Green Mountain Care Board new powers to manage the financial health of hospitals and insurers in the state. The GMCB, an independent state agency in Vermont responsible for overseeing the…
Arizona Gov. Katie Hobbs recently signed a bill into law that requires a licensed medical professional to have the final say in claims denials and prior authorization decisions. The new law prohibits insurers from using AI as the final decision-maker…
New Hampshire lawmakers are moving to address surprise ambulance billing with proposed legislation that would prohibit insurers from charging patients the balance between what their insurance covers and what ambulance services bill. The bill would mandate that insurers reimburse for…
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The trade group representing insurers is warning budget legislation could lead to ‘unprecedented’ coverage losses. In a May 22 statement, AHIP President Mike Tuffin said that proposed budget legislation would increase uninsured rates and could raise premiums in the individual…
In a reversal, Colorado will continue to cover GLP-1s for state employees who already have prescriptions, the Colorado Sun reported May 20. Copays for those individuals will increase from $30 to $120 in July, and the state’s health plan will…
CMS will audit every Medicare Advantage plan for potential overpayments annually, in what the agency called an “aggressive” plan to step up oversight. According to a May 21 news release, the agency plans to audit each of the more than…
Federal lawmakers have reintroduced the “Improving Seniors’ Timely Access to Care Act,” a bipartisan bill that aims to streamline the prior authorization process for Medicare Advantage enrollees. The proposal would establish an electronic prior authorization process for Medicare Advantage plans,…
Medicare could face nearly $500 billion in cuts over the next decade under Republicans’ “One Big Beautiful Bill Act,” which also proposes significant reductions to Medicaid and other healthcare programs. According to a May 20 report from the nonpartisan Congressional…