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The two-midnight rule and Medicare Advantage: 8 updates
In 2024, Medicare Advantage plans must provide coverage for an inpatient admission when the admitting physician expects the patient to require hospital care for at least two midnights, otherwise known as the two-midnight rule. -
CMS extends Medicaid waivers to 2025
CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. -
Lawmakers pitch expanded doula coverage in Medicaid
Federal lawmakers are proposing allowing Medicaid reimbursement of doulas and midwives in every state. -
Illinois expands weight loss drug coverage to state employees
Illinois is expanding coverage of weight-loss drugs to state employees, a move Gov. JB Pritzker's office estimates could cost up to $210 million annually, WBEZ reported April 30. -
Biden administration: DACA recipients eligible for ACA coverage
Individuals who are part of the Deferred Action for Childhood Arrivals program will be able to enroll in ACA marketplace plans beginning in November. -
State health plans must cover gender-affirming surgery, federal court rules
A federal appeals court has ruled that state health plans must cover gender-affirming surgery for transgender beneficiaries, The Washington Post reported April 30. -
CMS, NCQA delay health plan quality reporting following Change attack
CMS and the NCQA are extending the quality data submission deadline for health plans by two weeks due to "extraordinary circumstances" caused by the cyberattack on Change Healthcare in late February. -
California lawmakers trying again for single-payer
California lawmakers have introduced legislation again that would provide "comprehensive universal single-payer" health coverage for all 39 million residents of the state under a program called CalCare. -
CMS delays implementation of new Medicare, Medicaid data rules
CMS will delay implementation of new policies designed to heighten security around Medicare and Medicaid data that drew criticism from researchers. -
CMS finalizes 2025 Medicare Advantage rule: 11 key updates
CMS issued its final 2025 Medicare Advantage and Part D rule April 4, setting new standards around marketing, broker payments, and prior authorization. -
CMS finalizes marketplace network rules: 5 things to know
CMS finalized several proposed changes to regulations for the ACA marketplace in 2025. -
Why higher Medicare Advantage utilization wasn't reflected in 2025 rates
CMS has finalized a slight decrease in Medicare Advantage benchmark payments for 2025, despite large insurers reporting rising costs and utilization among MA members. -
CMS finalizes 2025 Medicare Advantage rates
CMS finalized a slight decrease in Medicare Advantage benchmark payments for 2025. -
Kentucky prior authorization gold carding bill 'dead'
Proposed legislation in Kentucky to create a gold carding program for prior authorization requests has failed, the Winchester Sun reported March 29. -
CMS to extend ACA signup window for those losing Medicaid coverage
CMS will extend a special enrollment period for ACA coverage with the goal of getting more people losing Medicaid insured. -
Biden cracks down on junk health plans
The Biden administration is cracking down on short-term 'junk' health plans that can leave members with poor coverage and large medical expenses. -
CMS to cut red tape for Medicaid, CHIP enrollment in final rule
CMS finalized new rules that are intended to eliminate barriers to Medicaid and CHIP access. -
Senators eye dual-eligible changes: 5 things to know
A bipartisan group of senators is introducing legislation to require states to offer integrated Medicaid and Medicare plans to dual-eligible beneficiaries. -
AMA calls for list of payers offering advanced provider payments following Change hack
The American Medical Association is asking for more flexibility and resources from the federal government for providers that continue to face disruptions from the Change Healthcare hack in late February. -
Biden administration pitches 'Medicaid-like' coverage in nonexpansion states
The Biden Administration is doubling down on a proposal to create "Medicaid-like" coverage for low-income adults in states that have not expanded the program.
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