Payer Policy Updates

Several states are considering regulating how insurers can use AI in prior authorization.  In January, a California law took effect that prohibits payers from making coverage decisions based solely on artificial intelligence algorithms. The law requires any denial, delay or…

Texas lawmakers have introduced legislation that would allow employers to offer health coverage that does not include certain state-mandated health benefits, such as childhood vaccines, hearing screenings, cancer screenings, mental health coverage and diabetes services. The bill was introduced March…

At least nine states are pushing to implement work requirements for their Medicaid programs.  President Donald Trump backed Medicaid work requirements during his first administration. During Mr. Trump’s first term in office, 13 states chose to implement work requirements in…

Idaho lawmakers have passed legislation aimed at transitioning the state’s Medicaid program to a managed care system while introducing work requirements for able-bodied adults and providing tax credits to help individuals purchase coverage on the state’s ACA exchange.

Minnesota lawmakers have introduced a bill that would require health insurance coverage for the management and treatment of obesity, including GLP-1s.

CMS is proposing a set of new regulations for ACA marketplaces, including shortening the annual enrollment window and rescinding eligibility for DACA recipients. 

UnitedHealthcare plans to cut prior authorization requirements by around 10% in 2025. 

Ohio lawmakers have introduced a new bill that would offer a tax credit to small businesses that provide employees with individual coverage health reimbursement arrangements, or ICHRAs. 

President Donald Trump has signed an executive order aimed at cracking down on price transparency requirements for hospitals and insurers. 

Aetna is walking back a proposed policy change involving reimbursement rates for services provided by nurse practitioners and nurse midwives.