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6 states with price transparency requirements for payers
Though federal price transparency requirements for payers have been in effect since July 2022, several states moved faster to enact their own requirements and add additional regulations, according to a July 21 analysis from the National Conference of State Legislatures. -
University of Texas dropping weight loss drug coverage for employees
The University of Texas System is planning to drop coverage for weight loss drugs such as Wegovy under its employee and retiree health plans, citing high costs and low adherence rates. -
Biden administration pitches tougher mental health parity standards for payers
The White House is proposing stronger standards for insurers' coverage of mental health services. -
Ascension drops weight loss drug coverage for employees
St. Louis-based Ascension has dropped coverage for weight loss drugs such as Wegovy from its employee health plan. -
'An industry-shifting moment': Employers, payers tussle over claims data
As insurance premiums continue to rise nationwide, lawsuits from large, self-insured employers are being filed against health insurers in an effort to access complete medical claims data and fulfill fiduciary duties under federal law. -
New bill aims to overturn ban on Medicare coverage of weight loss drugs
A new bill filed in the Senate July 20 aims to lift the ban on Medicare coverage of weight loss drugs such as Ozempic and Wegovy. -
CMS approves mobile crisis services for Medicaid enrollees in California, Kentucky
CMS has approved proposals from California and Kentucky for community-based mobile intervention teams to provide behavioral crisis services to Medicaid enrollees. -
CMS pitches expanded coverage of PET scans for Alzheimer's disease
CMS is proposing broader coverage of PET scans for patients with Alzheimer's disease, which can help determine if patients are eligible for newly-approved drugs to treat the disease. -
8 recent CMS moves
From requiring hospitals to post the cost of services in more consumer-friendly formats to proposing complete coverage of HIV prevention drugs for Medicare enrollees, these are eight CMS updates Becker's has reported since June 22: -
CMS wants Medicare to cover PrEP without cost-sharing
CMS is proposing new coverage guidelines for HIV prevention drugs in Medicare, requiring the program to cover the drugs without cost sharing for beneficiaries. -
Oregon removes immigration status as Medicaid coverage obstacle
Medicaid coverage in Oregon is available to all adults and children who meet eligibility criteria — regardless of immigration status — as of July 1. -
Medicare will cover Alzheimer's drug Leqembi: 5 things to know
Medicare will provide broader coverage of Leqembi, a drug that has been shown to slow the progression of Alzheimer's disease, now that the drug has received full FDA approval. -
White House taking aim at surprise medical bills, 'junk' insurance
President Joe Biden announced a series of actions aimed at addressing surprise medical billing, unfair medical debt and "junk" short-term insurance plans. -
CMS updates Medicare drug price negotiation guidelines
CMS published updated guidance for the Medicare Drug Price Negotiation program, based on feedback from more than 7,500 public comments. -
Government watchdog wants CMS to up auditing of Medicaid managed care
The Government Accountability Office is urging CMS to consider adding Medicaid managed care programs to the scope of its recovery audit program. -
The 2-midnight rule and Medicare Advantage: 6 things to know
There are major changes afoot for Medicare Advantage plans in 2024 and when they are required to cover inpatient services in hospitals for their members. The changes are likely to present challenges for hospitals and how physicians document inpatient care. -
California lawmakers reach deal on largest-ever Medicaid investment
California lawmakers and healthcare stakeholders have reached a major deal that represents the largest-ever investment in Medi-Cal, the state's Medicaid program, Politico reported June 24. -
CMS pitches Medicare coverage pathway for new medical devices
CMS is proposing a new pathway for Medicare coverage of new treatments designated as breakthrough devices. -
13 recent CMS moves
From proposed price transparency requirements under Medicaid to a new No Surprises Act website, these are 13 CMS moves reported by Becker's since April 1: -
CMS to states: Slow down Medicaid redeterminations
CMS officials are urging states to double-down on efforts to prevent people from unnecessarily losing Medicaid coverage.
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