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Legislation would up Medicare Advantage transparency standards
A bipartisan group of senators is introducing legislation that would require Medicare Advantage plans to report more encounter data. -
Medicare Advantage ads still under CMS scrutiny
From October to December, airwaves are flooded with advertisements for Medicare Advantage plans, urging beneficiaries to call and review their options. -
'Worse than people can imagine': 5 Medicaid redeterminations updates
It's been more than seven months since the first states began the process of unwinding the continuous Medicaid enrollment period in place for three years during the pandemic, resulting in state agencies and beneficiaries reporting major operational challenges and exacerbated care access issues. -
Why BCBS Massachusetts is cutting 14K prior authorization requirements
Blue Cross Blue Shield of Massachusetts' plan to remove 14,000 prior authorization requirements for home care services is a response to the capacity crisis in the state's hospitals, the payer's chief medical officer Sandhya Rao, MD, told NPR affiliate WBUR Nov. 8. -
CMS proposes new Medicare Advantage audit appeals process
CMS is proposing a standard appeals process for risk adjustment data validation audits in Medicare Advantage. -
CMS proposes more crackdowns on Medicare Advantage marketing, broker payments
CMS is proposing a set of new Medicare Advantage rules, including new standards that would impose more limits on plans' payments to brokers and limit the role of third-party marketers. -
CMS proposes health equity mandates for Medicare Advantage prior authorizations
CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. -
BCBS Massachusetts to cut 14,000 prior authorization requirements
Blue Cross Blue Shield of Massachusetts is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1. -
UnitedHealthcare's 2nd wave of prior authorization cuts begins
The second and final wave of UnitedHealthcare's prior authorization cuts began Nov. 1. -
Private payer's prices highest in upper Midwest and Southeast, price transparency study finds
Payers' negotiated prices for office visits and medical services can vary widely from county to county, according to a price transparency study published Oct. 27 in JAMA Health Forum. -
Senators want to bust Medicare Advantage 'ghost' networks
Lawmakers are introducing a bill to crack down on inaccurate provider directories in Medicare Advantage. -
Lawmakers look to ease Medicaid churn
A group of U.S. senators and representatives are introducing legislation to provide Medicaid enrollees with a year of continuous coverage. -
Senators urge more action from CMS on misleading Medicare Advantage marketing
A group of senators says CMS actions to crack down on misleading marketing of Medicare Advantage plans do not go far enough. -
The Better Medicare Alliance's vision for MA: 10 things to know
The Better Medicare Alliance is recommending a set of policies to Congress and CMS to improve prior authorization, behavioral health access, equity and more in the program. -
Michigan codifies ACA provisions into state law
Michigan has codified several provisions of the Affordable Care Act into state law, ahead of a Supreme Court case that could strike down the law's preventive care coverage requirements. -
Former BCBS CEO: Health plans should consider medical marijuana coverage
Payers could soon face pressure to reconsider medical marijuana coverage policies following HHS' recommendation in August that the Drug Enforcement Administration reschedule the drug to a substance accessible through a prescription under federal law. -
Lawmakers are scrutinizing managed care
Federal lawmakers have been probing payers on a variety of issues in recent months, raising concerns on prior authorizations, Medicare Advantage costs, artificial intelligence and more. -
Looming government shutdown could disrupt Medicaid redeterminations
A government shutdown could cause hiccups in the unwinding of Medicaid continuous coverage requirements. -
AHIP backs legislation expanding Medicare Advantage supplemental benefits
Two lawmakers are introducing legislation that would expand the scope of supplemental benefits offered in Medicare Advantage. -
AHIP, health systems on opposite sides of No Surprises Act debate
Payers and providers don't agree on much when it comes to the No Surprises Act dispute resolution process.
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