Payer Policy Updates

A federal judge has paused implementation of CMS regulations capping the amount Medicare Advantage companies can pay brokers that sell their plans. 

CMS has approved requests from five states to provide Medicaid coverage to incarcerated people before they are released. 

Oregon has launched a program to provide Medicaid benefits to individuals earning up to 200% of the federal poverty level, the Oregon Capital Chronicle reported July 1. 

Blue Cross and Blue Shield of Rhode Island is eliminating nearly 65% of prior authorization requirements for primary care providers by early 2025. 

The House Ways and Means Committee advanced a proposal to allow Medicare coverage of weight loss drugs for beneficiaries who were prescribed the drug for at least a year before switching to Medicare. 

Lawmakers are pushing CMS to do more to prevent misuse of artificial intelligence by Medicare Advantage plans. 

A federal court kept the ACA preventive care mandate in place for now but raised questions about its constitutionality. 

Washington state opened applications for its Medicaid-like health insurance program for  undocumented adult immigrants on June 20.

Three states recently passed legislation reforming the prior authorization process:

In 2025, Minnesota's Medicaid program will no longer award managed care contracts to for-profit HMOs.