Monday, April 3, 2023: Payers

The Centers for Medicare and Medicaid Services (CMS) announced Friday that it will phase in controversial changes to the Medicare Advantage risk adjustment model over three years. The Biden administration wasn’t persuaded by the insurance industry and other health...

Thursday, March 30, 2023: Payers

Bill Cassidy and Jeff Merkley introduced legislation to cut overpayments to Medicare Advantage plans by updating risk adjustment policies, with Cassidy saying in a statement that the bill will help squeeze out waste in the MA program. The legislation comes amid...

Wednesday, March 29, 2023: Payers

UnitedHealthcare, the nation’s largest health insurer, is expected to announce plans today to reduce the number of prior authorization requirements for a list of medical procedures and devices. The insurer also said it would eliminate, starting next year, many...

Thursday, March 23, 2023: Payers

California Governor Gavin Newsom is tapping federal health care funding to cover rent for homeless people and those at risk of losing their housing. States are barred from using federal Medicaid dollars to pay directly for rent, but California’s governor is asking the...

Tuesday, March 21, 2023: Payers

The Medicaid and CHIP Payment and Access Commission (MACPAC) released proposals for Congress as part of its March report last week and included a recommendation that would give states the power to not pay full prices under Medicaid for drugs approved under the Food...

Monday, March 20, 2023: Payers

A group of House lawmakers is hoping to outlaw the use of spread pricing by pharmacy benefit managers (PBMs) in the Medicaid program. The Drug Transparency in Medicaid Act, reintroduced Friday, is the latest PBM reform bill launched by this Congress. The bipartisan...