Policy and Regulation News

CMS Releases Alzheimer’s Treatment National Coverage Determination

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CMS has finalized its national coverage determination for monoclonal antibodies directed against amyloid, a new potential treatment for Alzheimer’s disease. The agency moved forward with its...

How The No Surprises Act Seeks to Change Surprise Billing

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The No Surprises Act used a couple of methods to reduce surprise billing, though the need for some modifications may remain, according to a resource from AHIP. “The real problem of surprise...

CMS: 2023 Medicare Advantage, Part D Rate Sees 8.5% Revenue Boost

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CMS announced an 8.5 percent boost on average to payer revenues next year in the 2023 Medicare Advantage and Part D Rate, according to a CMS press release. This final rate announcement was higher than...

Uninsured May Lose Access to COVID-19 Services Without Federal Funds

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Uninsured individuals may lose access to free COVID-19 testing, treatment, and vaccines when federal funds and supplies are exhausted, according to an issue brief from the Kaiser Family Foundation...

MACPAC Highlights Dual Eligible Challenges in CMS Proposed Rule

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Transitioning Medicare-Medicaid plans into dual eligible special needs plans may pose challenges that the proposed rule for 2023 Medicare Advantage and Medicare Part D policy and technical changes...

How Eliminating Individual Mandate Impacted the Latino Community

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After Congress zeroed out the Affordable Care ACct's individual mandate, the Latino community experienced a rise in uninsurance that coincided with a deterioration in other important quality of...

Payers React to State of the Union 2022 on ARPA, Drug Costs

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Major payer organizations are reacting to payer-related aspects of the State of the Union address, including making permanent the American Rescue Plan Act premium subsidies and lowering drug...

BBBA, Medicaid Expansion Could Expand Coverage For HIV Community

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In states that have not adopted Medicaid expansion, individuals with HIV have limited access to care, but pending legislation and potential future expansions could change those circumstances, a Kaiser...

CMS Updates Medicare Coverage for Certain Lung Cancer Screenings

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CMS has announced that it will expand the eligibility criteria for a national coverage determination for lung cancer screenings. “Expanding coverage broadens access for lung cancer screening to...

AHIP Comments on Alzheimer’s Drug National Coverage Determination

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AHIP supported CMS on its national coverage determination for monoclonal antibodies (mAbs) directed against amyloid for treating Alzheimer’s Disease and offered recommendations for clarification...

CMS Issues Over-the-Counter Coronavirus Testing Guidance

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CMS released guidance around the over-the-counter coronavirus testing requirement, providing greater clarity regarding what kinds of direct-to-consumer access mechanisms fall under compliance and...

AHIP Calls On Congress to Address Price Gouging of COVID-19 Tests

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AHIP is urging Congress to take action and address the ongoing price gouging of COVID-19 tests that payers are facing from out-of-network providers. In a statement submitted to the House Committee...

Medicare Will Cover OTC Coronavirus Tests At The Counter

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CMS has announced that Medicare will cover over-the-counter coronavirus tests. Medicare beneficiaries will be able to access free over-the-counter coronavirus tests through covidtests.gov. The tests...

CMS Seeks Input on Medicare Advantage, Part D Health Equity Index

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In the 2023 Medicare Advantage and Part D Advance Notice, CMS is requesting comments on the agency’s health equity index which it seeks to introduce into Part D and Medicare Advantage Star...

Industry Reacts to Report on Payer Mental Health Parity Compliance

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Healthcare stakeholders are responding to the 2022 Mental Health Parity and Addiction Equity Act (MHPAEA) Report, with the American Medical Association (AMA) releasing a statement saying that this...

Key Payer Concerns in Proposed 2023 Benefit, Payment Parameters

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Payers are responding to the proposed Notice of Benefit and Payment Parameters for 2023 for the individual health insurance marketplace. The proposed rule addressed a broad range of issues on the...

Top Reasons Why Health Plans Fail Mental Health Parity Compliance

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Payers have not improved their execution of the mental health parity compliance assessment, the Department of Labor’s Employee Benefits Security Administration (EBSA) recently reported to...

Consumers Face Struggles with COVID-19 Testing Access, Coverage

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More than 20 percent of consumers have experienced barriers to COVID-19 testing in the last six months, such as struggling to find a test or forgoing a test because there were no testing options...

AHIP, BCBSA Back HHS, Interim Final Rule in Surprise Billing Lawsuit

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AHIP and the Blue Cross Blue Shield Association (BCBSA) have filed amicus briefs that support the Department of Health and Human Services (HHS) in the surprise billing lawsuit raised by the Texas...

How Private Payers, Medicaid Cover At-Home COVID-19 Testing

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A handful of the largest private payers are evenly split regarding whether they provide direct coverage for at-home COVID-19 testing, according to the Kaiser Family Foundation (KFF) which assessed both...