CMS Mulling Further Crackdown On Insurers’ Prior Authorization Policies
CMS Administrator Chiquita Brooks-LaSure agreed that patient and provider frustrations with insurers' prior authorization requirements have risen in recent years, Modern Healthcare reports. Elevance, Cerebral, Cedars-Sinai, and other industry names are also in the news.
Modern Healthcare:
Prior Authorization Crackdown May Be Coming: CMS’ Brooks-LaSure
The Centers for Medicare and Medicaid is evaluating whether it needs to take further steps cracking down on health insurance companies' prior authorization requirements. Patient and provider annoyance with prior authorization has boiled over in recent years, which CMS Administrator Chiquita Brooks-LaSure acknowledged at the American Hospital Association's annual conference in Washington, D.C., on Monday. (McAuliff, 4/15)
Modern Healthcare:
Why Elevance, SCAN Are Suing Over Medicare Advantage Star Ratings
Insurance companies have hit federal agencies with a flurry of lawsuits in recent months over the government’s administration of the Medicare Advantage star ratings program. Four health insurance companies have sued the Centers for Medicare and Medicaid Services, CMS Administrator Chiquita Brooks-LaSure, the Health and Human Services Department and HHS Secretary Xavier Becerra over the process for determining carriers’ scores in the federal quality ratings program. (Tepper, 4/15)
KFF Health News:
Lawsuit Alleges Obamacare Plan-Switching Scheme Targeted Low-Income Consumers
A wide-ranging lawsuit filed Friday outlines a moneymaking scheme by which large insurance sales agency call centers enrolled people into Affordable Care Act plans or switched their coverage, all without their permission. According to the lawsuit, filed in U.S. District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards. (Appleby, 4/16)
Modern Healthcare:
Cerebral Fined $7M By FTC Over Social Media Data Disclosure
Digital mental health company Cerebral, based in Walnut, has agreed to pay more than $7 million in fines, limit how it shares sensitive patient data and provide consumers an easier way to cancel its services. The Department of Justice, through a referral by the Federal Trade Commission, issued a proposed order on Monday that fined Cerebral more than $7 million for allegedly disclosing consumers' sensitive personal health information and failing to honor its easy cancellation promises. (Turner, 4/15)
Modern Healthcare:
How Cedars-Sinai’s AI Tools Reach Spanish-Speaking Patients
As the excitement over artificial intelligence-driven tools builds, some health systems are looking to expand their use to improve communication with patients who don't speak English. Los Angeles-based Cedars-Sinai said last week it had launched a version of its Cedars-Sinai Connect app for Spanish-speaking patients and their families. The app offers an AI-enabled symptom checker and allows patients to chat with primary care providers through video or text messaging. (Perna, 4/15)
Also —
Axios:
Physician Assistants' Push For Title Change Gains Momentum
Physician assistants have won the first round in an unusual push to rebrand themselves as physician associates. And doctors aren't amused. The title change reflects PAs' growing prominence in the health care system amid a nationwide physician shortage, and dovetails with other efforts to increase PAs' autonomy. (Goldman, 4/16)
