Author: Scott Welch
On January 15, 2026, the California Department of Managed Health Care (DMHC) issued new guidance in All-Plan Letter (APL) 26-002 clarifying the obligation of health care service plans, including Medi-Cal managed care plans, to reimburse providers for COVID-19 testing and immunizations. California Medical Association (CMA)-sponsored Senate Bill 510 (2021) requires health plans and insurers to reimburse providers ...
Pharmacies may have a better chance to win racketeering lawsuits against other insulin supply-chain players than health plans or patients do. U.S. District Judge Brian Martinotti recently issued two rulings that let pharmacies, or “direct purchaser” plaintiffs, move ahead with claims against pharmacy benefit managers that were based on the federal Racketeer Influenced and Corrupt ...
A few small changes to your daily routine could add years to your life. Combined shifts in sleep, exercise and diet may significantly extend lifespan and years spent in good health, according to a new study published in The Lancet. Researchers at the University of Sydney analyzed data from 59,078 adults in the U.K. Biobank. Their sleep ...
Hospital leaders are getting long-awaited clarity from Congress this week as lawmakers unveil a bipartisan healthcare deal tied to a broader government funding package. The 771-page proposal includes major wins for providers, including a multiyear delay of Medicaid DSH cuts, key Medicare payment extensions for rural hospitals and permanent hospital-at-home authority. It also preserves pandemic-era telehealth flexibilities ...
About 20% of Nevadans who actively selected a health plan through the state’s marketplace, Nevada Health Link, picked a new public option, Nevada Health Authority Director Stacie Weeks told lawmakers Jan. 6. In 2025, Nevada secured federal approval for its Battle Born State Plans, which have premium reduction targets. Nevada Health Link is offering these plans for the first time. ...
A lack of Democratic cooperation and strict Senate rules threaten the legislative viability of the White House framework.
Nevada was awarded nearly $180 million in federal money this week to help modernize the state’s rural health care system and bolster access to it, according to the Trump administration and state officials. “Today’s announcement highlights the Trump administration’s commitment to strengthening the rural health workforce, modernizing facilities and technology, and deploying innovative care models ...
Agencies have one year to use all the money. Twenty projects have “spending concerns,” but the state has not publicly expressed worries about the deadline.
The Centers for Medicare & Medicaid Services (CMS) is continuing to pay Medicare Advantage (MA) plans more — $76 billion more in 2026 — than if those same patients were enrolled in traditional fee-for-service Medicare. That higher cost comes despite a policy CMS redesigned in 2024 to limit MA plans’ ability to exaggerate patients’ health ...
House negotiators have put two major pharmacy benefit manager provisions in big, “must pass” spending package that’s now speeding toward a vote on the House floor. One provision in the Consolidated Appropriations Act, 2026 package would require PBMs to provide employers and other health plan sponsor fiduciaries with detailed prescription drug benefits tracking reports, to help ...