This month's policy signals for health systems:
House bill targeting prior authorization introduced
Bipartisan group of House representatives introduce bill targeting Medicare Advantage (MA) prior authorization: The Medicare Advantage Improvement Act of 2026 introduced April 20 would tighten existing timelines for prior authorization responses and require real-time authorization decisions for some services. The bill would also create a compliance scoring system for MA plans, and those with low scores could see up to a 2% automatic payment cut to all of a given insurer’s MA plans. Read the press release from the office Rep. Mariannette Miller-Meeks, M.D., and more from Becker’s Hospital Review.
Relatedly, insurers announce they will be voluntarily adopting a standardized approach to prior authorization requests: In a joint statement released April 24, AHIP, the Blue Cross Blue Shield Association, and several undersigned health plans announced their commitment to “streamline, simplify and reduce prior authorization”. Specific actions that the plans have committed to include making specific reductions to prior authorization appropriate to local markets, honoring existing prior authorizations for a transition period, and enhancing beneficiary communications. Read the joint press release from AHIP and more at Fierce Healthcare and Inside Health Policy.
Nebraska first state to implement Medicaid work requirements
Nebraska rolls out Medicaid work requirements, becoming first state to do so: States were given until January 1, 2027, to craft and implement a community service requirement for Medicaid participants ages 19 to 64, putting Nebraska’s implementation 8 months ahead of schedule. Advocates have warned that the quick implementation could cause some otherwise eligible beneficiaries to lose coverage, though the state has said they have prepared for the requirements through staff training and communications to impacted enrollees. Nebraska has also published a list of conditions the state considers “medically frail” that would exempt beneficiaries from the new requirements. Read more from The Hill, Modern Healthcare, and Inside Health Policy.
Brookings publishes No Surprises Act Databook
Brookings Center on Health Policy publishes databook analyzing prices for healthcare services after arbitration under No Surprises Act (NSA): Researchers at Brookings analyzed government data from 2024 and parts of 2023, finding that some healthcare prices actually rose after the law’s arbitration process, despite the goals of the NSA. Specifically, prices for emergency services, imaging, and pediatric critical care after arbitration in 2024 were all higher than in-network price estimates prior to the enactment of the NSA. Researchers attribute this in part to arbitrators deciding in favor of providers more often. Access the databook and read more at Healthcare Dive.