All Insurance Policy Changes (Page 1306)

Continuing from page 1305. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
[California] Updated housing deposits for Managed Care members: $5,000 maximum — providers must update authorizations
Anthem BCBS·Effective Jun 1, 2026
Effective June 1, 2026, California Medicaid Managed Care (Anthem Blue Cross) updated the maximum authorization for Community Supports housing deposits to $5,000 per waiver period. The policy clarifies allowable expenses (application fees, security deposits, utility setup/first month costs, medically necessary adaptive aids, and basic household items) with new spending caps: $1,000 for the primary member, $500 per additional household member, and $2,500 maximum for all basic household items combined. Providers must update authorizations and referrals to reflect these new limits and eligibility requirements.
Low impact
[Ohio] How care providers can support members in challenging times
Anthem BCBS·Identified Jun 3, 2026
Anthem Medicaid (Ohio) is promoting their Complex Case Management program to help members with chronic conditions and social determinants of health. This is an informational bulletin about an existing service offering, not a billing policy change. Providers can refer patients by phone (844-441-1505) or email, and members can self-refer via their ID card Member Services number.
Low impact
[Ohio] Your patients' healthcare journey: understanding their rights and responsibilities
Anthem BCBS·Identified Jun 3, 2026
This is an informational bulletin from Anthem Blue Cross and Blue Shield Medicaid reminding Ohio providers about member rights and responsibilities. The policy directs providers to review Section 12 of the provider manual for specific member eligibility and rights information, emphasizing collaboration between patients, providers, and plans. No billing workflow changes or new requirements are introduced.
Low impact
[Ohio] Insights on utilization management for care providers
Anthem BCBS·Effective Jun 2, 2026
Anthem Blue Cross Blue Shield Ohio Medicaid has published updated utilization management (UM) guidance clarifying their prior authorization processes, contact procedures, and submission methods. This is an informational policy reinforcing existing UM protocols with no substantive changes to authorization requirements—it serves as a reference guide for providers on how to submit prior auth requests and escalate UM denial decisions.
Low impact
Critical Incident Management System Monthly Provider Demonstration in June
Texas Medicaid·Effective Jun 9, 2026
FEI Systems is hosting a monthly provider demonstration webinar for the Critical Incident Management System (CIMS) on June 9, 2026, from 10-11 a.m. This training is specifically for providers serving individuals with intellectual and developmental disabilities through various Texas programs.
Low impact
Registration Open: 2026 Quality in Long-Term Care Conference
Texas Medicaid·Identified Jun 3, 2026
This is an announcement for the 2026 Quality in Long-Term Care Conference registration, not a policy change affecting medical billing. The notice also mentions that inactive TMHP user accounts are deactivated after 90 days of inactivity.
Low impact
HHSC Publishes Revised PL 2026-06 (Replaces Provider Letter 15-06)
Texas Medicaid·Effective Jun 1, 2026
HHSC has revised the process for submitting Medicaid occupancy reports for nursing facilities. Effective June 1, 2026, all Medicaid occupancy reports must be submitted through the Texas Unified License Information Portal (TULIP) instead of the previous system.
Low impact
HHSC Reminds Regulated Providers to Update Emergency Preparedness Plans for Hurricane Season
Texas Medicaid·Effective Jun 1, 2026
HHSC is reminding Texas healthcare providers to update their emergency preparedness plans for the 2026 hurricane season starting June 1. This affects regulated facilities including nursing homes, assisted living, hospices, hospitals, dialysis centers, and child care operations that must maintain current emergency response plans.
Medium impact
Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective January 1, 2026
Texas Medicaid·Effective Jan 1, 2026
Texas Medicaid & Healthcare Partnership (TMHP) is implementing reimbursement rate updates for certain HCPCS procedure codes under the Children with Special Health Care Needs (CSHCN) Services Program effective January 1, 2026. TMHP will automatically identify and reprocess affected claims, with adjustments appearing on future Remittance and Status (R&S) Reports.
Low impact
Using the Provider Newsroom
Cigna·Effective Jun 2, 2026
Cigna has launched a new Provider Newsroom portal that consolidates news, policy updates, and information across all lines of business in one centralized location. The platform allows providers to create personalized accounts, filter content by specialty or topic, and receive customized newsfeeds for relevant updates.
Medium impact
Avoid Imaging for Low Back Pain When Not Indicated
BCBS Texas·Effective Jun 2, 2026
Blue Cross Blue Shield of Texas is tracking a HEDIS quality measure for appropriate low back pain imaging, discouraging X-rays, MRIs, or CT scans within 28 days of diagnosis for uncomplicated cases in patients ages 18-75. Providers should focus on conservative treatment first and verify prior authorization requirements for advanced imaging.
Medium impact
Standard Professional Fee Schedules: Q2 Updates Now Available for DE, PA, and WV
Highmark·Identified Jun 3, 2026
Highmark has released Q2 2026 updates to standard professional fee schedules for Delaware, Pennsylvania, and West Virginia markets. The updated fee schedules are now available through the Provider Resource Center via Availity Essentials and will affect reimbursement rates for professional services.
Medium impact
REVISED: Continuous Glucose Monitor (CGM) Systems and Supplies – Effective 6/1/2026
Arkansas Medicaid·Identified Jun 3, 2026
Failed to analyze policy change
Low impact
Midwife workforce survey
Minnesota Medicaid (MHCP)·Identified Jun 3, 2026
The Minnesota Department of Health and Department of Human Services are conducting a voluntary workforce survey for midwives to gather data on practices, barriers, and access to maternity care services. This is a data collection initiative, not a billing or coverage policy change, and does not directly impact medical billing operations or claim processing.
Low impact
Trogarzo ® (Ibalizumab-Uiyk)
UnitedHealthcare·Effective Jun 1, 2026
Updated policy for Trogarzo (Ibalizumab-Uiyk), an HIV treatment drug covered under medical benefits. This policy update affects coverage criteria, prior authorization requirements, or billing procedures for this specialty medication used in multidrug-resistant HIV treatment.
Medium impact
Tocilizumab Injection for Intravenous Infusion
UnitedHealthcare·Effective Jul 1, 2026
UnitedHealthcare has revised their Medical Benefit Drug Policy for Tocilizumab injection for intravenous infusion, effective July 1, 2026. This policy update affects coverage and billing requirements for this specialty drug used primarily in rheumatology and oncology practices.
Medium impact
Spevigo ® (Spesolimab-Sbzo)
UnitedHealthcare·Effective Jun 1, 2026
UHC has updated their medical benefit drug policy for Spevigo (Spesolimab-Sbzo), a specialty medication used for treating generalized pustular psoriasis. This policy update affects coverage criteria, prior authorization requirements, or administration guidelines for this high-cost specialty drug.
High impact
Sodium Hyaluronate
UnitedHealthcare·Effective Jul 1, 2026
UnitedHealthcare has revised their Medical Benefit Drug Policy for Sodium Hyaluronate effective July 1, 2026. This policy update affects coverage and billing requirements for hyaluronic acid injections commonly used for joint pain and osteoarthritis treatment.
Low impact
RNA-Targeted Therapies (Amvuttra ® and Onpattro ® )
UnitedHealthcare·Effective Jun 1, 2026
UnitedHealthcare updated their Medical Benefit Drug Policy for RNA-targeted therapies Amvuttra and Onpattro effective June 1, 2026. This policy change affects coverage criteria and billing requirements for these specialized hereditary transthyretin amyloidosis medications.
Medium impact
Provider Administered Drugs – Site of Care
UnitedHealthcare·Effective Jul 1, 2026
A new medical policy regarding Provider Administered Drugs – Site of Care has been revised and will become effective July 1, 2026. This policy update affects medical benefit drug coverage but the specific changes are not detailed in the provided content.
Medium impact
Oxlumo ® (Lumasiran) and Rivfloza ® (Nedosiran)
UnitedHealthcare·Effective Jun 1, 2026
UnitedHealthcare updated the medical benefit drug policy for Oxlumo (Lumasiran) and Rivfloza (Nedosiran), two specialty medications used for rare genetic conditions. This policy update affects coverage criteria and potentially prior authorization requirements for these high-cost specialty drugs.
Medium impact
Natalizumab (Tyruko ® & Tysabri® )
UnitedHealthcare·Effective Jul 1, 2026
UnitedHealthcare has revised their medical benefit drug policy for Natalizumab (Tyruko® & Tysabri®), which are specialty medications used primarily for multiple sclerosis and Crohn's disease treatment. This policy update will take effect July 1, 2026 and may impact prior authorization requirements, coverage criteria, or billing procedures for these high-cost specialty drugs.
Medium impact
Maximum Dosage and Frequency
UnitedHealthcare·Effective Aug 1, 2026
UnitedHealthcare has revised their Maximum Dosage and Frequency policy for medical benefit drugs, effective August 1, 2026. This policy update will likely impact how medication dosing limits are evaluated and may affect prior authorization requirements or coverage determinations for prescription drugs administered in medical settings.
Medium impact
Korsuva ® (Difelikefalin)
UnitedHealthcare·Effective Jul 1, 2026
UnitedHealthcare has updated their medical benefit drug policy for Korsuva (Difelikefalin), which is used to treat chronic kidney disease-associated pruritus in adult hemodialysis patients. This policy update will take effect July 1, 2026 and may impact coverage criteria, prior authorization requirements, or billing procedures for this specialty medication.
Medium impact
Entyvio ® (Vedolizumab)
UnitedHealthcare·Effective Aug 1, 2026
UnitedHealthCare has revised their medical benefit drug policy for Entyvio (vedolizumab), a specialty medication used to treat inflammatory bowel diseases like Crohn's disease and ulcerative colitis. The updated policy changes coverage criteria, prior authorization requirements, or administration guidelines for this high-cost infusion therapy.

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Archive by year

2023 2024 2025 2026

[California] Updated housing deposits for Managed Care members: $5,000 maximum — providers must update authorizations

[Ohio] How care providers can support members in challenging times

[Ohio] Your patients' healthcare journey: understanding their rights and responsibilities

[Ohio] Insights on utilization management for care providers

Critical Incident Management System Monthly Provider Demonstration in June

Registration Open: 2026 Quality in Long-Term Care Conference

HHSC Publishes Revised PL 2026-06 (Replaces Provider Letter 15-06)

HHSC Reminds Regulated Providers to Update Emergency Preparedness Plans for Hurricane Season

Reimbursement Rate Updates for Certain CSHCN HCPCS Procedure Codes Effective January 1, 2026

Using the Provider Newsroom

Avoid Imaging for Low Back Pain When Not Indicated

Standard Professional Fee Schedules: Q2 Updates Now Available for DE, PA, and WV

REVISED: Continuous Glucose Monitor (CGM) Systems and Supplies – Effective 6/1/2026

Midwife workforce survey

Trogarzo ® (Ibalizumab-Uiyk)

Tocilizumab Injection for Intravenous Infusion

Spevigo ® (Spesolimab-Sbzo)

Sodium Hyaluronate

RNA-Targeted Therapies (Amvuttra ® and Onpattro ® )

Provider Administered Drugs – Site of Care

Oxlumo ® (Lumasiran) and Rivfloza ® (Nedosiran)

Natalizumab (Tyruko ® & Tysabri® )

Maximum Dosage and Frequency

Korsuva ® (Difelikefalin)

Entyvio ® (Vedolizumab)