All Insurance Policy Changes (Page 6)

Continuing from page 5. 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
New Medications Requiring Approval & Site of Care Management Updates Effective October 1, 2026
CareFirst BlueCross BlueShield·Identified Jul 28, 2026
Failed to analyze policy change
High impact
Medicaid Budget Impact on Provider Reimbursement: Update
Kentucky Medicaid·Effective Jul 22, 2026
Kentucky Medicaid has reversed the previously announced 4% reduction to provider reimbursement rates effective immediately. Reimbursement rates will remain at current levels. This is a temporary solution while the state works on longer-term Medicaid funding strategies.
Medium impact
HB2 Waitlist Verification Letter
Kentucky Medicaid·Effective Jan 31, 2026
Kentucky HB 2 requires providers to collect and submit Provider Attestation forms for all individuals currently on Michelle P. Waiver (MPW) or Home and Community Based (HCB) Waiver waitlists by January 31, 2027. The attestation must include primary diagnosis, required waiver services, and provider signature from eligible clinicians. Individuals who do not submit attestations will be removed from the waitlist after documented outreach attempts.
Medium impact
Topical Rosacea Products (Revised)
Humana·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
Besremi (ropeginterferon alfa-2b-njft) (Revised)
Humana·Identified Jul 28, 2026
This is a revised Prior Authorization policy for Besremi (ropeginterferon alfa-2b-njft), a medication for Medicare Advantage members. The policy update requires prior authorization before dispensing this drug. Billing teams must implement this requirement immediately to prevent claim denials.
Medium impact
Uptravi® (selexipag) (Revised)
Humana·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
Sinonasal and Eustachian Tube Surgical Procedures - Medicare Advantage (Revised)
Humana·Identified Jul 28, 2026
This Medicare Advantage policy defines coverage criteria for minimally invasive sinonasal and Eustachian tube surgical procedures. Coverage requires that patients have chronic or recurrent disease and have failed appropriate medical management prior to surgery. Billing teams must ensure prior authorization processes verify these prerequisites before claims submission.
Low impact
Provider Letter 2026-13: Re: Executive Order 2025-16 Attestation Update
Oklahoma SoonerCare·Identified Jul 28, 2026
OHCA is eliminating the separate attestation process for Executive Order 2025-16 compliance. Providers now verify compliance through routine provider enrollment and contract renewal instead of submitting separate attestations. Currently enrolled providers require no immediate action until their regular renewal cycle.
High impact
DSS Important Message - Hospital Monthly Important Message - 07.20.2026
Connecticut Medicaid (HUSKY Health)·Effective Jul 1, 2026
Connecticut DSS is updating CMAP Addendum B V27.2 effective July 1, 2026 to incorporate 2026 HCPCS code changes (additions, deletions, descriptions). Updated PDF and Excel files will be posted July 28, 2026. Payment rate changes for procedure codes with status indicators G, K, or K1 were already loaded July 9, 2026. Additionally, psychiatric Collaborative Care Model (CoCM) coverage begins July 1, 2026 for HUSKY Health members, and clinical review criteria are being updated. Prior authorization requirements for inpatient elective admissions are clarified, with emphasis on timely authorization updates to prevent claim denials.
Medium impact
DSS Important Message - Open Office Hours for Multi-Factor Authentication/Security Questions; Multi-Factor Authentication Mandated Enrollment on August 1, 2026; Security Question Updates, Notifications
Connecticut Medicaid (HUSKY Health)·Effective Aug 1, 2026
Connecticut Medical Assistance Program (CMAP) is mandating Multi-Factor Authentication (MFA) enrollment for all providers, trading partners, and drug labelers accessing the secure web portal by August 1, 2026. Users must choose between Authenticator App or Email Verification methods. Additionally, security question structure has been updated to use structured dropdown menus (effective May 13, 2026), and password change notifications are now sent to users and Master Users when account security information is modified.
High impact
Temporary Deactivation of Maximum Daily Limits for Drugs on Crossover Claims
Missouri Medicaid (MO HealthNet)·Effective Jul 23, 2026
Missouri Medicaid has temporarily deactivated maximum daily limits for drugs on crossover claims (claims involving both Medicare and Medicaid). This means pharmacy claims that previously hit daily cap limits will now process without restriction during this temporary period. Billing teams must stop applying daily maximums to crossover drug claims and monitor for when this policy expires.
High impact
Department of Mental Health and Brain Injury Waiver Providers: Be Prepared for Electronic Visit Verification Hard Launch
Missouri Medicaid (MO HealthNet)·Effective Oct 1, 2026
The Missouri Department of Mental Health and Brain Injury Waiver program is implementing a hard launch of Electronic Visit Verification (EVV) requirements on October 1, 2026. After this date, all claims for DDD and Brain Injury Waiver personal care services (Provider Type 85) must have an active EVV vendor in the EVV Aggregator Solutions (EAS) system and verified visits documented, or claims will be automatically denied.
High impact
Upcoming Mandatory MFA Implementation for eMOMED
Missouri Medicaid (MO HealthNet)·Effective Aug 15, 2026
eMOMED (Missouri Medicaid's electronic system) is implementing mandatory Multi-Factor Authentication (MFA) effective 8/15/2026. All users must have already selected and registered an MFA method (SMS, Email, or Authenticator App) by the enforcement date, or they will be unable to log in to the system.
Medium impact
Bureau of Special Health Care Needs Program Name Changes
Missouri Medicaid (MO HealthNet)·Identified Jul 28, 2026
Failed to analyze policy change
Medium impact
Mutual News August 2026 Newsletter
Medical Mutual of Ohio·Effective Oct 30, 2026
Mutual of Omaha released an August 2026 policy update with new medical policies (including Sacral Nerve Stimulation), updates to existing policies (Bone Graft Materials and Digital Therapeutics), and numerous Avalon LBM policy updates affecting laboratory and diagnostic testing. Material changes are effective 90 days from notice date (October 30, 2026), while administrative changes take effect 15 days from notice. New prior authorizations take effect 30 days from notice (August 31, 2026).
Low impact
Introducing Preventive Care Connections
L.A. Care Health Plan·Effective Jul 28, 2026
L.A. Care Health Plan is launching Preventive Care Connections, a new provider communication series designed to support primary care practices in improving preventive care delivery, increasing Annual Wellness Visit completion, and addressing barriers to care. The initiative will roll out practical resources over coming months covering Community Resource Centers, transportation benefits, community link services, and balance billing compliance, culminating in a comprehensive toolkit.
Low impact
Introducing Preventive Care Connections
L.A. Care Health Plan·Effective Jul 28, 2026
L.A. Care Health Plan is launching 'Preventive Care Connections,' a new provider resource series designed to support Primary Care Physicians in improving preventive care delivery and increasing Annual Wellness Visit completion. The initiative will roll out practical tools and resources over coming months addressing transportation barriers, social determinants of health, member engagement, and compliance topics, culminating in a consolidated toolkit.
High impact
26-839 Prior Authorization Now Required for Outpatient Hospice Services
Health Net·Effective Jul 9, 2026
Effective July 9, 2026, Health Net/CalViva Health now requires prior authorization for outpatient hospice services under updated Medi-Cal regulations. Hospice providers must immediately stop using the CTI email inbox (HospiceCTIforms@centene.com) and submit all prior authorization requests through standard channels (fax, phone, or provider portal) with complete required documentation including Certificate of Terminal Illness, Medi-Cal Election Notice, and plan of care.
High impact
26-838 Prior Authorization Now Required for Outpatient Hospice Services
Health Net·Effective Jul 9, 2026
Effective July 9, 2026, Health Net requires prior authorization for outpatient hospice services under updated Medi-Cal regulations. Hospice providers must immediately stop submitting requests via email to HospiceCTIforms@centene.com (disabled September 14, 2026) and instead use fax, phone, or the provider portal. All prior authorization requests must include Certificate of Terminal Illness, Medi-Cal Hospice Program Election Notice, initial plan of care, and other required documentation.
High impact
26-851 Definitive Drug Testing Billing Change, Effective October 1, 2026
Health Net·Effective Oct 1, 2026
Health Net will no longer reimburse CPT codes 80320-80377 for definitive drug testing effective October 1, 2026. Providers must transition to HCPCS G-series bundled laboratory codes (G0480-G0483) to avoid claim denials. All billing systems, charge masters, and workflows must be updated before the effective date.
High impact
26-840 Prior Authorization Now Required for Outpatient Hospice Services
Health Net·Effective Jul 9, 2026
Effective July 9, 2026, Health Net requires prior authorization for outpatient hospice services under Medi-Cal regulations in Imperial County. Hospice providers must immediately stop using the CTI email inbox and submit all prior authorization requests through standard channels (fax, phone, or provider portal) with complete required documentation to avoid claim delays and denials.
High impact
26-944 Electronic Claims Payments with Zelis are Going Live
Health Net·Effective Jul 29, 2026
Health Net is implementing a new electronic claims payment system through Zelis, requiring all providers (except those already enrolled in ZAPP Edge) to select an electronic payment option by July 29, 2026, to avoid receiving paper checks. Providers must enroll in either the Health Net ePayment Center or Zelis payment options to maintain uninterrupted electronic claims payments.
High impact
26-946 Electronic Claims Payments with Zelis are Going Live
Health Net·Effective Jul 29, 2026
Health Net is implementing a new electronic claims payment system through Zelis, requiring all providers (except those already enrolled in ZAPP Edge) to select an electronic payment option by July 29, 2026, to avoid payment delays via paper check. Providers must enroll in either Health Net ePayment Center or Zelis payment options; capitation payments are unaffected.
High impact
26-945 Electronic Claims Payments with Zelis are Going Live
Health Net·Effective Jul 29, 2026
Health Net is implementing a new electronic claims payment system through Zelis, requiring all providers (except those already enrolled in ZAPP Edge) to select an electronic payment option by July 29, 2026, or face payment delays via paper check. Providers must enroll in either the Health Net ePayment Center or Zelis payment services to maintain uninterrupted electronic claims reimbursement.
Medium impact
26-887 Integrate "One Small Thing" Into Postpartum Visits Today
Health Net·Effective Jul 27, 2026
HealthNet California (Medi-Cal, Imperial County) is implementing a new 1-2 minute intervention called 'One Small Thing' to be integrated into postpartum visits. This initiative aims to strengthen patient support and improve follow-up care during postpartum encounters. Providers, PPGs, hospitals, ancillary providers, community support providers, ECM providers, and behavioral health providers must incorporate this intervention into postpartum visit workflows.

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2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 6) | PolicyChanges.app

New Medications Requiring Approval & Site of Care Management Updates Effective October 1, 2026

Medicaid Budget Impact on Provider Reimbursement: Update

HB2 Waitlist Verification Letter

Topical Rosacea Products (Revised)

Besremi (ropeginterferon alfa-2b-njft) (Revised)

Uptravi® (selexipag) (Revised)

Sinonasal and Eustachian Tube Surgical Procedures - Medicare Advantage (Revised)

Provider Letter 2026-13: Re: Executive Order 2025-16 Attestation Update

DSS Important Message - Hospital Monthly Important Message - 07.20.2026

DSS Important Message - Open Office Hours for Multi-Factor Authentication/Security Questions; Multi-Factor Authentication Mandated Enrollment on August 1, 2026; Security Question Updates, Notifications

Temporary Deactivation of Maximum Daily Limits for Drugs on Crossover Claims

Department of Mental Health and Brain Injury Waiver Providers: Be Prepared for Electronic Visit Verification Hard Launch

Upcoming Mandatory MFA Implementation for eMOMED

Bureau of Special Health Care Needs Program Name Changes

Mutual News August 2026 Newsletter

Introducing Preventive Care Connections

Introducing Preventive Care Connections

26-839 Prior Authorization Now Required for Outpatient Hospice Services

26-838 Prior Authorization Now Required for Outpatient Hospice Services

26-851 Definitive Drug Testing Billing Change, Effective October 1, 2026

26-840 Prior Authorization Now Required for Outpatient Hospice Services

26-944 Electronic Claims Payments with Zelis are Going Live

26-946 Electronic Claims Payments with Zelis are Going Live

26-945 Electronic Claims Payments with Zelis are Going Live

26-887 Integrate "One Small Thing" Into Postpartum Visits Today