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Monday, Jun 30 2025

Full Issue

CMS Launches Prior Authorization Trial For Some Medicare Services

Health care service companies are being asked to join a program that relies on technology to review certain fee-for-service Medicare requests. A program-affiliated medical professional will give the final ruling on a claim. Plus, Social Security Administration payment changes start in July.

The Centers for Medicare and Medicaid Services will test a new model that adds prior authorization requirements to some services for traditional Medicare. The Center for Medicare and Medicaid Innovation unveiled the Wasteful and Inappropriate Service Reduction, or WISeR, demonstration Friday. (Tepper, 6/27)

In other Medicare news 鈥

Blue Shield of California will end commissions for new enrollments in some of its wider network Medicare Advantage plans next week. The nonprofit insurer will cease paying brokers who sign up new members in its preferred provider organization, or PPO, plans in Alameda, Orange and San Diego counties effective July 1, the company wrote in a notice to third-party sellers Thursday. 鈥淭his was a difficult business decision but one we believe is necessary in the current climate,鈥 the insurer said in the notice. (Tepper, 6/27)

The North Carolina Senate proposed budget released in April would cut state funds for a popular program that helps seniors make better choices for their Medicare plans.聽For now, the program stands, as state lawmakers are at a standstill on budget negotiations and don鈥檛 expect to come to an agreement before the new fiscal year starts on July 1. (Vitaglione, 6/30)聽

On Social Security payments 鈥

The Social Security Administration, which overpays billions in benefits annually, will start withholding some benefits sent to overpaid recipients. (Snider, 6/29)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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