Payer

Colorado’s fee-for-service Medicaid payments for applied behavior analysis did not fully comply with federal and state requirements, according to a February report from HHS’ Office of Inspector General.  The OIG audited 2022 and 2023 payments, examining whether the state’s fee-for-service…

As federal enforcement of the Mental Health Parity and Addiction Equity Act stalls, states are increasingly shaping the future of behavioral health coverage, according to a Jan. 21 article on The Commonwealth Fund’s website.  The 2008 law bars insurers and…

EmblemHealth will pay $2.5 million after an investigation by the New York attorney general’s office found the insurer violated parity laws and failed to ensure access to mental healthcare services because of inaccurate listings, also known as “ghost networks.” The…

Humana has invested more than $1.7 million in community organizations across Illinois to expand behavioral and maternal healthcare services and address housing stability and workforce development needs.  The investment aligns with priorities outlinked by the Illinois Department of Healthcare and…

Evernorth Behavioral Health, a subsidiary of The Cigna Group, is eliminating prior authorization requirements for transcranial magnetic stimulation, effective March 6, 2026.  The change applies to contracted providers treating patients enrolled in Evernorth and Cigna Healthcare plans. Services provided before…

Missouri’s MO HealthNet Medicaid program recently shifted to an All Patient Refined Diagnosis Related Groups payment system for acute hospital inpatient services — a shift that is reshaping operations at St. Louis-based SSM Health.  The model replaces a per diem…

The U.S. Department of Labor has reached a settlement with Oakland, Calif.-based Kaiser Foundation Health Plan to resolve its investigations into the company’s alleged failure to provide timely and appropriate access to mental health and substance use disorder services.  The…

Like other chronic conditions, behavioral health issues often persist throughout a patient’s life, and can be marked by periods of worsening symptoms. This reality contributes to a fragmented care system and tight reimbursement rates. In response, behavioral health leaders are…

Maine made tens of millions of dollars in improper Medicaid payments for services provided to children with autism, according to a January 2026 audit from the HHS Office of Inspector General. The report reviewed the state’s 2023 fee-for-service Medicaid claims…

Anthem Blue Cross and Blue Shield in Virginia and Riverside Health, based in Newport News, Va., have reached a multi-year agreement to maintain in-network access to Riverside’s integrated care network.  The agreement allows Anthem members continued in-network access to Riverside’s…