Insurance Updates

Key Items This Month

Several significant policy and operational changes merit immediate attention from providers and practice administrators. This month’s updates include substantial workforce investment opportunities, critical regulatory deadlines, and important reimbursement guideline clarifications.

Five priorities for your attention:

1. New York providers: Applications are now open for the $48.3M HEALR loan repayment program, with employer-sponsored applications due January 31, 2026, and individual applications due February 15, 2026. Maximum awards range from $50,000 to $300,000 depending on specialty.
2. Medicare telehealth: Current flexibilities have been extended through January 30, 2026, but providers should prepare for potential policy changes as federal legislation remains under consideration.
3. Prior authorization: New CMS response time requirements take effect January 1, 2026, requiring standard requests to be completed within 7 days and expedited requests within 72 hours. Incomplete documentation will likely result in outright denials rather than requests for additional information.
4. Cultural competency requirements: Free, accredited training offering CME and CE credits is available through Horizon BCBS of New Jersey through year-end 2025.
5. Plan changes: Multiple payer updates take effect January 1, 2026, including Fidelis Care Medicare Advantage plan name changes, new product offerings, and formulary modifications.