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Compliance

This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.

Breaking Down Biden’s $7.3T Proposed Budget For 2025: Here Are His Top Health Priorities

The administration said his budget (PDF) will lower healthcare costs and drug prices, expand access to prescription drugs, build upon the Affordable Care Act (ACA) and fortify Medicare through a tax on the wealthy. Many of these priorities were previewed during Biden's State of the Union address last week.

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US Government Calls For Insurance Companies To Make Advanced Payments Following Cyberattack Disruption

The US government on Sunday urged insurance companies to make advanced payments to health care providers following a cyberattack that disrupted insurance processing systems. The cyberattack had “significant impact” on Change Healthcare, a unit of health IT giant UnitedHealth Group, which processes 15 billion health care transactions annually. CNN previously reported that the cyberattack has resulted ...

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Federal Appeals Court Hears Arguments In ACA’s Free Preventive Care Mandate Case

For now, insurers and employers are still not required to cover certain free preventive care services, such as cancer screenings and HIV-preventing medications, until the federal appeals court makes its decision later this year.

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California Attorney General Boosts Bill Banning Medical Debt From Credit Reports

California Attorney General Rob Bonta announced Monday that he is throwing his weight behind legislation to bar medical debt from showing up on consumer credit reports, a Democratic-led effort to offer protection to patients squeezed by health care bills. Bonta is a sponsor of Sen. Monique Limón’s bill, which seeks to block health care providers, as ...

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‘Cybersecurity Is Patient Safety’: What The Ransomware Attack On Change Healthcare Should Teach The Industry

As the disruption caused by the cyberattack at Change Healthcare stretches beyond its tenth day, cybersecurity experts say the incident could spur greater emphasis on enhancing protocols—and greater oversight from the feds.

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Case Threatening Obamacare Mandate For Cost-Free Preventive Services Goes Before Federal Appellate Court

With access that millions of Americans have to preventive care at stake, a conservative federal appeals court on Monday picked apart how the Biden administration has tried to maneuver around the latest significant challenge to Obamacare.

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Congress Reaches Spending Deal With Doc Pay Bump, Delayed DSH Cuts And More

A bipartisan spending bill unveiled Sunday narrows some of this year’s cuts to physician Medicare pay, pushes back scheduled disproportionate share hospital (DSH) payment cuts and increases annual funding for community health centers, among other provisions that would prevent a partial government shutdown on March 8, if signed. The 1,050-page deal (PDF) between red and blue ...

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State Attorneys General Call For Federal PBM Reforms

State attorneys general are urging Congress to pass three bills that would reform pharmacy benefit manager practices and bring more transparency to their work. A bipartisan group of 39 state attorneys general sent a letter to Senate and House leaders Feb. 20, highlighting the urgent need for federal action. While efforts to regulate PBMs are occurring on the state ...

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CAA Pharmacy Rx Data Collection (RXDC) Compliance Requirements Due By 6/1

The Consolidated Appropriations Act (CAA) of 2021 introduced a web of transparency-related regulations and compliance items for health plans, insurance issuers, agents, and providers – all intending to improve clarity and accountability in health care. The CAA prioritizes transparency in health care by requiring annual reports from plans and insurance issuers on prescription drug costs and overall ...

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CAA 2023 Prescription Drug Data Collection (RXDC) Carrier Reference

The Consolidated Appropriations Act (CAA) of 2021 created a myriad of new compliance requirements for health plans and insurance issuers, aiming to increase “transparency” in health care. One key requirement is the Rx Data Collection (RxDC), which requires plans and issuers to report on prescription drug and health care spending for the 2023 calendar year by ...

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