ACA Category Banner

Compliance & Regulations

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.

ACA’s Employer Mandate: IRS Announces Higher Penalties For Noncompliance

The IRS has announced the 2024 employer mandate penalties under the Affordable Care Act for employers with 50 or more full-time equivalent employees. Under the ACA, employers may be subject to an employer mandate penalty for (1) failing to offer minimum essential coverage to 95% of full-time employees (A Penalty) or (2) offering coverage that is not affordable (B Penalty).

Read More

CAA 2022 Prescription Drug Data Collection (RxDC) Requirements For Health Plans – Due June 1st, 2023

The Consolidated Appropriations Act (CAA) Rx Data Collection (RxDC) component requires health plans/issuers to produce and file reports on prescription drug and health care spending for the 2022 calendar year by 6/1/2023. These reports are due annually and will be due by June 1st each year thereafter.

Read More

Congressman Seeks to Plug ‘Shocking Loophole’ Exposed by KHN Investigation

A U.S. lawmaker is taking action after a KHN investigation exposed weaknesses in the federal system meant to stop repeat Medicare and Medicaid fraud and abuse. Rep. Lloyd Doggett (D-Texas) said he decided to introduce a bill in the House late last week after KHN’s reporting revealed what he called a “shocking loophole.” “The ability of fraudsters ...

Read More

U.S. Drops Appeal Of UnitedHealth Acquisition Of Change Healthcare

The U.S. Justice Department has dismissed its own appeal challenging UnitedHealth Group’s (UNH.N) nearly $8 billion acquisition last year of Change Healthcare, a court filing showed. The healthcare deal was seen as a blow to the Biden administration’s tougher enforcement of antitrust issues. The Justice Department had argued the deal would give UnitedHealth, the largest U.S. health ...

Read More

Employers Call On Congress To Focus On 4 Key Health Policy Priorities

As a divided Congress prepares to take up health care reform once again, a national organization that advocates for employer sponsored health plans has shared a lengthy and detailed wish list for elected officials to consider.

Read More

Legal Challenges To No Surprises Act Regulations Leave Dispute Resolution Process In Flux

Enacted at the end of 2020, the federal No Surprises Act (NSA) prohibits certain health care providers and facilities that provide their services outside of health plan provider networks from “balance billing.” As a result, those providers and facilities cannot hold patients responsible for the difference between what the provider or facility charges and what ...

Read More

Here Are The Top Health Items In Biden’s New Fiscal 2024 Proposed Budget

President Joe Biden released his budget for the 2024 federal fiscal year, outlining new investments to expand Medicaid, drug price reforms and other new policies. While the budget itself is unlikely to get enacted by a divided Congress, the document does outline key health priorities for the administration.

Read More

Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years.

Read More

Senators Urge CMS To Close ‘Loopholes’ In Payer Price Transparency Rule

Two top senators are urging the Biden administration to address “loopholes” that they said allow insurers to skirt price transparency requirements. Sens. Maggie Hassan, D-New Hampshire, and Mike Braun, R-Indiana, wrote in a letter (PDF) to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure that the agency should update its regulations to “ensure that there is ...

Read More

White House Budget Leans Into Drug Pricing, Obamacare Expansion

President Biden’s budget proposal focuses heavily on expanding access to health care and lowering the cost of prescription drugs. In an effort to extend the life of Medicare’s hospital trust fund, the budget proposal would increase the number of drugs that can be negotiated, and allow those negotiations to begin sooner. The plan builds off the Inflation ...

Read More