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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.

Upcoming SCOTUS Case Could Weaken the Impact of Regulation on Key Patient and Consumer Protections

The U.S. Supreme Court is considering jointly two cases, Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce, that could affect the impact of federal regulations in implementing laws passed by Congress. Although these cases are focused on regulations pertaining to the fishing industry, the court’s decision could have significant implications for numerous other policy ...

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The New DOL Fiduciary Rule: How It Could Change Your Company’s 401(K) Plan

The DOL's latest iteration, proposed in 2023 and soon to become final, will ensure that advisors prioritize their clients' best interests when recommending investments, prompting employers to make necessary adjustments.

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Biden To Roll Back Trump’s Expansion Of Short-Term Health Insurance Plans

The rule, which was proposed last summer as part of a series of actions aimed at lowering health care costs, limits the duration of new sales of these controversial plans to three months with the option of renewal for a maximum of four months total, the administration said Thursday.

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CMS Final Rule On Broker Comp, Health Equity Could Shake Up Medicare Advantage

Centers for Medicare & Medicaid Services finalized a host of actions ranging from broker compensation, health equity, mental health, supplemental benefits and biosimiliars, in the Contract Year 2025 Medicare Advantage and Part D final rule Thursday night.

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After Public Push, CMS Curbs Health Insurance Agents’ Access to Consumer SSNs

Until last week, the system that is used to enroll people in federal Affordable Care Act insurance plans inadvertently allowed access by insurance brokers to consumers’ full Social Security numbers, information brokers don’t need.

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As Compliance Become More Complex, Employers Turn To Brokers For Guidance, Survey Finds

Sixty-nine percent of brokers cited ever-changing federal and state mandates as a leading market force driving their firms to add new products and service offerings.

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Biden Expands Window To Try And Keep Millions More Low-Income Americans Insured

President Joe Biden is widening a critical window for low-income Americans to join Obamacare, in a move aimed at reinforcing a central element of his reelection bid: That he presided over a historic expansion of health care coverage.

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Hospitals Are Adding Billions in ‘Facility’ Fees for Routine Care

Tim Ebel’s visit with an ear, nose and throat specialist at an Ohio clinic last October came to $348. At the same time, he got a second bill for $645. The hospital system that owns the Avon, Ohio, clinic had charged him separately for use of the office where he met his physician. It is ...

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Providers ‘Wasted’ $10.6B In 2022 Overturning Claims Denials, Survey Finds

More than 100 provider organizations want the Centers for Medicare & Medicaid Services (CMS) to take a tougher stance on Medicare Advantage (MA) plans’ practices following an industry survey estimating billions per year are spent fighting claims denials. Providers spent nearly $20 billion in 2022 pursuing delays and denials across all payer types, yet those ...

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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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