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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.

Annual Employee Benefits Compliance Responsibilities On January 1st

The start of each year marks an important date for employers as they face annual compliance responsibilities related to their health plans, the Affordable Care Act (ACA), and COBRA. Staying on top of these regulations is crucial for compliance and to avoid significant non-compliance penalties.

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AI in Healthcare: Calls for Stricter Standards Amid OpenAI Leadership Shuffle

Recent disruptions in OpenAI’s top brass have sparked intense dialogue within the healthcare sector, emphasizing the urgent need for robust standards governing the implementation of generative AI technologies. With Microsoft recruiting former OpenAI executives Sam Altman and Greg Brockman, concerns are growing that few corporations may soon dictate the trajectory of healthcare AI, potentially molding ...

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2024 FSA, HSA, and HDHP Plan Limits

A health Flexible Spending Account (FSA) is an employer-sponsored benefit that allows eligible employees to save pre-tax dollars to pay for qualified medical expenses. Employees can elect a specific dollar amount, up to a certain limit, to set aside annually.

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Proposals On PBMs And Medical Devices Advanced By House Subcommittee

The House Committee on Energy and Commerce health subcommittee pushed forward 21 proposals on Tuesday, some of which will restrict the power of pharmacy benefit managers (PBMs). Democrats supported many of the proposals put forward by Republicans, including legislation reining in PBMs that had support from 60 organizations representing patients, providers, pharmacists, small businesses and ...

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CMS Tightening Network Adequacy Standards For Exchange Plans

Beginning in 2025, health plans sold in state-run insurance exchanges would be required to meet time and distance standards that are at least as adequate as mandated on federal marketplaces, according to a rule released by the Centers for Medicare & Medicaid Services (CMS) on Wednesday. Time and distance standards would be calculated at the ...

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Senate Subcommittee Mulls Guardrails For Healthcare AI

The technology could reduce clinicians’ administrative work or speed drug discovery, but the rapidly evolving field may need more human oversight to prevent harm, lawmakers and witnesses said.

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AMA Urges Coverage Of Obesity Treatments As Payers Balk At Costs

The American Medical Association called on insurance companies, employers, and government programs to cover obesity treatments even as many remain reluctant to pay for them, fearing the costs of covering the drugs at a mass scale. The large physicians’ lobbying group voted to pass a resolution at the association’s interim meeting Monday saying it will ...

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Small Group Annual Special Open Enrollment Window: Nov. 15 – Dec. 15

The Affordable Care Act (ACA) requires medical health insurers to offer an annual one-month Special Open Enrollment Window (SOEW), when eligible Small Group employers can purchase medical coverage without having to meet standard employer-contribution and/or employee-participation ratios.

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CMS Finalizes 2024 Medicare Hospital, Doctor Payments, 340B Fix And Price Transparency Requirements

Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.

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Unions Worry Drug Cost Legislation Could Hit Their Health Plans

As Congress takes on companies managing prescription drug benefits, newly emboldened unions are sending a message to lawmakers: Don’t mess with our health plans. Why it matters: Unions have a history of shaping the health care agenda, and their voice could be especially notable as organized labor flexes its muscle this year. State of play: There’s unusual bipartisan agreement among lawmakers on the ...

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