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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.

White House Announces Rule That Would Cut Insurance Red Tape Over Mental Health And Substance Use Disorder Care

The Biden administration announced a final rule on Monday meant to expand access and lower costs for care for mental health and substance use disorders. Most provisions in the rule will apply to group health plans and health insurance issuers for plan years starting January 1 or after. Under this rule, mental health and substance use ...

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California Weighs Blocking Private Equity Health Deals

California lawmakers are debating whether to go where Congress won't and pass legislation that would give the state the ability to block private equity acquisitions of health care facilities or providers.

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Biden Administration Blocks Two Private Sector Enrollment Sites From ACA Marketplace

Federal regulators have blocked two private sector enrollment websites from accessing consumer information through the federal Obamacare marketplace, citing “anomalous activity.” The unusual step comes as the Centers for Medicare & Medicaid Services is under the gun to curb unauthorized enrollment and switching of Affordable Care Act plans by rogue agents. The agency received more ...

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Harris-Walz Ticket Sharpens Contrast With Trump-Vance on Health Care

Vice President Kamala Harris’ selection of Minnesota Gov. Tim Walz as her running mate is making health care a front-burner issue in the final sprint to the November presidential election. Walz, a 60-year-old former high school teacher and football coach, has a record of supporting left-leaning health care initiatives during his two terms as governor ...

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California Bill Would Require State Review of Private Equity Deals in Health Care

A bill pending in California’s legislature to ratchet up oversight of private equity investments in health care is receiving enthusiastic backing from consumer advocates, labor unions, and the California Medical Association, but drawing heavy fire from hospitals concerned about losing a potential funding source. The legislation, sponsored by Attorney General Rob Bonta, would require private equity groups ...

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Hospitals That Pursue Patients For Unpaid Bills Will Have To Tell L.A. County

Hospitals must promptly report to the Los Angeles County Department of Public Health every time they try to collect medical debt from patients, under an ordinance backed Tuesday by county supervisors. The ordinance, which requires a second vote to be adopted, requires hospitals to tell the county within a month or two of initiating debt ...

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Republicans Challenge CMS Premium Stabilization Program Legality

Leading Republicans are looking toward the Government Accountability Office (GAO) to ensure CMS’ new premium stabilization demonstration program is legal and in the best interest of seniors. In a recent letter written by House Energy and Commerce Committee Chair Cathy McMorris Rodgers, R-WA, Senate Finance Committee Ranking Member Mike Crapo, R-ID, and House Ways and ...

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Appeals Court Upholds Ruling That Struck Down Surprise Billing Arbitration Process

The Fifth Circuit Court's ruling, which was filed late last week, confirms a February 2023 decision from the court in the Eastern District of Texas, vacating arbitration methodology set by the Centers for Medicare & Medicaid Services (CMS).

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Nearly Half Of Online Pharmacies Selling Weight Loss Drugs Are Operating Illegally, Study Finds

Consumers who try to buy popular weight loss drugs online without a prescription risk being scammed or receiving unsafe products, a new study shows. About 42% of online pharmacies that sell semaglutide, the active ingredient in Novo Nordisk’s anti-obesity drug Wegovy, are illegal, operating without a valid license and selling medications without prescriptions, according to a ...

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CMS Announces New ‘Premium Stabilization’ Program

The Centers for Medicare & Medicaid Services (CMS) is creating a voluntary demonstration program to support changes to Medicare Part D under the Inflation Reduction Act (IRA). The agency also finalized bid information for contract year 2025, with a base beneficiary premium increase of $2.08 for people with Part D. The IRA is designed to ...

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