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.
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.
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 ...
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 ...
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 ...
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 ...
The Delinking Revenue from Unfair Gouging (DRUG) Act would require pharmacy benefit managers that contract with a carrier offering federal health benefits plans to “de-link” the fees they charge insurers from the price of drugs.
A bipartisan group of senators announced Friday that it is working on new legislation for “long-term reforms” to physician payments under Medicare and other program changes. In a joint release, U.S. Sens. Catherine Cortez Masto, D-Nevada; Marsha Blackburn, R-Tennessee; John Barrasso, R-Wyoming; Debbie Stabenow, D-Michigan; Mark Warner, D-Virginia; and Minority Whip John Thune, R-South Dakota ...
Patients were protected from more than 10 million surprise medical bills thanks to reforms in the No Surprises Act, according to a new survey. The analysis, backed AHIP and the Blue Cross Blue Shield Association, found that nearly 80% of claims disputed under the law were resolved before reaching the independent dispute resolution (IDR) stage, a ...
A recommendation on the 2024 Measures Under Consideration list, brought forward by the Federation of American Hospitals (FAH), would add a quality measure in the Medicare Advantage (MA) star ratings system that mandates health plans to report certain prior authorization denial rates. The Measures Under Consideration list gives feedback to the Centers for Medicare & ...
As Amazon builds out its healthcare business and expands its reach into hybrid primary care, pharmacy operations and virtual care, there are promising opportunities to integrate these services to offer a better healthcare experience. A year after its big-ticket acquisition of One Medical, Amazon’s pharmacy business is piloting a program to provide pharmacy consultations to One ...