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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.

Labor Board Widens Definition Of Employee

The National Labor Relations Board (NLRB) returned Tuesday to an Obama-era standard for determining independent-contractor status — effectively broadening the number of people who have a protected right to unionize under the National Labor Relations Act.

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Another PBM Reform Bill Has Been Introduced In Congress. Here’s What It Includes

Yet another bill that aims to reform the pharmacy benefit management industry has been introduced in Congress, this time by the Senate Finance Committee. The Patients Before Middlemen Act would prevent PBMs that contract with Medicare Part D plans from tying service fees to the price of a drug, rebates, discounts or other fees. PBMs would also ...

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Biden Administration Announces Lower Out-of-Pocket Prescription Drug Costs for 43 Drugs

The Biden Administration announced Thursday that the Inflation Reduction Act is continuing to lower out-of-pocket prescription drug costs for Medicare beneficiaries. As of July 1, 2023, coinsurances for 43 drugs will be lower for beneficiaries who take these medications. The savings will range from $1 to $372 per average dose, depending on the individual coverage. ...

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The Coverage Reshuffle: Health Insurance Projections & Health Care Spending, 2023-33

The end of COVID continuous coverage requirements for Medicaid and the expiration of enhanced Obamacare premium subsidies after 2025 will affect both health-care spending and sources of coverage. The Congressional Budget Office in late May released its latest estimates for Americans younger than age 65.

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Bill To Finance A State-Run Healthcare System Advances To Assembly Health Committee

SB 770, a bill advancing Single Payer in California passed off the Senate Floor last week and is now heading to the Assembly Health Committee.

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Compromise Struck To Preserve Obamacare’s Preventive Care Mandate

The Texas conservatives challenging Obamacare’s preventive care mandate have reached a tentative compromise with the Justice Department that preserves free coverage for a range of services — from syphilis tests to depression screenings.

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Take An X To The Public Health Insurance Option

There’s an old proverb—everything old is new again. That is certainly true for healthcare policy. Last month, Sen. Bernie Sanders, I-Vt., introduced the Medicare for All Act of 2023, the single-payer health plan the Vermont socialist has been pushing for years. President Biden will surely dust off his old proposal for a public option whenever he launches ...

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Offering “Cash In Lieu Of Benefits” – Compliance Considerations

Employers commonly ask brokers if they can offer a cash payment to an employee in lieu of paying for that employee’s benefits. This option is permitted, and it is referred to as a “cash in lieu of benefits” option (or a “pay in lieu of benefits” option). However, there are compliance aspects brokers need to ...

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Court Seeks Compromise That Might Preserve Preventive Health Insurance Mandates As Appeals Play Out

Federal appeals court judges are seeking compromise on whether government requirements that health insurance include coverage for HIV prevention, cancer screenings and some other types of preventive care can be maintained while a legal battle over the mandates plays out.

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FDA Chief’s Unwelcome Message To Biotech Execs: ‘Prices Of Drugs Are Too High’

The Food and Drug Administration’s top official Wednesday told a Boston gathering of biopharma industry leaders something few of them wanted to hear: Americans are paying too much for prescription medicines. ”The prices of drugs are too high in the US, and we have to come to grips with it,” FDA Commissioner Robert Califf told ...

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