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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.

As Trump Punts on Medical Debt, Battle Over Patient Protections Moves to States

With the Trump administration scaling back federal efforts to protect Americans from medical bills they can’t pay, advocates for patients and consumers have shifted their work to contain the nation’s medical debt problem to state Capitols. Despite progress in some mostly blue states this year, however, recent setbacks in more conservative legislatures underscore the persistent ...

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California Expands Vaccine Coverage Requirements

On September 17, California Governor Gavin Newsom signed Assembly Bill 144 (AB 144) into law, a move in response to recent changes in immunization recommendations by the U.S. Food and Drug Administration (FDA). The bill, which took effect immediately, mandates that health plans cover a wide range of preventive care services, including immunizations, without cost-sharing or utilization ...

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States Are Cutting Medicaid Provider Payments Long Before Trump Cuts Hit

Every day for nearly 18 years, Alessandra Fabrello has been a medical caregiver for her son, on top of being his mom. “It is almost impossible to explain what it takes to keep a child alive who should be dead,” said Fabrello, whose son, Ysadore Maklakoff, experienced a rare brain condition called acute necrotizing encephalopathy ...

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As the Trump Administration and States Push Health Data Sharing, Familiar Challenges Surface

The Northeast Valley Health Corp. in Los Angeles County could be a poster child for the benefits of sharing health data electronically. Through a data network connecting its records system with other providers, the health center receives not just X-ray and lab results but real-time alerts when hospitals on the network admit or discharge its ...

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AHIP Says Member Plans Will Continue To Cover Vaccines With No Cost-Sharing Through 2026

A major health insurance group reaffirmed that its member plans will uphold current vaccine coverage despite any changes that an influential advisory panel could make to federal recommendations. The pledge to continued vaccine coverage comes ahead of a scheduled meeting Thursday of a federal advisory committee with a slate of new members handpicked by Department of Health ...

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Democrats Are Barreling Toward A Shutdown With No Clear Plan To Get Out

Democrats are gearing up to reject a GOP stopgap funding bill and potentially spark a government shutdown. What happens then, no one seems to know. Two weeks ahead of the key deadline, party leaders are staking out a rhetorical hard line demanding that their Republican counterparts come to the negotiating table to discuss concessions on health care ...

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Trump’s Effort To Target Television Drug Ads Could Have Massive Implications

An effort by President Trump’s administration to curb advertising for pharmaceutical drugs on television is posing a potential marketing hurdle for some of the country’s largest drugmakers while threatening a key revenue stream for media companies.

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HHS Expands Access To Catastrophic Plans Ahead Of Premium Pain On ACA Exchanges

The move will give more Americans a coverage alternative with low monthly premiums come November’s open enrollment, but could come at the expense of people who remain in standard ACA plans.

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Key House Committee Lays Groundwork For Health Extenders

Committee could extend telehealth flexibilities in Medicare coverage, expiring provisions in pandemic preparedness law

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Study Suggests No Surprises Act Protections Are Reducing Patients’ Out-Of-Pocket Costs

While data released earlier this week raised questions about the administrative costs associated with No Surprises Act (NSA) arbitrations, a second study suggests the legislation is working to reduce out-of-pocket costs for members. Researchers at Harvard University and Mass General Brigham examined a sample of 17,351 privately insured adults, 8,204 of which lived in states that gained ...

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