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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.

Premiums Not Expected To Change Significantly For 2022, But Keep An Eye On Pandemic Costs

Premiums for health insurance for individuals and small group markets are not expected to see large adjustments from carriers in 2022, a new report has found. Regional differences in health care delivery might result in some variation of premiums, due in large part to the COVID-19 pandemic, the report said. The new report, released by the ...

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Providers And Insurers Want More Details, Leniency On Surprise Billing Ban

Providers and insurers want the federal government to take it easy on them as they try to put the surprise billing ban into practice, according to comments on the first regulation stemming from the No Surprises Act. Both industries say they want to protect consumers against balance billing but remain worried they don’t have essential ...

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Hospital Execs See Delta Pressure Dragging Into Early Fourth Quarter: Jefferies Poll

Dive Brief: * The delta variant’s impact on hospitals that began to emerge mid-July is expected to peak late in the third quarter or early in the fourth, according to a new survey of 40 hospital CEOs and CFOs conducted by Jefferies. * Elective and non-emergent volumes were tracking down by about 30% in early September, leading ...

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Biden Administration Unveils Plans To Lower Prescription Drug Costs

Health and Human Services Secretary Xavier Becerra on Thursday unveiled the Biden administration’s road map to lowering the cost of prescription drugs. The plan, summarized in a 29-page document, supports legislation that allows the federal government to negotiate lower prices on the costliest drugs each year and pass those savings on to private insurers. Current ...

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Medical Loss Ratio (MLR) Rebate Checks In 2021

The Affordable Care Act (ACA) requires group health plans to spend a minimum percentage of premium dollars on members’ health care expenses and services. Likewise, it sets a threshold on the maximum amount of premium dollars that can be spent on other administrative costs, such as marketing, profits, salaries, agent commissions, etc. These requirements, known ...

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Medicare’s Trust Fund Faces Insolvency In 2026. Here’s How That Squares With Democrats’ Efforts To Expand The Health Insurance Program

It’s a situation that appears incongruous: Congressional Democrats want to expand Medicare’s benefits while a trust fund that supports the program is facing insolvency. Indeed, some Republican lawmakers have seized on that looming problem as a reason to oppose a proposal to add dental, vision and hearing coverage to Medicare. The provision is included in ...

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Industry Pushes For More Time Before Surprise Billing Ban Enforced

Payers and hospitals say with the COVID-19 pandemic ongoing and key elements still unreleased, it will be difficult to comply by Jan. 1.

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Surgeon General: U.S. To ‘Monitor’ Whether Vaccine Exemptions Being Used Properly

U.S. Surgeon General Dr. Vivek Murthy has advised that the Biden administration will “monitor” to ensure no one abuses COVID-19 vaccine exemptions. President Biden last week announced a mandate that required any company with at least 100 employees to mandate its workforce. The only way to avoid the mandate is to claim an exemption on either religious or medical grounds. Some critics ...

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Survey: Employers Rethinking Return-To-Work Plans As COVID-19 Surges

The surge of COVID-19 cases caused by the delta variant has employers rethinking their plans for returning to work — and planning for business to stabilize later than expected, a new survey shows. Most employers expected a stabilized business environment by the end of this year, but their confidence has declined from 65% to 57% over the past ...

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Retired Seniors in U.S. Aren’t Covered by Biden’s Vaccine Plan

President Joe Biden’s new Covid-19 plan will mandate vaccines for 100 million working Americans, but one group was conspicuously absent from this week’s announcement: senior citizens. They’re also the most likely to be hospitalized or die from the virus — by a wide margin. Retired seniors have been far more accepting of vaccines than their ...

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