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.
The Affordable Care Act (ACA) introduced Medical Loss Ratio (MLR) requirements for fully insured medical plans. These rules require insurers to spend a substantial portion of premium dollars on actual health care services and quality improvements. In turn, they limit the dollars that can go toward administrative costs like marketing, salaries, agent commissions, and profits. The MLR ...
When President Donald Trump signed a law adding work requirements for some Medicaid recipients, he may have undercut lawmakers in at least 14 states who were designing their own plans, according to health industry observers. Georgia is the only state with a work requirement in place for Medicaid, but several states have been pursuing such ...
House Democrats are sounding the alarm and demanding more information about a new Department of Health and Human Services (HHS) demonstration they say will increase red tape by adding prior authorization requirements in Medicare. Led by Reps. Suzan DelBene (D-Wash.) and Ami Bera (D-Calif.), a group of 17 Democrats questioned why HHS would want to test adding prior authorization ...
President Trump on Tuesday threatened to impose tariffs of up to 250 percent on pharmaceutical imports, the highest rate he’s discussed to date. “We’ll be putting a, initially small tariff on pharmaceuticals,” Trump told CNBC’s “Squawk Box.” “But in one year, one in a half years maximum, it’s going to go to 150 percent, and ...
The health IT arm of the Department of Health and Human Services finalized a rule this week that federal leaders say will remove red tape and enable faster prior authorization and real-time prescription benefit checks. The policy changes also will improve electronic prescribing standards, the agency said. The final rule, called the Health Data, Technology, ...
The new numbers will affect what some employers owe if employees apply, and get, federal premium subsidies.
The American Benefits Council is urging Congress to consider the cost to employers, workers and their families as it proposes changes to the 340B drug pricing program.
Nevada Attorney General Aaron Ford and Democratic officials in 20 other states filed a lawsuit challenging a new federal health insurance rule that tightens restrictions for enrolling in marketplace plans through the Affordable Care Act and bans coverage requirements for gender-affirming care. The officials argue that the new rule could strip coverage from millions of ...
NEW YORK (AP) — The U.S. Department of Labor is aiming to rewrite or repeal more than 60 “obsolete” workplace regulations, ranging from minimum wage requirements for home health care workers and people with disabilities to standards governing exposure to harmful substances. If approved, the wide-ranging changes unveiled this month also would affect working conditions at constructions sites and in ...
In late June 2025, the California legislature approved a delay to the new fertility benefit mandate for fully insured group health plans — including coverage for In Vitro Fertilization (IVF) and other specified services. Originally set to take effect July 1, 2025, under Senate Bill 729 (signed in Fall 2024), the mandate will now apply ...