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.
Anthem and Humana have invested nearly $140 million to form a new pharmacy benefit manager, as criticism over traditional PBMs’ operations kickstarts business at startups that promise transparency. The insurers will hold a minority stake in the new joint venture, named DomaniRx, which is being championed by SS&C Technologies. The Windsor, Conn.-based fintech company owns ...
The budget package Democrats are assembling in Congress would likely provide the biggest jolt to the American health care system since the passage of the Affordable Care Act in 2010, according to sources familiar with work on the plan.
The COVID-19 pandemic may have given little health problems a chance to take root in our bodies and turn into big problems, because of decreased use of preventive care and other routine care.
The delta variant of the novel coronavirus is now responsible for 83 percent of all sequenced COVID-19 cases in the United States, Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky said Tuesday. That estimate is a major increase from just over two weeks ago. For cases tallied during the week of July 3, the CDC ...
President Joe Biden said Wednesday that children under the age of 12 could be eligible to receive a Covid-19 vaccine “soon,” predicting that the government could green light the rollout for young Americans in the next few months. “Soon, I believe,” Biden said when asked by CNN’s Don Lemon when most children under 12 would be able ...
President Joe Biden’s executive order of July 9 included various steps toward making good on campaign promises to take on pharmaceutical companies by allowing the importation of prescription drugs and curbing the high cost of medicines.
CMS is proposing to extend Medicare coverage of certain telehealth services granted for the COVID-19 public health emergency to the end of 2023 to help gather data that can determine whether the services should be permanently covered.
Senators working to keep the bipartisan infrastructure deal alive are zeroing in on Medicare prescription drug rebate formulas to offset up to $60 billion of the $1.2 trillion package, people familiar with the matter tell Axios.
A new analysis found only 5.6% of hospitals were fully compliant with a major price transparency rule, with most failures centered on not posting payer-negotiated prices. The analysis released Friday by the group PatientRightsAdvocate.org is the latest evidence of widespread noncompliance with the rule, which went into effect back in January. “These findings align with previous research indicating ...
The Biden administration wants to include a per-bed monetary penalty for larger hospitals that do not comply with a price transparency rule after several analyses have shown widespread noncompliance among facilities. The administration included the provision in the proposed 2022 Outpatient Prospective Payment System (OPPS) proposed rule released Monday by the Centers for Medicare & ...