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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.

What’s Next On The No Surprises Act

The No Surprises Act may have shielded patients from unexpected medical bills, but it's left a bureaucratic mess, with providers and insurers fighting over who'll cover the costs and Congress weighing whether to step back in.

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Sanders, Cassidy Reach Deal To Increase Access To Generic Prescription Drugs, Reform PBMs

Sens. Bernie Sanders, I-Vermont, and Bill Cassidy, R-Louisiana, reached a deal on new legislation that aims to increase access to generic drugs and impose transparency measures on pharmacy middlemen. The two senators, the new leaders of the powerful Senate Committee on Health, Education, Labor and Pensions (HELP), said the legislative package will “reform pharmacy benefit managers and expand ...

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Justice Department Announces Nationwide Coordinated Law Enforcement Action to Combat COVID-19 Health Care Fraud

The Department of Justice today announced criminal charges against 18 defendants in nine federal districts across the United States for their alleged participation in various fraud schemes involving health care services that exploited the COVID-19 pandemic and allegedly resulted in over $490 million in COVID-19 related false billings to federal programs and theft from federally ...

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DOL Offers Post-COVID Guidance For Employer Health Plans

What does the end of the COVID public health emergency on May 11 mean for health benefits? The expiration of COVID-19 era public health benefits, including COVID-19 coverage mandates for health insurance and the suspension of Medicaid dis-enrollments, means many workers and employers need to reorient themselves in the health care marketplace. Now, the U.S. Department of ...

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ACA Insurers Must Include Mental Health Providers In Plans: CMS

The Centers for Medicare and Medicaid Services will require insurers on the Affordable Care Act exchanges to include substance abuse and mental health providers in their plans, among other things.

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A Change for Next Year: Get Health Insurance Information Using California’s Tax Form

Starting next year, California will join at least 10 states — including Colorado, Maryland, and Massachusetts — using tax forms to point people toward the lower-cost coverage available through state insurance marketplaces.

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Justice Department Seeks Stay on Parts of ACA Preventive Services Ruling

The Department of Justice (DOJ) wants a federal judge to ensure that preventive care coverage requirements in the Affordable Care Act (ACA) remain available while it appeals a ruling striking the provisions down. The DOJ filed on Wednesday a request with the U.S. District Court for the Northern District of Texas for a partial stay ...

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The Biden Administration Will Hang on to Some COVID Pandemic Emergency Powers

Even though the Biden administration is ending its highest-profile Covid-19 emergency declaration next month, it’s still going to hold on to some pandemic-era powers. The Department of Health and Human Services gave governors a heads-up on Friday that it is planning to keep pharmacists’ ability to administer Covid-19 and flu vaccines past the end of ...

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Electronic Health Records Rule Sets Up “Bridge to Nowhere” Insurers Say

A Biden administration effort stemming from the 21st Century Cures Act to make health data sharing more transparent is facing pushback from health insurers. Why it matters: The rule from the Office of the National Coordinator for Health Information Technology aims to get providers and payers to share patient health information in a more seamless way. But health ...

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Employers Should Review Common Severance Agreement Terms Due to New NLRB Decision

Historically, employers have routinely included confidentiality and non-disparagement provisions in severance agreements with departing employees. Such provisions can be important for protecting sensitive personnel data or proprietary business information from disclosure. But in light of a recent National Labor Relations Board (NLRB) decision, employers in both unionized and non-union workplaces should review their agreements and consider ...

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