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.
Employers offering prescription drug benefits to their employees have an important annual duty: by October 14th each year, they must notify Medicare-eligible employees and their Medicare-eligible dependents whether their plan’s drug coverage is "creditable" or "non-creditable" as compared to a standard Medicare Part D drug plan.
On September 27, California Governor Gavin Newsom signed into law two bills that will impact health care service plans and insurers in the state. AB 3275 – Health Care Coverage: Claim Reimbursement AB 3275 amends, repeals, and adds California Health and Safety Code §§ 1371, 1371.34, 1371.35, Insurance Code §§ 10123.13, 10123.147, and Welfare and ...
Californians with medical debt will no longer have to worry about unpaid medical bills showing up on their credit reports under legislation signed Tuesday by Gov. Gavin Newsom, adding the nation’s most populous state to a growing effort to protect consumers squeezed by unaffordable medical bills. The bill, by Sen. Monique Limón (D-Santa Barbara) and backed by ...
The ERISA Industry Committee, a group for employers with self-funded benefit plans, says Congress should make pharmacy benefit managers fiduciaries. ERIC notes that its own employer members have been fiduciaries for decades.
MLRs are calculated based on calendar year spending. If insurers fail to meet the required thresholds, they must rebate premiums to policyholders by September 30th of the following year.
The Federal Trade Commission took action Friday against the nation’s three largest pharmacy benefit managers, accusing the companies of artificially inflating insulin list prices that resulted in patients paying more for the medications. The agency alleges that CVS Health’s Caremark Rx, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx and their affiliated group purchasing organizations ...
Health care is the most frequent target for ransomware attacks: In 2023, the FBI says, 249 of them targeted health institutions — the most of any sector. And health executives, lawyers, and those in the halls of Congress are worried that the federal government’s response is underpowered, underfunded, and overly focused on protecting hospitals.
Republicans voted Wednesday morning in favor of a resolution disapproving of a Biden administration rule limiting access to association health plans. With a vote of 23-12, House Committee on Education and the Workforce members offered support for association health plans, a provision that is supported by some organizations such as the National Federation of Independent ...
California Gov. Gavin Newsom will soon decide whether the most populous U.S. state will join 25 others in regulating the middlemen known as pharmacy benefit managers, or PBMs, whom many policymakers blame for the soaring cost of prescription drugs. PBMs have been under fire for years for alleged profiteering and anticompetitive conduct, but efforts to ...
The Biden administration announced a final rule on Monday meant to expand access and lower costs for care for mental health and substance use disorders. Most provisions in the rule will apply to group health plans and health insurance issuers for plan years starting January 1 or after. Under this rule, mental health and substance use ...