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Compliance & Regulations

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.

Here Are The Top Health Items In Biden’s New Fiscal 2024 Proposed Budget

President Joe Biden released his budget for the 2024 federal fiscal year, outlining new investments to expand Medicaid, drug price reforms and other new policies. While the budget itself is unlikely to get enacted by a divided Congress, the document does outline key health priorities for the administration.

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Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients

Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years.

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Senators Urge CMS To Close ‘Loopholes’ In Payer Price Transparency Rule

Two top senators are urging the Biden administration to address “loopholes” that they said allow insurers to skirt price transparency requirements. Sens. Maggie Hassan, D-New Hampshire, and Mike Braun, R-Indiana, wrote in a letter (PDF) to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure that the agency should update its regulations to “ensure that there is ...

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White House Budget Leans Into Drug Pricing, Obamacare Expansion

President Biden’s budget proposal focuses heavily on expanding access to health care and lowering the cost of prescription drugs. In an effort to extend the life of Medicare’s hospital trust fund, the budget proposal would increase the number of drugs that can be negotiated, and allow those negotiations to begin sooner. The plan builds off the Inflation ...

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Cigna Hit With ERISA Class Action Lawsuit For Allegedly Overcharging Members

An ERISA class action suit has been filed against Cigna Health and Life Insurance Co. in Connecticut District Court, alleging the insurer is overcharging for medical services.

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House Oversight Panel Launches New Probe Into Major PBM Tactics

A key House panel is demanding documents and communications from major pharmacy benefit managers CVS Caremark, Express Scripts and OptumRx on what they call anti-competitive tactics such as spread pricing and rebates. The probe, announced Wednesday by the House Oversight Committee, is the latest signal Congress is seeking reforms to the PBM industry, as efforts ...

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CMS Says Surprise Billing Arbitration Can Resume For Some Disputes — Others Remain On Pause

Dive Brief: Arbiters can resume resolving payment disputes between providers and payers involving cases in which care was delivered prior to Oct. 25, the CMS said Friday. However, the arbitration process to is still on hold for disputes regarding services delivered on or after that date, following a federal judge’s decision earlier this month. The CMS is ...

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Advocates, Lawmakers Warn That Biden Telehealth Rule Will Worsen Opioid Crisis

Doctors, public health experts, and even Democratic members of Congress are sounding the alarm on a new Biden administration proposal to restrict access to a key addiction-treatment medication. The proposal would curtail access via telehealth to buprenorphine, a common and highly effective drug used to treat opioid use disorder. While doctors can currently give out both new ...

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Companies Can No Longer Silence Laid-Off Employees In Exchange For Severance

National Labor Relations Board this week put employers on notice that they can no longer silence laid-off employees in two very specific ways that the board says violates employees’ rights under sections 7 and 8(a)(1) of the National Labor Relations Act.

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Humana To Shed Employer Group Commercial Business

Humana is exiting the employer group commercial market after a strategic review of its business lines, the insurer announced Thursday.

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