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 insurance industry relies on a steady flow of publicly available data to predict losses, price policies, and mitigate financial exposure. What happens when those data streams dry up? We’re on the verge of finding out. Recent governmental workforce reductions, agency closures and “streamlining” initiatives fostered by President Donald Trump, his unelected advisor, Elon Musk, ...
The Consolidated Appropriations Act (CAA) of 2021 introduced a complex set of transparency-related compliance requirements for health plans, insurance issuers, agents, and providers – all designed to improve clarity and accountability in health care. One of the CAA’s key transparency initiatives is the annual Rx Data Collection (RxDC) reporting requirement, which mandates that health plans and ...
The Trump administration issued its first major set of proposed changes to the Affordable Care Act on Monday that federal officials said are intended to crack down on fraud in the program. Policy experts said they will make it harder for consumers to sign up for coverage, potentially reducing enrollment.
New legislation advanced by a voice vote March 4 would codify 14 pre-deductible healthcare services through high-deductible health plans (HDHPs). It codifies guidance from President Donald Trump’s first term increasing flexible coverage options for HDHPs. The bill would allow medical products and services like beta-blockers, blood pressure monitors, glucometers, inhalers and cholesterol drugs to be ...
As President Donald Trump wrapped up his first term in 2020, he signed legislation to protect Americans from surprise medical bills. “This must end,” Trump said. “We’re going to hold insurance companies and hospitals totally accountable.” But the president’s wide-ranging push to slash government spending, led by billionaire Elon Musk, is weakening the federal office ...
President Donald Trump signed an executive order Tuesday to reinforce rules, put into place during his first term, that push hospitals and payers to make healthcare prices more transparent for patients. The order directs the Departments of the Treasury, Labor, and Health and Human Services to rapidly implement and enforce the Trump healthcare price transparency ...
According to reporting by The Mercury News, one of California’s leading daily newspapers, about one-fourth of all health insurance claims in the Golden State were denied last year. Some may have been denied due to Artificial Intelligence (AI). However, new legislation prohibits health insurers from relying solely on AI to deny a claim based on medical necessity. ...
Shortly before returning to the courtroom, Sutter Health has reached an “agreement in principle” to settle a long-running and recently revived antitrust class-action lawsuit, according to a Sunday evening legal filing and statement from the legal counsel for the plaintiffs shared Monday morning. The case, Sidibe et al v. Sutter Health, was filed in the ...
Proposed legislation could make California one of only a handful of states that require insurers to disclose denial rates and reasoning, which the industry often considers proprietary information.
The Trump administration, perhaps surprisingly, chose to defend the legality of the Inflation Reduction Act’s (IRA’s) drug price negotiation program enacted under President Joe Biden. In a filing Feb. 19, the government agreed with the legal arguments used by the prior administration and by a lower court, dealing a blow to pharmaceutical drugmakers enraged by the program. ...