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.
Last year’s Inflation Reduction Act included what on its face seems a modest proposal: The federal government would for the first time be empowered to negotiate prices Medicare pays for drugs — but only for 10 very expensive medicines beginning in 2026 (an additional 15 in 2027 and 2028, with more added in later years).
The Affordable Care Act (ACA) requires fully insured group health plans to spend a minimum percentage of premium dollars on members’ health care expenses and services. Likewise, it sets a threshold on the maximum amount of premium dollars that can be spent on other administrative costs, such as marketing, profits, salaries, agent commissions, etc. These ...
Minutes after Lainey Arebalo gave birth to her third child last September, hospital staff noticed her son was having trouble breathing. They recommended placing the infant in an ambulance so he could receive care at a better-equipped pediatric facility 23 miles away. Within days of receiving that extra care, Avebalo was able to bring her ...
Arlene Wright is a doctor, but she doesn’t want people to call her one. “I usually tell my patients ‘your majesty’ or ‘your highness’ is fine,” she said. Wright has been a nurse for more than 20 years in Fort Myers, Fla. She began working in hospitals as a teenage candy striper in Upstate New ...
“How much is the ice cream?” A simple enough question, featured on a new TV and online advertisement, posed by a man who just wants something cold. A woman behind the counter responds with a smile: “Prices? No, we don’t have those anymore. We have estimates.” The satirical ad pretends to be a news report highlighting ...
The U.S. Equal Employment Opportunity Commission on Monday proposed a rule endorsing a broad application of a new federal law extending stronger legal protections to pregnant workers.
The Centers for Medicare & Medicaid Services (CMS) has again suspended arbitration of out-of-network payment disputes between providers and payers due to a court order that the agency’s implementation of the No Surprises Act had run afoul of proper notice-and-comment procedure. The decision stems from a Texas Medical Association (TMA) complaint filed in the U.S. ...
The notice arrived in an envelope stamped “important information,” telling Kristin Fortner she needed to prove that she and her husband still deserved Medicaid. She filled out the form within a week of receiving it this past winter and mailed it back. So she was perplexed by a phone call almost three months later from ...
Lobbying groups representing different camps of the healthcare industry have come together to urge the Centers for Medicare & Medicaid Service (CMS) to reconsider “conflicting regulatory proposals” that require different electronic standards for electronic data exchanges during prior authorization. The American Hospital Association, the American Medical Association and the Blue Cross Blue Shield Association’s joint ...
A key Senate committee on Wednesday advanced bipartisan legislation aimed at regulating pharmacy benefit managers, the intermediaries in the prescription drug supply chain who negotiate discounts with drug companies on behalf of insurance plans. The Senate Finance Committee approved the measure by a vote of 25-1, showing the broad bipartisan interest in PBM reform. Only ...