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 Consolidated Appropriations Act (CAA) of 2021 created a myriad of new compliance requirements for health plans and insurance issuers, aiming to increase “transparency” in health care. One key requirement is the Rx Data Collection (RxDC), which requires plans and issuers to report on prescription drug and health care spending for the 2023 calendar year by ...
The Delinking Revenue from Unfair Gouging (DRUG) Act would require pharmacy benefit managers that contract with a carrier offering federal health benefits plans to “de-link” the fees they charge insurers from the price of drugs.
A bipartisan group of senators announced Friday that it is working on new legislation for “long-term reforms” to physician payments under Medicare and other program changes. In a joint release, U.S. Sens. Catherine Cortez Masto, D-Nevada; Marsha Blackburn, R-Tennessee; John Barrasso, R-Wyoming; Debbie Stabenow, D-Michigan; Mark Warner, D-Virginia; and Minority Whip John Thune, R-South Dakota ...
Patients were protected from more than 10 million surprise medical bills thanks to reforms in the No Surprises Act, according to a new survey. The analysis, backed AHIP and the Blue Cross Blue Shield Association, found that nearly 80% of claims disputed under the law were resolved before reaching the independent dispute resolution (IDR) stage, a ...
A recommendation on the 2024 Measures Under Consideration list, brought forward by the Federation of American Hospitals (FAH), would add a quality measure in the Medicare Advantage (MA) star ratings system that mandates health plans to report certain prior authorization denial rates. The Measures Under Consideration list gives feedback to the Centers for Medicare & ...
As Amazon builds out its healthcare business and expands its reach into hybrid primary care, pharmacy operations and virtual care, there are promising opportunities to integrate these services to offer a better healthcare experience. A year after its big-ticket acquisition of One Medical, Amazon’s pharmacy business is piloting a program to provide pharmacy consultations to One ...
The ban on surprise medical bills protected patients from more than 10 million claims for out-of-network services in the first nine months of 2023, according to new estimates by health insurer groups. But the process for settling billing disputes is still in disarray. Why it matters: AHIP and the Blue Cross Blue Shield Association said more than 670,000 ...
Rule would require Medicare Advantage organizations, Medicaid and other government-sponsored health programs to include specific reasons for denying requests
The bill’s introduction comes days before Gov. Gavin Newsom would present his plan for closing the state’s $68 billion budget deficit. Newsom has repeatedly cited his commitment to protecting the expansion, which is estimated to cost $4 billion per year.
New Biden administration rule could impose stricter test for Uber, Lyft and others to classify workers as contractors