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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.

Small Group Annual Special Open Enrollment Window: Nov. 15 – Dec. 15

The Affordable Care Act (ACA) requires medical health insurers to offer an annual one-month Special Open Enrollment Window (SOEW), when eligible Small Group employers can purchase medical coverage without having to meet standard employer-contribution and/or employee-participation ratios.

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CMS Finalizes 2024 Medicare Hospital, Doctor Payments, 340B Fix And Price Transparency Requirements

Regulators finalized a number of rules Thursday with sweeping implications for providers in the Medicare program, including rates for next year that doctors and hospitals slammed as insufficient.

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Unions Worry Drug Cost Legislation Could Hit Their Health Plans

As Congress takes on companies managing prescription drug benefits, newly emboldened unions are sending a message to lawmakers: Don’t mess with our health plans. Why it matters: Unions have a history of shaping the health care agenda, and their voice could be especially notable as organized labor flexes its muscle this year. State of play: There’s unusual bipartisan agreement among lawmakers on the ...

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Biden Admin Rolls Out Cybersecurity Toolkit For Health Care

The Biden administration is ramping up efforts to harden defenses around the U.S. health care infrastructure, releasing an updated cyber "toolkit" to help the sector better defend against hackers.

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In New Order On AI, Biden Is Scrambling To Catch Up To Emerging Risks In Health Care

President Biden ordered the nation’s leading health agencies on Monday to develop a plan for regulating artificial intelligence tools already widely in use within hospitals, insurance companies, and other health-related businesses. The order directs the Department of Health and Human Services to establish a safety program to receive reports of AI-related harms and unsafe practices ...

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Biden Administration Overhauls Surprise Billing Resolution Process Amid Controversy

The Biden administration is moving to overhaul how health insurers and healthcare providers hash out payment for surprise medical bills, amid heavy criticism of the process. Regulators proposed a rule on Friday that they say is the result of feedback received on that independent dispute resolution process, or IDR. The changes are meant to make billing ...

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ACA Compliance: 4 Common Violations And 3 Strategies To Avoid Them

You can avoid the most common pitfalls of ACA noncompliance if you understand the most common types of violations and then implement three strategies to prevent falling victim to them.

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Some Health Care Legislation Could Pass Congress Despite Leadership Turmoil

The leadership turmoil in the U.S. House of Representatives has clouded the outlook for passing health care legislation this year. However, there’s also a lot of momentum in Congress behind the health policy work that already has been done, so some health care reforms “have a chance of hitching a ride on a big catch-all bill at the end of the year.

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U.S. Halts Collection On Some Past-Due Covid Loans, Sparking Federal Probes

The U.S. government has halted some efforts to collect an estimated $62 billion in past-due pandemic loans made to small businesses, concluding that aggressive attempts to recover the money — a portion of which may have been lost to fraud — could cost more than simply writing off the debt. The Small Business Administration, which ...

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New California Law Takes A Step Toward Single-Payer Healthcare

Gov. Gavin Newsom signed a bill Saturday that sets the stage for California to work toward universal healthcare, such as a single-payer system that progressive activists have sought for years.

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