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.
Medical experts urged Congress to hold insurance companies accountable for inaccurate medical directories that can hamper access for patients seeking mental health treatments. The problem, referred to as a “ghost network,” occurs when health insurance providers ostensibly provide coverage, but direct customers to nonexistent or unavailable doctors and providers. “In my view, it’s a breach ...
A new KFF analysis finds that an estimated 1.7 million Medicaid enrollees could become ineligible for federal Medicaid under proposed work requirements and presents state-by-state projections, based on estimates of coverage loss from the Congressional Budget Office (CBO). States could continue to provide Medicaid to those enrollees but would not receive federal matching funds for doing so. ...
Some employers have already followed the advice in a ruling by a federal district court judge in Texas that struck down mandates for no-cost preventive care in the Affordable Care Act and have stopped paying for certain services. The National Alliance of Healthcare Purchaser Coalitions polled 30 employers who cover 1.5 million workers, and found 72% of ...
House lawmakers are kick-starting the legislative process for a number of health care bills at the same time their Senate counterparts are shaping their own package on drug pricing, and members appear to be finding common ground on pharmacy benefit managers.
The Centers for Medicare & Medicaid Services (CMS) today unveiled two notices of proposed rulemaking (NPRMs), Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM), that together would further strengthen access to and quality of care across Medicaid and the Children’s Health Insurance Program (CHIP), the nation’s largest health coverage programs. ...
Despite cybersecurity experts’ repeated warnings, the insurance sector, along with other industries, is not doing a great job when it comes to creating secure passwords, says new research by password manager NordPass. Though employees are repeatedly warned to take better care of corporate accounts, passwords such as “password” and “123456” still score high on the ...
The No Surprises Act may have shielded patients from unexpected medical bills, but it's left a bureaucratic mess, with providers and insurers fighting over who'll cover the costs and Congress weighing whether to step back in.
Sens. Bernie Sanders, I-Vermont, and Bill Cassidy, R-Louisiana, reached a deal on new legislation that aims to increase access to generic drugs and impose transparency measures on pharmacy middlemen. The two senators, the new leaders of the powerful Senate Committee on Health, Education, Labor and Pensions (HELP), said the legislative package will “reform pharmacy benefit managers and expand ...
The Department of Justice today announced criminal charges against 18 defendants in nine federal districts across the United States for their alleged participation in various fraud schemes involving health care services that exploited the COVID-19 pandemic and allegedly resulted in over $490 million in COVID-19 related false billings to federal programs and theft from federally ...
What does the end of the COVID public health emergency on May 11 mean for health benefits? The expiration of COVID-19 era public health benefits, including COVID-19 coverage mandates for health insurance and the suspension of Medicaid dis-enrollments, means many workers and employers need to reorient themselves in the health care marketplace. Now, the U.S. Department of ...