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.
“California has taken action proactively to enact strong consumer protections into state law, including requirements on health plans to cover preventive care with no cost sharing to enrollees.
A federal judge in Texas who previously ruled to dismantle the Affordable Care Act struck down a narrower but key part of the nation's health law Thursday in a decision that opponents say could jeopardize preventive screenings for millions of Americans.
On February 21, 2023, the IRS released Final Rules amending the existing requirements related to mandatory e-filing of information returns, including Forms 1094-C and 1095-C, among others. The final rules are effective for all applicable returns due on or after January 1, 2024.
A key Senate committee advanced legislation to ban pharmacy benefit manager tactics, such as spread pricing and clawback fees, and heighten transparency of the industry. The Senate Commerce Committee passed the PBM Transparency Act of 2023 by a vote of 18 to 9 on Wednesday, advancing the reform legislation to the full Senate. Lawmakers said the legislation ...
The arbitration process in the No Surprises Act, which was enacted to make the health care system more transparent, has become “a big mess,” a U.S. senator said last Wednesday at a Senate Finance Committee hearing.
The IRS has announced the 2024 employer mandate penalties under the Affordable Care Act for employers with 50 or more full-time equivalent employees. Under the ACA, employers may be subject to an employer mandate penalty for (1) failing to offer minimum essential coverage to 95% of full-time employees (A Penalty) or (2) offering coverage that is not affordable (B Penalty).
CAA 2022 Prescription Drug Data Collection (RxDC) Requirements For Health Plans – Due June 1st, 2023
The Consolidated Appropriations Act (CAA) Rx Data Collection (RxDC) component requires health plans/issuers to produce and file reports on prescription drug and health care spending for the 2022 calendar year by 6/1/2023. These reports are due annually and will be due by June 1st each year thereafter.
A U.S. lawmaker is taking action after a KHN investigation exposed weaknesses in the federal system meant to stop repeat Medicare and Medicaid fraud and abuse. Rep. Lloyd Doggett (D-Texas) said he decided to introduce a bill in the House late last week after KHN’s reporting revealed what he called a “shocking loophole.” “The ability of fraudsters ...
The U.S. Justice Department has dismissed its own appeal challenging UnitedHealth Group’s (UNH.N) nearly $8 billion acquisition last year of Change Healthcare, a court filing showed. The healthcare deal was seen as a blow to the Biden administration’s tougher enforcement of antitrust issues. The Justice Department had argued the deal would give UnitedHealth, the largest U.S. health ...
As a divided Congress prepares to take up health care reform once again, a national organization that advocates for employer sponsored health plans has shared a lengthy and detailed wish list for elected officials to consider.