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.
A major health insurance group reaffirmed that its member plans will uphold current vaccine coverage despite any changes that an influential advisory panel could make to federal recommendations. The pledge to continued vaccine coverage comes ahead of a scheduled meeting Thursday of a federal advisory committee with a slate of new members handpicked by Department of Health ...
Democrats are gearing up to reject a GOP stopgap funding bill and potentially spark a government shutdown. What happens then, no one seems to know. Two weeks ahead of the key deadline, party leaders are staking out a rhetorical hard line demanding that their Republican counterparts come to the negotiating table to discuss concessions on health care ...
An effort by President Trump’s administration to curb advertising for pharmaceutical drugs on television is posing a potential marketing hurdle for some of the country’s largest drugmakers while threatening a key revenue stream for media companies.
The move will give more Americans a coverage alternative with low monthly premiums come November’s open enrollment, but could come at the expense of people who remain in standard ACA plans.
Committee could extend telehealth flexibilities in Medicare coverage, expiring provisions in pandemic preparedness law
While data released earlier this week raised questions about the administrative costs associated with No Surprises Act (NSA) arbitrations, a second study suggests the legislation is working to reduce out-of-pocket costs for members. Researchers at Harvard University and Mass General Brigham examined a sample of 17,351 privately insured adults, 8,204 of which lived in states that gained ...
Prior authorization is similar to how private insurers operate, often resulting in a delay or denial of treatments
As a late-summer COVID-19 spike sweeps across the Bay Area, health experts warn that access to vaccines this fall will be clouded by confusion — and some believe that is intentional. The Food and Drug Administration is expected to restrict eligibility for the updated 2025–26 vaccines to adults 65 and older and those with underlying health conditions. Millions of Americans who ...
A district court in Texas has ruled against the Department of Health and Human Services, deciding to vacate several provisions imposed last year impacting how Medicare Advantage (MA) plans market products. The Centers for Medicare & Medicaid Services (CMS) finalized a rule in April 2024 that fixed broker and agent compensation and raised the pay ...
The Centers for Medicare & Medicaid Services (CMS) this week released new data fueling a narrative of rampant broker fraud on the Affordable Care Act (ACA) exchanges. Plans received data finding 23% of enrollees did not have a claim in 2019. That number jumped sharply to 35% last year. Before the pandemic, the data were ...