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Compliance & Regulations

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.

Insurance Lobby Blasts Medicare Advantage Audit Rule

Dive Brief: The AHIP insurance lobby blasted the Biden administration for finalizing a rule that seeks to claw back millions of dollars from health insurers through Medicare Advantage audits that will apply retroactively to payments beginning in 2018. AHIP called the final rule “unlawful” and “fatally flawed” in a Monday statement following the rule’s release. The lobby ...

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Insurer Price Transparency Rule: What Has Been Disclosed?

To improve the accessibility of price information for commercial health care consumers and other stakeholders, the departments of Health and Human Services, Labor, and Treasury implemented the Transparency in Coverage Final Rule (hereafter, the Insurer Price Transparency Rule) in October 2020. The rule has two key provisions for all insurers offering individual and group commercial health insurance ...

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CVS Health Goes Live With Virtual Care Service With A Focus On Primary Care, Mental Health

As part of its new virtual primary care service, CVS Health is expanding telehealth-based mental health care to include appointments with licensed therapists and psychiatrists. The retail drugstore giant announced its virtual care offering last May to give consumers access to primary care, on-demand care, chronic condition management and mental health services. CVS executives say the virtual primary care offering is ...

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These Benefits Will Disappear When Biden Ends The Covid National And Public Health Emergencies In May

President Joe Biden intends to end the Covid-19 national and public health emergencies on May 11, the White House said Monday. That means that many Americans could have to start paying for Covid-19 testing and treatment after the declarations cease.

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McCarthy: ‘We won’t touch Medicare or Social Security’

Speaker Kevin McCarthy (R-Calif.) said on Thursday that House Republicans will not target Medicare or Social Security in their negotiations over the debt ceiling.

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It’s ‘Telehealth vs. No Care’: Doctors Say Congress Risks Leaving Patients Vulnerable

The $1.7 trillion spending package Congress passed in December included a two-year extension of key telehealth provisions, such as coverage for Medicare beneficiaries to have phone or video medical appointments at home. But it also signaled political reluctance to make the payment changes permanent, requiring federal regulators to study how Medicare enrollees use telehealth.

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Health Care Spending In The US Is Nearly Double That Of Other Wealthy Nations

In 2021, the U.S. spent 17.8 percent of GDP on health care, nearly double the average of 9.6 percent for high-income countries, according to a new report from The Commonwealth Fund. Health care spending per capita in the U.S. was three or four times greater than for countries like South Korea, New Zealand and Japan. Researchers ...

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Why Drugmakers Have Raised Prices On Nearly 1,000 Drugs So Far This Year

With pharmaceutical companies hiking prices on nearly 1,000 drugs in January, some consumers might experience sticker shock next time they pick up prescriptions. The price increases come as a new federal law requires companies to pay Medicare a rebate if they increase prices above the rate of inflation. Other Inflation Reduction Act provisions — such as capping Medicare recipients’ out-of-pocket ...

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Biden Administration Seeks To Recoup $4.7 Billion From Medicare Advantage Plans

The Biden administration on Monday finalized an oft-delayed plan to step up audits of Medicare Advantage insurers in order to identify and recover overpayments. Why it matters: Studies and audits have identified billions of dollars of excess payments to health plans that weren’t supported by patients’ medical records, but federal officials in the past backed off many ...

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The DOL’s 2023 Regulatory Agenda: New Rules For 401(K)S And Group Health Plans

From defining “fiduciary” and “employer” to seeking feedback on pooled employer plans, the Department of Labor has released an ambitious regulatory agenda for the next six months. “Our Regulatory Agenda additionally reflects our ongoing commitment to the Biden Administration’s prioritization of economic security, raising wages, supporting worker organizing and empowerment, and addressing the threat of climate change, ...

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