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.
Earlier versions of the bill included provisions that would have limited an employer to including only $10,200 in spending on employee-only coverage and $27,500 in spending for family coverage coverage from taxable income.
The PBM Act would make CVS, Cigna and UnitedHealth — and any other companies that own health insurers or PBMs — sell pharmacy assets.
Republicans on Capitol Hill have sent a preliminary offer to Democrats for numerous health care policies to be tacked onto the continuing resolution that lawmakers are moving to complete before the Dec. 20 deadline to avert a government shutdown.
Members of state legislatures are looking for a way to regulate self-funded employer plans. The National Council of Insurance Legislators held a general session on the impact of the Employee Retirement Income Security Act of 1974 on state health insurance regulation last month in San Antonio, during NCOIL’s annual meeting. Federal law leaves regulation of ...
Congressional Democrats have privately proposed a deal to Republicans that would extend expiring Affordable Care Act subsidies by one year, with lawmakers worried by new estimates that 2.2 million people will otherwise lose health coverage, according to five people who spoke on the condition of anonymity to discuss the proposal. The move accompanied a broader ...
The start of the new year brings renewed annual compliance responsibility for employers regarding their health plans, the Affordable Care Act (ACA), and COBRA. Staying informed and proactive in these areas is critical to avoid penalties and ensure compliance. Benefits advisors and insurance brokers play a vital role in helping employers navigate these annual complexities. ...
A group of legislators is calling on the Department of Justice to dig into whether pharmacy benefit managers played a role in the opioid epidemic. The letter (PDF) was sent to Attorney General Merrick Garland last week and was signed by Reps. Buddy Carter, R-Georgia; Raja Krishnamoorthi, D-Illinois; Deborah K. Ross, D-North Carolina; and Cliff Benz, R-Oregon. ...
The Centers for Medicare & Medicaid Services is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov. 26. Under the Contract Year 2026 MA and Part D proposed rule (PDF), CMS is choosing to follow conventional medical thinking that obesity is a disease. As such, the agency is then able to ...
The country’s largest pharmacy benefit managers and group purchasing organizations are going on offense against the Federal Trade Commission (FTC). Express Scripts, Caremark and Optum Rx—owned by Cigna, CVS Health and UnitedHealth Group, respectively—are arguing in a new lawsuit the FTC’s recent actions and administrative process subvert the U.S. Constitution by reforming an industry by ...
Unauthorized switching of Affordable Care Act plans appears to have tapered off in recent weeks based on an almost one-third drop in casework associated with consumer complaints, say federal regulators. The Centers for Medicare & Medicaid Services, which oversees the ACA, credits steps taken to thwart enrollment and switching problems that triggered more than 274,000 complaints ...