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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.

New California Law Takes A Step Toward Single-Payer Healthcare

Gov. Gavin Newsom signed a bill Saturday that sets the stage for California to work toward universal healthcare, such as a single-payer system that progressive activists have sought for years.

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Doctors And Insurers Clash Over US Law That Protects Against Surprise Billing

Private equity-backed staffing companies are fighting No Surprises Act, which protects patients from unexpected out-of-network bills

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White House Leaves One Trump-Era Policy Alone

The Biden administration has gutted many of former President Donald Trump’s health care policies, but there’s one that the White House has yet to touch, Kelly reports. It’s a 2019 rule that expanded individual coverage health reimbursement arrangements, or ICHRAs, which allowed employers to provide tax-exempt subsidies to help workers purchase Obamacare plans. The Biden administration’s ...

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Court Strikes Down HHS Rule that Allowed Insurers to Not Count Copay Assistance

In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and ...

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Lawmakers, Payers And Providers All Air Grievances With Federal No Surprises Act Implementation

Amid a flurry of partisan roadblocks rolling out across Capitol Hill, representatives on both sides of the aisle came together Tuesday to critique federal agencies’ rollout of the No Surprises Act and throw their support behind court-ordered rewrites of independent dispute resolution (IDR) regulations. During a hearing exploring the “flawed implementation” of the law intended ...

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As Biden Plans To Ban Medical Debt From Credit Scores, Advocates Press For More Change

The dramatic impact of medical debt on credit scores may soon be a thing of the past. On Thursday, the White House announced a plan outlined by the Consumer Financial Protection Bureau (CFPB) to eliminate medical debt from credit reports. The move — which follows an earlier decision from the three main credit bureaus to eliminate paid medical debt, medical ...

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Compliance With The CAA’s Gag Clause Prohibition

The Consolidated Appropriations Act (CAA) of 2021 made a number of federal changes to the U.S. health care system, with the goal of increasing transparency. One of the most immediate changes was the prohibition of gag clauses in contracts between insurance plans, insurance issuers, and providers. Gag clauses are contractual provisions that restrict plans or ...

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Answers To Q4 Frequently Asked Questions

Throughout the year, especially during Q4, we know you are bound to have questions about Underwriting, Client Experience, Enrollment, and Compliance. That’s why we’ve compiled this list of the most frequently asked questions (FAQs) during peak season.

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House Committees Introduce New Healthcare Price Transparency Legislation

A trio of House committees unveiled new legislation (PDF) Friday to lower costs and increase transparency for patients. The Lower Costs, More Transparency Act includes provisions from the House Energy and Commerce Committee, the Ways and Means Committee and the Education and the Workforce Committee and is designed to help patients be more informed when making healthcare decisions regarding ...

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Another Annual Group Health Plan Compliance Deadline On The Horizon (Action Required By October 14th)

All employers offering prescription drug benefits to employees are required to provide annual notifications to Medicare-eligible employees and dependents before October 15th, regarding the drug status of their plan(s).

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