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.
The California legislative season drew to a close September 30th, with Governor Newsom signing several Senate and Assembly Bills that increase the benefits fully insured health plans in California must cover, focusing on maternal healthcare, preventive care, and AI protections.
The U.S. Supreme Court plans to look at states’ ability to regulate pharmacy benefit managers this term. Glen Mulready, Oklahoma’s insurance commissioner, is trying to overturn an appeals court ruling that found that the Employee Retirement Income Security Act of 1974 benefits rule uniformity provisions preempts state efforts to regulate PBMs when the PBMs are serving ...
The proposed rule comes after the CMS reported a growing number of complaints about ACA health plan applications submitted by brokers.
The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote in a Wednesday report. The Centers for Medicare & Medicaid Services (CMS) has required hospitals to post the prices for numerous ...
Employers offering prescription drug benefits to their employees have an important annual duty: by October 14th each year, they must notify Medicare-eligible employees and their Medicare-eligible dependents whether their plan’s drug coverage is "creditable" or "non-creditable" as compared to a standard Medicare Part D drug plan.
On September 27, California Governor Gavin Newsom signed into law two bills that will impact health care service plans and insurers in the state. AB 3275 – Health Care Coverage: Claim Reimbursement AB 3275 amends, repeals, and adds California Health and Safety Code §§ 1371, 1371.34, 1371.35, Insurance Code §§ 10123.13, 10123.147, and Welfare and ...
Californians with medical debt will no longer have to worry about unpaid medical bills showing up on their credit reports under legislation signed Tuesday by Gov. Gavin Newsom, adding the nation’s most populous state to a growing effort to protect consumers squeezed by unaffordable medical bills. The bill, by Sen. Monique Limón (D-Santa Barbara) and backed by ...
The ERISA Industry Committee, a group for employers with self-funded benefit plans, says Congress should make pharmacy benefit managers fiduciaries. ERIC notes that its own employer members have been fiduciaries for decades.
MLRs are calculated based on calendar year spending. If insurers fail to meet the required thresholds, they must rebate premiums to policyholders by September 30th of the following year.
The Federal Trade Commission took action Friday against the nation’s three largest pharmacy benefit managers, accusing the companies of artificially inflating insulin list prices that resulted in patients paying more for the medications. The agency alleges that CVS Health’s Caremark Rx, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx and their affiliated group purchasing organizations ...