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 Centers for Medicare & Medicaid Services (CMS) has again suspended arbitration of out-of-network payment disputes between providers and payers due to a court order that the agency’s implementation of the No Surprises Act had run afoul of proper notice-and-comment procedure. The decision stems from a Texas Medical Association (TMA) complaint filed in the U.S. ...
The notice arrived in an envelope stamped “important information,” telling Kristin Fortner she needed to prove that she and her husband still deserved Medicaid. She filled out the form within a week of receiving it this past winter and mailed it back. So she was perplexed by a phone call almost three months later from ...
Lobbying groups representing different camps of the healthcare industry have come together to urge the Centers for Medicare & Medicaid Service (CMS) to reconsider “conflicting regulatory proposals” that require different electronic standards for electronic data exchanges during prior authorization. The American Hospital Association, the American Medical Association and the Blue Cross Blue Shield Association’s joint ...
A key Senate committee on Wednesday advanced bipartisan legislation aimed at regulating pharmacy benefit managers, the intermediaries in the prescription drug supply chain who negotiate discounts with drug companies on behalf of insurance plans. The Senate Finance Committee approved the measure by a vote of 25-1, showing the broad bipartisan interest in PBM reform. Only ...
California’s highest court has revived a high-profile lawsuit that could have a major impact on whether insurers can punish physicians who refer patients to out-of-network providers. The case, which has bounced around courts in the Golden State since 2012, pits the nearly 50,000-member California Medical Association (CMA) against Aetna, one of the nation’s largest health ...
The Biden administration on Thursday asked employers to give workers who lose Medicaid coverage more time to sign up for health insurance through their jobs. Medicaid is the state- and federally funded program that covers health care costs for people with low incomes. States have resumed checks for Medicaid eligibility this year after pausing the practice during ...
The new regulations, which still need to go through a public comment period, would require insurers to study whether their customers have equal access to medical and mental health benefits and to take remedial action, if necessary.
The Supreme Court just issued two decisions that will affect the legal landscape for employers for years to come. Although the Court’s rulings on affirmative action and religious accommodation will have different short-term impacts, it is highly likely that each decision will give rise to new legal challenges that could significantly alter how employers hire and manage their workers.
COVID vaccine makers should price their updated shots for the fall at a reasonable rate that would reflect the benefits they received through government investments, the U.S. Department of Health and Human Services (HHS) said on Thursday. The U.S. government will also launch a $1 billion “Bridge Access Program” for this fall, to help those ...
The U.S. Department of Labor today announced a final rule that will require certain employers in designated high-hazard industries to electronically submit injury and illness information – that they are already required to keep – to the department’s Occupational Safety and Health Administration. The final rule takes effect on Jan. 1, 2024, and now includes the ...