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.
As a late-summer COVID-19 spike sweeps across the Bay Area, health experts warn that access to vaccines this fall will be clouded by confusion — and some believe that is intentional. The Food and Drug Administration is expected to restrict eligibility for the updated 2025–26 vaccines to adults 65 and older and those with underlying health conditions. Millions of Americans who ...
A district court in Texas has ruled against the Department of Health and Human Services, deciding to vacate several provisions imposed last year impacting how Medicare Advantage (MA) plans market products. The Centers for Medicare & Medicaid Services (CMS) finalized a rule in April 2024 that fixed broker and agent compensation and raised the pay ...
The Centers for Medicare & Medicaid Services (CMS) this week released new data fueling a narrative of rampant broker fraud on the Affordable Care Act (ACA) exchanges. Plans received data finding 23% of enrollees did not have a claim in 2019. That number jumped sharply to 35% last year. Before the pandemic, the data were ...
The Affordable Care Act (ACA) introduced Medical Loss Ratio (MLR) requirements for fully insured medical plans. These rules require insurers to spend a substantial portion of premium dollars on actual health care services and quality improvements. In turn, they limit the dollars that can go toward administrative costs like marketing, salaries, agent commissions, and profits. The MLR ...
When President Donald Trump signed a law adding work requirements for some Medicaid recipients, he may have undercut lawmakers in at least 14 states who were designing their own plans, according to health industry observers. Georgia is the only state with a work requirement in place for Medicaid, but several states have been pursuing such ...
House Democrats are sounding the alarm and demanding more information about a new Department of Health and Human Services (HHS) demonstration they say will increase red tape by adding prior authorization requirements in Medicare. Led by Reps. Suzan DelBene (D-Wash.) and Ami Bera (D-Calif.), a group of 17 Democrats questioned why HHS would want to test adding prior authorization ...
President Trump on Tuesday threatened to impose tariffs of up to 250 percent on pharmaceutical imports, the highest rate he’s discussed to date. “We’ll be putting a, initially small tariff on pharmaceuticals,” Trump told CNBC’s “Squawk Box.” “But in one year, one in a half years maximum, it’s going to go to 150 percent, and ...
The health IT arm of the Department of Health and Human Services finalized a rule this week that federal leaders say will remove red tape and enable faster prior authorization and real-time prescription benefit checks. The policy changes also will improve electronic prescribing standards, the agency said. The final rule, called the Health Data, Technology, ...
The new numbers will affect what some employers owe if employees apply, and get, federal premium subsidies.
The American Benefits Council is urging Congress to consider the cost to employers, workers and their families as it proposes changes to the 340B drug pricing program.