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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.

Mental Health Therapists Seek Exemption From Part of Law to Ban Surprise Billing

Groups representing a range of mental health therapists say a new law that protects people from surprise medical bills puts providers in an ethical bind and could discourage some patients from care. The therapists take no issue with the main aim of the legislation, which is to prevent patients from being blindsided by bills, usually ...

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Men Who Tend To Worry Have Increased Risk Factors For Heart Disease, Stroke: Study

You can worry yourself into facing a greater risk of heart disease and stroke. Particularly if you’re a middle-aged man, according to a new study. Middle-aged men who worry more or are prone to feeling overwhelmed, compared to those with lower levels of worry and anxiety, developed more high-risk factors for heart disease, stroke, and Type ...

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Medicare Advantage Plans Could See Nearly 8% Increase In Revenue

The Centers for Medicare and Medicaid Services on Wednesday proposed increasing Medicare Advantage payment by 7.98% in 2023 as they eye future changes to its risk adjustment model. In a proposed payment policy for 2023, the agency asked for feedback on whether MA’s risk adjustment model and star ratings could address the impacts of social ...

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Small-Group Insurance Market Remained Stable During Pandemic, But Long-Term Concerns Remain

The small-group health insurance market remained stable over the last year, despite the uncertainty caused by the COVID-19 pandemic, a new report has found. However, the long-term health of the market remains uncertain, as the number of small employers offering health insurance has been decreasing over the years.

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White House Frustrations Grow Over Health Chief Becerra’s Handling Of Pandemic

White House officials have grown so frustrated with top health official Xavier Becerra as the pandemic rages on that they have openly mused about who might be better in the job, although political considerations have stopped them from taking steps to replace him, officials involved in the discussions said.

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Commercial Insurer Spending Rising Faster Than Medicare

Just over half of the total U.S. population receives health insurance through commercial plans that are offered by employers or purchased by individuals. In recent years, commercial health insurers’ per-person spending on hospitals’ and physicians’ services has grown more quickly than analogous spending by the Medicare fee-for-service (FFS) program, according to analysis by the Congressional ...

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AHIP Warns Proposed ACA Exchange Rule Could Threaten Market’s Growing Stability

AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there. For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit the ability for ...

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COVID-19 Sick Pay In California Would Return Under Deal Between Newsom, Lawmakers

Gov. Gavin Newsom and state lawmakers reached an agreement Tuesday to again require employers to provide workers with up to two weeks of supplemental paid sick leave to recover from COVID-19 or care for a family member with the virus. The legislation, which lawmakers would likely fast-track to the governor in the coming weeks, would ...

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Payers, Researchers Warn CMS Proposal Could Cut Funds To Insurers Enrolling High-Risk Consumers

Proposed changes to a CMS program that shifts funds to insurers that attract higher-risk consumers, intended to boost plan enrollment by lowering some premiums, could have the opposite effect and should be abandoned, researchers from the Brookings Institution and the University of Southern California argue in a new analysis. The CMS risk adjustment program established under ...

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Biden Administration Withdraws Vaccine-Or-Test Mandate For Large Employers

The Biden administration is withdrawing its Covid vaccination-or-test requirement for large employers, citing the Supreme Court’s recent decision to block the rule. The Labor Department’s Occupational Safety and Health Administration, or OSHA, said Tuesday that the withdrawal of the emergency mandate would be effective Wednesday. The Supreme Court this month blocked the mandate, which required larger businesses to ensure that ...

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