Category Archives: Health Care Reform

Prohibited Restrictions and Rescission Clarified in Agency FAQs

Compliance with preventive health service requirements and other mandates of the health care reform law, along with disclosure obligations involving mental health parity requirements for health plans, were addressed in frequently asked questions issued by the U.S. Departments of Labor,…

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Impact on Life Duration & Quality Drives Drug Value

A prescription drug’s ability to prolong life is a top factor health plans are using when fixing benchmark prices for drug reimbursement, followed by the drug’s ability to improve the patient’s quality of life, health care stakeholders said at an…

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Care Coordination: Providers, Payers & Plans Put Consumer First

Health plans and their sponsors should pay close attention to the health care providers that are improving consumer experiences and clinical outcomes, and take note of how they are doing it. In a system where it’s every provider for himself,…

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How Health Plans Help Providers Convert to Quality & Value Models

Health care providers need help moving to value-based reimbursement and adopting accountable care models, and insurers and health plans often provide the best support, health plan executives told a recent conference. They discussed best practices for helping providers adopt value…

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Supreme Court Seeks New Accommodation in Birth Control Case

Religious non-profit employers that are not eligible for a church exemption seemed more likely to change the process of opting out of the Affordable Care Act requirement that health plans cover contraceptives and family planning services without cost-sharing. In a two-page…

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IRS Extends ACA Employer Reporting Due Dates

Employers will have 60 more days to send notices to participants and beneficiaries, and about 90 more days to send notices to the IRS about health coverage offered and employees’ health coverage status, the IRS announced Dec. 28. IRS Notice…

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Spending Law Brakes Cadillac Tax for Two Years

Employers will have two more years in which to respond to an Affordable Care Act tax on high-cost health plans, which was due to take effect in 2018. On Dec. 18, President Obama signed an omnibus spending package that includes…

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ACA Proposal Addresses Balance Billing and Narrow Networks

Employers that purchase small group coverage that is federally regulated under the Affordable Care Act will have additional assurances that their plan members will not be balance billed in certain situations, under proposed rules issued in pre-publication form on Nov….

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Health Plans Should Learn New Rules to Prevent Balance Billing

Thanks to cost pressures exacerbated by the Affordable Care Act, narrow-network plans have increased in popularity because of their lower premiums, but plans using such networks need to think about associated potential problems with poor provider access, balance billing and…

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Grandfathered Plan and Patient Protection Guidance Finalized

How much a health plan may change before losing grandfathered plan status was addressed in a final Affordable Care Act rule issued on Nov. 13 by the three U.S. departments that administer ACA reform. The rule (which takes effect on Jan. 1, 2017) finalizes…

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