News & Analysis as of

Health Insurance Regulatory Oversight

Cooley LLP

Will AI Be Your New Doctor? Probably Not, Thanks to Recent Trends in State Regulation

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As the use of artificial intelligence (AI) becomes increasingly commonplace, some have raised concerns about its use in medicine, particularly when AI assumes a role that is traditionally held by a physician or other licensed...more

Benesch

Dental/DSO Intelligence Monthly Report: July 2025

Benesch on

As government scrutiny of the healthcare industry intensifies, enforcement agencies are casting wider nets to recover funds based on narrowly interpreted violations. This puts not only healthcare providers but also those...more

Katten Muchin Rosenman LLP

CMS Unveils New Prior Authorization “WISeR Model” for Electrical Nerve Stimulators, Skin and Tissue Substitutes and Knee...

CMS recently announced a new model it will be using to pilot the use of artificial intelligence and machine learning in reviewing prior authorizations submitted for certain services CMS has identified as being at greater risk...more

Arnall Golden Gregory LLP

Locked Out: How a Federal Moratorium on AI Regulation Could Reshape Healthcare Oversight

On May 22, 2025, the U.S. House of Representatives passed the “One Big Beautiful Bill Act” (H.R. 1) by a vote of 215-214, which includes a significant provision imposing a 10-year moratorium on state and local regulation of...more

Mitchell, Williams, Selig, Gates & Woodyard,...

2025 Arkansas Insurance Legislation Summary: General

This is the first article in a series of summaries of insurance legislation from the 95th Arkansas General Assembly. The 95th Arkansas General Assembly convened on January 13, 2025, and recessed on April 16, 2025. The...more

Pullman & Comley - Connecticut Health Law

Head of Connecticut OHS to Resign

Late last week, Governor Lamont announced that the Commissioner of the Office of Health Strategy (OHS), Deidre Gifford, plans to retire from state service in June. No successor was named. ...more

Wiley Rein LLP

[Podcast] Contracting for Success: Key Legal Considerations When Segmenting Pharmacy Benefit Programs

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In this episode of The Wiley Contracting Chronicles, co-hosts Jordan Ross and Brooke DeLoatch take a deeper dive into program segmentation within pharmacy benefit programs. After outlining the concept in their previous...more

Mayer Brown

US NAIC Spring 2025 National Meeting Highlights: Innovation, Cybersecurity, and Technology (H) Committee

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On March 26, 2025, the Innovation, Cybersecurity, and Technology (H) Committee (“H Committee”) met at the Spring 2025 US National Meeting of the National Association of Insurance Commissioners (“NAIC”). The meeting covered...more

Mintz - Health Care Viewpoints

Health Law Diagnosed – Understanding the New Massachusetts Health Care Market Review Law

In the latest episode of Health Law Diagnosed, host Bridgette Keller discusses the new Massachusetts Health Care Market Review Law and what this means for health care providers, investors, and other key stakeholders. She is...more

Sheppard Mullin Richter & Hampton LLP

Artificial Intelligence Infiltrating Healthcare in Illinois and its Effects on Insurers

On November 25, 2024, the Illinois State Legislature introduced House Bill 5918 IL HB5918, the Artificial Intelligence Systems Use in Health Insurance Act (“AI Act”). It provides the Illinois Department of Insurance (the...more

The Volkov Law Group

Antitrust Division AAG Outlines Need for More Aggressive Antitrust Enforcement in the Healthcare Industry

The Volkov Law Group on

In an interesting political twist, the difference in approaches to antitrust enforcement between Democrat and Republican Administrations has been narrowing. It used to be that the difference in party control of the Antitrust...more

Holland & Knight LLP

Regulation of AI in Healthcare Utilization Management and Prior Authorization Increases

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Over the past two years, federal and state government agencies have moved to regulate the deployment of artificial intelligence (AI) in the healthcare setting, including in the utilization management (UM) and prior...more

Holland & Knight LLP

The Future for AI Usage in California Healthcare Hinges on Governor's Indication of State Limits

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With the surge of artificial intelligence (AI) development in recent years, state legislatures, including California's, have contemplated how to balance patient safety and quality of care with the need for and expectation of...more

ArentFox Schiff

Fast Five: Important Law and Policy Updates for US Health Care Transactions

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With the end of the first quarter of 2024, we highlight five developments, changes, or challenges that health systems, hospitals, nursing homes, clinics, physician practices, health insurers, and other health care providers,...more

Mintz - Health Care Viewpoints

New Mexico’s Health Care Consolidation Oversight Act: An Overview

On March 1, 2024, New Mexico joined a growing number of states in enacting legislation that increases oversight of certain health care transactions. Senate Bill 15 (S.B. 15), which adds a new section to the New Mexico...more

Polsinelli

CMS Announces Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, and Texas

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Recently the Centers for Medicare & Medicaid Services (“CMS”) announced in a newly released MedLearn Matter (MLN7867599, July 2023) that effective as of July 13, 2021, any “new hospice agency” located in the states of Texas,...more

Robinson+Cole Health Law Diagnosis

California Governor Signs Trailer Bill to State Budget Increasing Oversight of Health Care Entities Statewide

On June 30, 2022, Governor Gavin Newsom signed the 2022-2023 California state budget, which included a trailer bill, Senate Bill 184 (the Bill) which makes numerous statutory revisions impacting health programs and consumers....more

Foley & Lardner LLP

Nevada is Latest State to Enhance Oversight of Health Care Transactions

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On October 1, 2021, Nevada will join a handful of states that are actively seeking to monitor the growth and impact of health care transactions in their states, and will also designate specific contracting practices viewed as...more

Herbert Smith Freehills Kramer

NAIC Considers PBM Regulation; Additional Requirements Possibly on Tap

Pharmacy benefit managers (PBMs) should consider the implications of a model law making its way through the National Association of Insurance Commissioners (NAIC) that would establish a licensure requirement and rules of...more

Ballard Spahr LLP

NYDFS requires regulated institutions to submit plans describing preparations for LIBOR transition by Feb. 7

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The New York Department of Financial Services has sent a letter to the institutions that it regulates requiring each such institution, by February 7, 2020, to provide to DFS a description of its “plan to address its LIBOR...more

Polsinelli

Third Party Administrator Newsletter - December 2019

Polsinelli on

Vermont Regulatory Action: A Reminder that Insurers Must Maintain Oversight of Their TPA and PBM Business Partners The Vermont Department of Financial Regulation (the “Department”) recently took significant enforcement...more

Polsinelli

Vermont Regulatory Action: A Reminder that Insurers Must Maintain Oversight of their TPA and PBM Business Partners

Polsinelli on

The Vermont Department of Financial Regulation (the “Department”) recently took significant enforcement action against an insurer after determining that the insurer had violated various provisions of Vermont’s insurance laws,...more

Polsinelli

New Laws Impacting California Behavioral Health Care Providers and Labs

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As part of an increasing trend towards regulation of behavioral health, a pair of new laws have been adopted that will impact certain California behavioral health providers and laboratories, with two proposed companion laws...more

Seyfarth Shaw LLP

Take Note: EEOC Vacates the Incentive Sections of its Final Wellness Regulations

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Seyfarth Synopsis: The EEOC has withdrawn the incentive provisions in its ADA and GINA wellness program regulations. The remaining provisions have less bite as a consequence, especially in the ADA context. But HIPAA wellness...more

Ballard Spahr LLP

Final Regulations Expand Availability of Individual Insurance Not Meeting ACA Requirements

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The U.S. Departments of the Treasury, Labor, and Health and Human Services have jointly issued final rules modifying the definition of short-term, limited-duration insurance (STLDI). STLDI provides health coverage that is...more

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