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Regulatory Requirements Reporting Requirements Health Insurance

Hendershot Cowart P.C.

Qlarant, Novitas Audits Escalate as Medicare Skin Substitutes Spending Hits $1.6 Billion, CMS Seeks Evidence of Clinical...

Hendershot Cowart P.C. on

The wound care industry faces unprecedented scrutiny as Medicare Part B expenditures for skin substitutes exceeded $1.6 billion in the fourth quarter of 2023 alone. The spending surge has triggered a wave of skin substitute...more

Bass, Berry & Sims PLC

Reminder – Annual Deadline (July 31) to Report and Pay PCORI Fee is Approaching (UPDATED)

The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (PCORI fee) is due by Thursday, July 31, 2025....more

Foley & Lardner LLP

Risk Bearing Entity Requirements: Massachusetts

Foley & Lardner LLP on

This blog discusses the regulatory requirements that apply to risk-bearing entities in Massachusetts, including recent updates introduced by Chapter 343 of the Massachusetts Acts of 2024 (the Act). This blog is part of Foley...more

Bass, Berry & Sims PLC

Stuck in the Middle: Self-Funded Health Plans and Recent Challenges to State PBM Laws

In recent years, prescription drug prices have been top-of-mind for state legislators, who have responded by passing laws that seek to control that pricing in a variety of ways, including by regulating pharmacy benefit...more

Jackson Lewis P.C.

Make America Healthy Again: New Executive Order Revisits Group Health Plan Price Transparency

Jackson Lewis P.C. on

On February 25, 2025, President Trump signed “Making America Healthy Again with Clear, Accurate, and Actionable Healthcare Pricing Information,” an Executive Order with the stated purpose of making group health plans and...more

ArentFox Schiff

Massachusetts Enacts Drug Pricing Legislation: Introducing PBM Licensure, Mandatory Cost Reporting, and Consumer Cost-Sharing...

ArentFox Schiff on

On January 8, Massachusetts Governor Maura Healy signed into law “An Act Relative To Pharmaceutical Access, Costs And Transparency.” The Act will have a profound impact on all parties involved in setting and applying drug...more

Bricker Graydon LLP

What Goes Around Comes Around: White House Signals Increased Transparency in Coverage Enforcement

Bricker Graydon LLP on

On February 25, 2025, the White House issued a new executive order aimed at implementing many of the Administration's previously issued directives to health plans. ...more

Warner Norcross + Judd

IRS Releases ACA Reporting Relief Guidance

Warner Norcross + Judd on

At the end of last year, we told you about new legislation that provides employers with a little Affordable Care Act (ACA) reporting relief. Specifically, under the Paperwork Burden Reduction Act, applicable large employers...more

Woodruff Sawyer

Reminder: RxDC Reporting Due June 1st

Woodruff Sawyer on

With the 2024 reference year RxDC reporting deadline approaching in June, plan sponsors should re-familiarize themselves with the reporting requirements. The 2024 reference year RxDC Reporting Instructions have been released,...more

Mintz - Health Care Viewpoints

Massachusetts Aligns with National Trends and Enacts Sweeping Legislation to Regulate Pharmaceutical Benefit Managers

On the heels of a nationwide push to regulate pharmacy benefit managers (PBMs), Massachusetts enacted a landmark piece of legislation to increase transparency and oversight within the pharmaceutical supply chain, specifically...more

Polsinelli

Kansas Insurance Department Issues Data Call to All Third Party Administrators Licensed in Kansas

Polsinelli on

The Kansas Insurance Department (“Department”) recently issued a Data Call to all Third Party Administrators (“TPAs”) licensed in the state of Kansas. Pursuant to the Data Call, the Department has requested information...more

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