Healthcare policy and regulation
Policy and regulation significantly affect payers by dictating the standards for health plan offerings, determining coverage requirements, and influencing cost structures. These rules also guide patient data management, ensuring privacy and security, and play a crucial role in shaping overall healthcare market competition, payer strategies and healthcare spending.
Top Stories
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News
25 Feb 2026
New report shows NSA is working. So, why are payers, providers still mad?
A new report suggests greater in-network participation since the No Surprises Act, but more work needs to be done to iron out the law's wrinkles for major stakeholders. Continue Reading
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News
17 Feb 2026
HHS revives 340B rebate model idea, seeks industry feedback
HHS is seeking industry feedback on implementing a 340B rebate model after it scrapped a similar pilot earlier this month. Continue Reading
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News
08 Aug 2019
Finalized CMS Rule Supports Medicare Coverage for Gene Therapy
The finalized rule resolved some major contentions with prior versions and provided Medicare coverage for CAR T-cell therapy in healthcare facilities. Continue Reading
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News
15 Jul 2019
A Comprehensive Review of the Latest Affordable Care Act Hearing
In the Affordable Care Act hearing on July 9, the defendants focused on TCJA to defend the bill’s constitutionality while the plaintiffs clarified the government’s position on a remedy. Continue Reading
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News
11 Jul 2019
White House Abandons Rebate Rule Due to Medicare Spending
The White House’s rebate rule could have caused a significant rise in seniors’ health insurance premiums and $200 billion in Medicare spending. Continue Reading
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News
03 Jul 2019
ACA Risk Adjustment Worked as Intended in 2018, CMS Reports
CMS found that the ACA risk adjustment program successfully distributed the financial risk. Continue Reading
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News
21 Jun 2019
CMS Defines New Medicaid Integrity Guidelines
CMS set new integrity guidelines and warned states of future audits on Medicaid eligibility determinations. Continue Reading
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News
07 Jun 2019
How Does the Health Payer, Insurance Industry Support the Economy?
Health payers generate economic growth by providing insurance coverage, creating jobs, and making tax contributions, according to AHIP. Continue Reading
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News
22 Apr 2019
How to Be More Efficient in HEDIS Reporting
By remediating gaps in data collection, health plans can immediately improve the efficiency of HEDIS reporting. Continue Reading
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News
13 Nov 2017
Top 5 Most Common Healthcare Provider Fraud Activities
The most common healthcare provider fraud activities drain public payer finances and promote unsafe care conditions for beneficiaries. Continue Reading
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News
20 Sep 2017
Top 10 Healthcare Spending Categories in the United States
Many of the highest healthcare pending categories in the US continued to climb as indicated by significant growth in expenditure amounts. Continue Reading
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News
15 Jun 2017
AMA, AHA Call for Stronger Patient Insurance Protections
The AMA joins other prominent health industry groups in calling on the Senate to address patient insurance protection concerns. Continue Reading
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News
18 May 2017
CMS to Shutter Small Business Health Options Program Website
CMS will close its portal allowing small business to enroll members on the health insurance exchanges due to low usage rates. Continue Reading
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Feature
04 Nov 2016
The Progress and Challenges of the Affordable Care Act
Various clauses of the Affordable Care Act brought obstacles for insurers to overcome. Continue Reading
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Answer
15 Jun 2016
How the Affordable Care Act Changed the Face of Health Insurance
Why have health insurance rates gone up after the Affordable Care Act was implemented? Continue Reading