Regulatory Joe

ACA compliance for health plans is more complex than ever.
In this episode of Regulatory Joe, ClearFile President Joe Boyle shares five essentials every issuer needs to streamline filings, strengthen regulator relationships, and gain speed to market.
You’ll learn:
How proactive regulator engagement prevents delays and hearings
Why association partnerships amplify your voice on policy changes
The role of technology in reducing filing errors and rework
How strong reporting protects expansion opportunities
When and how to leverage vendor support
Stay ahead of shifting state and federal requirements with a complete compliance toolkit.
👉 Explore more episodes and resources at regulatoryjoe.com

TPA licensure and compliance essentials for administrators
Learn core requirements, surety bonds, timelines, renewals, and exemptions.
In this episode, ClearFile President Joe Boyle walks through what states actually ask for, how long licensure can take, why Q1 renewals catch teams off guard, and when ERISA self-funded work may be exempt.
You’ll learn how to budget for bonding, align filings to payer market strategy, and centralize your process so approvals move faster and renewals don’t become fire drills.
Clear, actionable takeaways for leaders who own compliance and market entry.
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The ACA individual market is facing its biggest shakeup yet.
With the elimination of enhanced subsidies, a shorter Open Enrollment window, and sweeping reforms under the “One Big Beautiful Bill,” health plans must rethink their strategies.
In this episode of Regulatory Joe, Joe Boyle sits down with Wesley Sanders, founder of Evensun Health, to discuss what these changes mean for carriers, members, and the sustainability of the individual market. You’ll learn:
📌 Why ACA membership will shift and how plans should target long-term, sustainable growth📌 How to prepare retention strategies in the face of reduced passive renewals📌 The operational moves that can make or break your filings and compliance
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The ACA Open Enrollment Period is changing—are you ready?
Millions of members typically enroll after December 15, but that window is now gone.
In this episode of Regulatory Joe, Joe Boyle breaks down what health plans need to do to protect enrollment, adjust crosswalk strategies, and seize growth opportunities heading into Plan Year 2026.
You'll learn why revalidating assumptions, preparing ops early, and acting on competitive intel is more important than ever.
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PBM compliance is changing fast. Licensure, reporting, and state regulations now require more than just a checklist—proactive PBMs must treat compliance as strategy.
In this episode of Regulatory Joe, Joe Boyle sits down with Mallory Mojarro of True Rx Health Strategists to break down how pharmacy benefit managers can build smarter compliance operations. From the role of centralized tracking tools to the growing influence of state-level legislation, Mallory shares practical steps PBMs can take to stay ahead of the curve—and avoid costly mistakes.
You’ll learn:
What systems help PBMs avoid compliance gaps
Why collaboration across legal, finance, and analytics matters
How to evaluate licensure costs strategically
And more!
Listen to the full episode and get more insights at regulatoryjoe.com

PBM licensure requirements are evolving fast—and compliance mistakes are getting costly. In this episode, we break down what every pharmacy benefit manager needs to know to stay licensed and competitive.
From rising state fees to unpredictable reporting timelines, regulators are putting more pressure on PBMs than ever before. Joe Boyle, President of ClearFile, explains the full licensure process, how to avoid common mistakes, and why proactive PBMs are gaining a strategic edge. 🔍
You’ll learn:
The difference between registration and full licensure
How to build trust with regulators and avoid delays
Why staffing and reporting strategy matters
What new trends are reshaping PBM compliance in 2025
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ACA staffing strategy is now mission-critical for health plans.
In this episode of Regulatory Joe, Joe Boyle explores how health plans can align their staffing models with enrollment growth, new filing demands, and evolving regulatory oversight.
From role-based to market-based models—and everything in between—Joe breaks down what works, when to transition, and how to onboard for long-term success.
💭 Check out all of Regulatory Joe's insights: regulatoryjoe.com

In this episode of Regulatory Joe, Penstock’s Joe Boyle outlines how health plans can make smart, scalable ACA investments now to capture market share in 2026, 2027 and beyond.
Whether you're a new issuer or optimizing your current ACA portfolio, this playbook covers the three most critical pillars:– Network development (build vs. rent decisions) – Service operations (in-house vs. offshore strategy) – Competitive intelligence (why it must be continuous, not episodic)
Joe also discusses non-financial investments that are often overlooked, including codified business processes, SERFF expertise, and interdepartmental coordination—all essential for regulatory success and long-term growth.
📌 Key Topics Covered:
ACA marketplace growth trends and issuer opportunity
Financial vs. non-financial investment strategies
What a smart "build vs. buy" analysis looks like
How competitive intel should shape your plan design
Timing, staffing, and infrastructure tips for entering new markets
Don’t fall behind on ACA strategy. Get clear, actionable insights from someone who’s helped dozens of health plans grow their QHP footprint.

The ACA marketplace is heading into one of its most uncertain years yet.
In this episode, Joe Boyle is joined by Jeff Grant—former Deputy Director of Operations at CCIIO and now president of Schedule F Consulting—to unpack what 2026 could bring for health plans.
They explore the potential expiration of enhanced premium tax credits (APTCs), the debate over re-funding cost-sharing reductions (CSRs), and how these shifts could reshape affordability, enrollment behavior, and silver loading strategies.
Plus: insights on rate setting amid uncertainty, the evolving role of ICHRAs, and what plans should be doing now to prepare for every scenario.

On this episode of Regulatory Joe, Joe Boyle is joined by Penstock’s Director of Plan Management, Bryan Connole, to dive into one of the biggest pain points in ACA regulatory filing: the pharmacy benefit template.
As Plan Year 2026 approaches, CMS and state agencies are tightening expectations—especially around prior authorization and template accuracy. Bryan shares what tripped up issuers last year, what tools are critical for success, and how internal misalignment (especially with PBMs and pharmacy teams) can derail your entire submission.
In this episode:
The top objection trends from Plan Year 2025
How to use CMS validation tools to avoid rework
Why cross-validation errors can still cost you—even if your template looks “clean”
What to expect from CMS as MPMS continues to evolve
Practical tips for internal coordination and compliance
Whether you're a seasoned filer or new to regulatory operations, this episode offers actionable insight to help you stay compliant, avoid objections, and file with confidence.
🎧 Listen now and future-proof your pharmacy benefit template strategy.