As details come into focus of the federal work requirements that will be imposed on state Medicaid programs next year, health systems are preparing for how the cuts will undermine their bottom line.
The new rules, released earlier this month,...Arizona News
A group of cities and Pima County, Arizona, has filed suit against the Centers for Medicare and Medicaid Services (CMS) for alleged violations of the Affordable Care Act of 2010 and the Administrative Procedure Act of 1946 when the federal agency made rule changes to health insurance exchanges effective next year.
The city plaintiffs...Arizona News
Criticism continues to mount against the Trump administration's plan to use AI-based prior authorization for Medicare claims. The Wasteful and Inappropriate Service Reduction (WISeR) model, now active in Arizona and five other states, has already generated reports of delayed care for seniors since its January launch. On Tuesday, a House...National News
The Centers for Disease Control and Prevention (CDC) has assessed that the ongoing outbreak of the Ebola virus in Central Africa could grow to 20,000 cases or more. As the disease continues its relatively unabated spread, the Trump administration's severe cuts to global public health response are brought into stark light.
The...National News
The Medicare Advantage star ratings system, which determines an insurer's annual bonus for participation in the federal program, may face significant challenges because of a recent court ruling requiring the Centers for Medicare & Medicaid Services (CMS) to recalculate the 2026 star ratings for one insurer, Clover Health. The scope...Arizona News
Contexture, Arizona’s designated health information exchange, confirmed it was approached regarding a federal health data initiative championed by HHS Secretary Robert F. Kennedy Jr., but declined to participate in the national effort seeking access to large-scale health data from state health information exchanges to support federal...Arizona News
Arizona's largest non-profit health system is elevating artificial intelligence to the executive suite, appointing Dr. John Rares Almasan as senior vice president and chief artificial intelligence, data and infrastructure officer, a newly created leadership position responsible for advancing AI strategy across the organization's clinical...Arizona News
Anyone who has circled a hospital parking lot on a 110-degree Arizona afternoon can appreciate HonorHealth's latest addition at Scottsdale Shea, a new 400-space patient and visitor parking garage designed to improve access and navigation across the growing campus.
As Arizona's population continues to grow and healthcare systems...Arizona News
A new West Health series examines one of healthcare's most persistent challenges: how to expand access to mental healthcare despite workforce shortages, long wait times, and a fragmented delivery system that often places treatment behind referrals, narrow networks, and months-long delays.
The series focuses on the Collaborative Care...National News
Nearly 165 million Americans receive health coverage through employer-sponsored insurance, yet the average annual premium for family coverage has climbed to nearly $27,000, more than doubling over the past decade and far outpacing inflation, according to a new issue brief from Georgetown University's Center on Health Insurance...CMS Rules
The provision getting the most attention in the interim final rule is that HHS declined to give states flexibility to create additional categories of "medically frail" Medicaid beneficiaries exempt from the new work requirements. The agency said the five exemption categories established in federal law are broad enough to cover...CMS Rules
Last week, the Departments of Health and Human Services (HHS), Treasury and Labor in partnership with the White House Office of Personnel Management (OPM) finalized a rule that would overhaul the dispute resolution framework for the No Surprises Act.
The rule will reduce administrative fees for disputes from $115 to $15 per dispute,...National News
Doctors may be routinely performing high risk vascular procedures unnecessarily, according to a new report from the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS). The report counts almost 140 doctors across the country with suspicious billing patterns related to the treatment.
Rates of...National News
Last week, the White House Office of Management and Budget (OMB) released proposed regulations that would give political appointees final say on federal research grants and centralize authority inside the OMB.
The OMB is headed by Russell Vought, a conservative strategist formerly with the Heritage Foundation, where he took a leading...National News
Last month, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) issued a report finding that unclear Medicare requirements may have led to overpayments to inpatient rehabilitation facilities (IRF). Industry representatives have shot back at the report and urged lawmakers to ignore it.
The OIG...National News
On Monday, pharmaceutical manufacturer Eli Lilly issued an ultimatum to 50 hospitals nationwide to submit comprehensive claims data over the next five days or be severed from discounts through the 340b prescription drug discount program.
In January, the company announced a new policy that would require hospital data in an effort to...Arizona News
Arizona's sweeping crackdown on Medicaid fraud continues to produce criminal convictions and measurable declines in suspicious billing activity, nearly three years after state officials first exposed the sober living home scandal that exploited vulnerable Native Americans and cost Arizona's Medicaid program billions of dollars.
The...Arizona News
The lawsuit names Aetna, Cigna, UnitedHealthcare, Humana, Elevance Health, Molina Healthcare, Centene and Health Care Service Corp. as defendants. The Arizona case adds to a growing body of litigation surrounding MultiPlan's out-of-network reimbursement practices.
According to Arizona's complaint, insurers allegedly shared...CMS Rules
Last summer, Congressional Republicans rallied to pass the One Big Beautiful Bill Act (OBBBA), which funded the Trump administration's agenda largely through cuts and alterations to the Medicaid program. Now, the administration is crafting rules to follow through on the directives in the bill, and is met with protest from provider groups...Arizona News
Arizona's provider shortage is dire, failing to keep up with the high numbers of new residents the state acquires every year. Both locally and nationally, recruitment and education programs are falling short of what is needed to meet the high demand for healthcare workers.
Arizona's doctor shortage is getting worse, according to...White Papers, E books, Reports and more
Institutional Special Needs Plans (I-SNPs), a special type of special needs plans offered through Medicare Advantage that serve qualified patients who reside in community settings or living facilities, are correlated with better outcomes for mortality and certain quality outcomes compared to Medicare fee-for-service (FFS) and non-I-SNP...
As the Centers for Medicare and Medicaid Services (CMS) weighs the expansion of Medicare Advantage (MA) coverage through automatic enrollment, it's worth asking if the program is meeting the needs of U.S. seniors at a responsible cost to the American taxpayer. Providers say no, and are calling for Congressional action to solve some of...
A new white paper from Milliman demonstrates areas for state child welfare agencies to use Medicaid more effectively to support clinical services while easing burdens on state and local budgets.
State child welfare agencies face external pressure to balance rising costs while increasing outcomes of child wellbeing under increased...National News
An outbreak of the Ebola virus in the Democratic Republic of Congo has international health agencies concerned that local medical response entities and hospitals are not up to the demand without the assistance of the U.S., which largely withdrew its international public health presence after President Donald Trump took office in...CMS Rules
Almost one year ago, 50 major health insurers met with U.S. health department leadership and pledged to rein in their use of prior authorization, which patients and providers complain severely disrupts the continuity of care. Now, despite industry studies demonstrating that the practice has been curbed by a little over 10%, the practice...
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