The Center for Medicare and Medicaid Innovation (CMMI) was created by the Affordable Care Act of 2010 to creatively work through issues of healthcare quality and rising health costs through demonstrations of payment mechanisms that prioritize health...
On Monday, President Donald Trump unveiled a new executive order that would overhaul the childhood vaccine schedule and reduce the number of vaccines recommended for all children.
The executive order is meant to circumvent ongoing litigation against the administration for changes made to vaccine policy, and the White House assured...
Last month, a federal judge vacated a 2023 Medicare payment rule that limited payouts to disproportionate share hospitals (DSH) which could deliver a significant boost to embattled safety-net providers facing compounding market and regulatory stressors.
The federal crackdown on Medicaid provider taxes and a sharp increase in...National News
The Trump administration's efforts to rescind federal support for transgender healthcare services continued this week as the Centers for Medicare and Medicaid Services (CMS) announced that Medicaid will stop paying for gender affirmative treatments for transgender minors.
The policy is set to go into effect beginning October 13, with...Arizona News
Arizona health insurers are requesting double-digit premium increases for small-employer plans covering at least 83,404 people and policyholders in 2027, according to the most recent filings.
The total reflects enrollment disclosed in Rate Review filings reviewed by The Hertel Report and excludes Cigna plans and a Blue Cross Blue...
Nearly half of Arizona hospitals operate in highly concentrated or monopoly markets, giving some health systems greater leverage to negotiate higher prices with commercial insurers, according to newly available hospital pricing and market data.
The Health Care Affordability Lab at Yale University found that 35 of the 77 Arizona...
The former director of the Office of Policy Planning at the Federal Trade Commission under President Joe Biden is leading the charge for a ban on prior authorizations with a new policy paper.
Hannah Garden-Monheit worked at the FTC on efforts to ban noncompete clauses in contracts and to investigate pharmacy benefits managers before...White Papers, E books, Reports and more
Arizona eliminated its broad certificate-of-need program more than three decades ago, placing the state ahead of a deregulatory policy now gaining renewed attention as states adjust to Medicaid funding changes under the One Big Beautiful Bill Act and implement projects supported by its $50 billion Rural Health Transformation...White Papers, E books, Reports and more
Noting the similarities inherent in the Ryan White HIV/AIDS Program (RWHAP), which provides federal funding for services for low-income people living with HIV and the Ending the HIV Epidemic in the United States (EHE) Initiative, the Assistant Secretary for Planning and Evaluation published a report on initiatives to end the HIV epidemic...Arizona News
AHCCCS has opened two Requests for Grant Applications (RFGAs) under the Arizona Rural Health Transformation Program (RHTP). The funding totals $13.5 million and the grants are designed to help rural healthcare organizations share operating costs and expand access to behavioral health and substance-use services.
Arizona received nearly...
Medicare Advantage enrollment is shifting rapidly as Humana and other major insurers withdraw from subpar markets en masse. This could spell coverage losses for up to hundreds of thousands of Medicare beneficiaries.
Across the board, Medicare Advantage (MA) enrollment has continued to rise into 2026 with an additional 1.1 million...
Five of the six insurers seeking to return to Arizona’s Affordable Care Act Marketplace in 2027 are requesting average premium increases of at least 24%, according to The Hertel Report’s review of rate filings submitted to the state.
The proposed increases remain subject to review and approval by the Arizona Department of...
The Medicare payment model for joint replacement care is back and mandatory for nearly all acute care hospitals, resurrected in the now final Hospital Inpatient Prospective System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS).
The final rule includes a pay boost for hospitals of 2.3%, which the Centers for...Arizona News
Steadfast Medicare Advantage insurer Humana will change direction and pull back from the program, according to an announcement made by the company in its second quarter earnings call. It is anticipated to withdraw from underperforming markets that will affect 600,000 beneficiaries. In 2025, Humana offered MA plans in three Arizona...
A federal judge has rejected the effort from a coalition of 25 states, including Arizona, to enjoin a rule by the Centers for Medicare and Medicaid Services (CMS) that would require patients to prove "medical frailty" in order to obtain an exemption from the federally mandated Medicaid work requirement authorized by the One Big Beautiful...
This week, the Trump administration announced new guidelines for Medicaid's oversight of autism therapy, a rapidly growing medical business that has been criticized for a lack of standards and oversight. The recommendations focus primarily on applied behavior analysis (ABA),
Earlier this year, the Office of Inspector General (OIG) at...News
Medicare improperly paid physicians an estimated $15.2 million for sacroiliac joint injections that failed to meet program requirements, according to a nationwide audit released by the Department of Health and Human Services Office of Inspector General.
Sacroiliac joint injections are Medicare Part B pain-management procedures used to...Arizona News
Arizona has eliminated more than $1 billion in medical debt for residents, passing the halfway point toward Gov. Katie Hobbs’ goal of canceling as much as $2 billion for up to one million Arizonans.
The cumulative total reflects several rounds of relief provided through a partnership between the state and the national nonprofit...National News
The Senate confirmed Erica Schwartz as director of the Centers for Disease Control and Prevention (CDC) Wednesday, giving the troubled public health agency its first permanent leader in nearly a year.
The 51-44 vote fell largely along party lines, with Sen. Tim Kaine of Virginia the only Democrat supporting Schwartz. She becomes the...Arizona Comings & Goings
Mimi Coomler was promoted from EVP and COO to the role of TMC Health President and CEO, replacing Former TMC Health President and CEO, Jennifer Mendrzycki, who left the leadership role for personal reasons.
According to Becker's Hospital Review, Coomler joined TMC Health in 2006 and previously served as chief hospital executive and...Arizona Comings & Goings
Phoenix Children’s appointed Joshua D. Koch, MD, senior vice president and hospital-based in chief, a newly created executive position intended to strengthen coordination across the pediatric health system’s hospital-based clinical services.
Reporting directly to President and CEO John R. Nickens IV, Koch will oversee critical...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) continues its efforts to curb the use of provider taxes as directed by the One Big Beautiful Bill Act of 2025 (OBBBA, H.R. 1). In a proposed rule issued last week, CMS announced it would go beyond what the law requires to further restrict the financing mechanism states use to increase...Arizona News
The Department of Health and Human Services has appealed a federal court ruling that struck down portions of a Centers for Medicare and Medicaid Services rule restricting enrollment in Affordable Care Act plans, siding with Pima County and a coalition of cities and advocacy groups.
In addition to the Arizona county, the cities of...Arizona News
AHCCCS has released two grant opportunities through the Arizona Rural Health Transformation Program designed to expand access to care and strengthen the financial and operational stability of rural healthcare organizations.
The Rural Health Innovative Care Pilot Program will support new approaches to delivering preventive, primary and...National News
Beneficiaries of color, disabled beneficiaries and rural beneficiaries are underrepresented in Medicare value-based payment models, according to a new study, raising concerns about health equity impacts projected by the models.
The Centers for Medicare and Medicaid Services (CMS) has tested over 50 value-based payment models for their...
Arizona News
