The Hertel Report

Congress Flip Sets Stage for New Health Policy Battles

National News

National News

CVS to Separate Retail Pharmacy and Insurance Businesses

CVS Health plans to split itself into two publicly traded companies, unwinding one of the most influential healthcare mergers of the past decade and potentially reshaping relationships among insurers, pharmacies and pharmacy benefit managers nationwide. The breakup is expected in the first half of 2028 and would separate CVS'...

CMS Rules

Deadline Looms for Medicaid Work Requirements - States Prepare for Changes

With less than two months before new Medicaid work requirements take effect Jan. 1, states are scrambling to build eligibility systems, hire staff and prepare beneficiaries, while federal regulators acknowledge implementation problems are likely and a recent court ruling reshapes a key exemption policy. The work requirements,...

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Concerns Mount Ahead of CMMI's Specialty Model Launch

Just weeks before the Ambulatory Specialty Model (ASM) is scheduled to launch, some of the nation's largest healthcare organizations are urging federal officials to delay the mandatory Medicare program, warning that unresolved technical issues and financial risks could undermine both physician participation and patient access to...

CMS Rules

Final Hospital OPPS and ASC Final Rule: CMS Raises Outpatient Rates, Expands Site-Neutral Payments for 2027

Medicare payments to hospital outpatient departments and ambulatory surgery centers will increase 2.3% in 2027, while new site-neutral policies will reduce reimbursement for certain imaging services performed at off-campus hospital facilities, according to a new final payment rule released Wednesday, Nov. 4. The final rule impacts...

CMS Rules

Home Health (HH) Prospective Payment System (PPS) Final Rule: Medicare Home-Health Payments to Rise 2.4% in 2027

The rule also expands CMS’s authority to revoke provider enrollment and recover improper payments. According to the Centers for Medicare and Medicaid Services, the increase includes a 2.1% payment update and a 0.3% increase associated with revisions to outlier payments. The agency is also continuing to recover what it considers...

CMS Rules

CMS Final CY 2027 MPFS: A Cut to Physician Pay & New ACO Incentives for 2027

The federal agency finalized a 2.31% reduction in Medicare’s 2027 physician conversion factor for most clinicians, exceeding the cut proposed in July, while increasing a key shared-savings rate and adding new ACO incentives. Medicare physicians will face lower reimbursement beginning Jan. 1, but accountable care organizations (ACOs)...

CMS Rules

Dialysis Providers Get Pay Bump Under CMS Rule

The Centers for Medicare & Medicaid Services (CMS) has finalized a sweeping update to Medicare's dialysis payment system for 2027, increasing payments to dialysis providers, expanding support for home-based treatment and overhauling several quality measures that affect facilities treating patients with kidney...

Arizona News

Healthcare Powers Arizona Job Growth

Healthcare accounted for more than half of Arizona's job growth over the past year, helping offset losses in sectors ranging from hospitality to finance. But industry leaders warn that persistent workforce shortages could limit the industry's ability to keep pace with demand. Arizona added 22,700 nonfarm jobs between September...

Arizona News

Kidney Care Overhaul Targets Status Quo

The Department of Health and Human Services (HHS) unveiled a sweeping national strategy to overhaul kidney care, aiming to boost early detection, increase competition in the dialysis market and accelerate innovation in treatment and transplantation. The plan was announced Tuesday by Health Secretary Robert F. Kennedy Jr. who...

Arizona News

CMS Moves to Tighten ACA Subsidies

The Centers for Medicare & Medicaid Services (CMS) is proposing stricter verification requirements for consumers seeking financial assistance through Affordable Care Act marketplaces, a move the Trump administration says will reduce fraud and ensure taxpayer-funded subsidies go only to eligible enrollees.  Under the proposed...

Arizona News

Mayo Clinic Arizona Study Finds Measurable Brain Response Within Minutes of Deep Brain Stimulation

The senior author of the study, Jonathon Parker, M.D., Ph.D., a Mayo Clinic neurosurgeon in Arizona, reported demonstrated measurable changes in the brain within 18 minutes of deep brain stimulation (DBS) in people with drug-resistant epilepsy, a finding that could eventually help clinicians personalize treatment without waiting months...

White Papers, E books, Reports and more

State to Federal Roadmap Series - Working Strategies to Address Healthcare Consolidation & Costs

A three-part Georgetown University Center on Health Insurance Reforms series released this month uses states’ experiences with transparency, pricing reforms, and market oversight to propose federal strategies addressing healthcare ownership transparency, hospital fair-pricing reforms, and oversight of hospital and provider...

National News

AMA & Other Physician Groups Back New Challenge to Medicaid Work Rule

The American Medical Association, Maryland State Medical Society and several national physician groups filed an amicus brief supporting a new lawsuit challenging CMS regulations governing exemptions from Medicaid work requirements. In Taylor v. Kennedy, the groups argue that CMS exceeded its authority by requiring people with serious...

National News

$25M Fraud Whistleblower Program Launched - Targeting Hospice & Home Health

The Trump administration unveiled a new $25 million whistleblower initiative designed to encourage the public to report fraud involving federal programs, offering cash rewards for tips that lead to criminal charges or significant enforcement actions. The announcement given on Tuesday by President Donald Trump and Vice...

National Reports & Surveys

Report Finds Insurers Blocking Women's Birth Control Access

More than a decade after the Affordable Care Act (ACA) guaranteed most privately insured Americans access to birth control without out-of-pocket costs, many women continue to face coverage denials, unexpected bills and administrative hurdles that can delay or prevent care.  In 2021, an estimated 61.4 million women ages 18 to 64 had...

National News

CMS Marketplace Broker Freeze Draws Lawsuit

The National Association of Benefits and Insurance Professionals (NABIP) is suing the Centers for Medicare & Medicaid Services (CMS) over a new moratorium that blocks thousands of agents and brokers from registering to sell Affordable Care Act marketplace coverage for the 2027 plan year, intensifying a dispute over how the...

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CMS Pushes MA Directory Overhaul, Protections for Members & Increased Scrutiny of PBMs

The Centers for Medicare & Medicaid Services (CMS) proposed new rules designed to improve the accuracy of Medicare Advantage provider directories, strengthen oversight of pharmacy benefit managers and expand financial protections for beneficiaries. The proposed rule would require Medicare Advantage (MA) plans to: ...

Arizona Comings & Goings

Phoenix Children's Adds HR & Marketing Leaders

Wanda Shoer will join Phoenix Children’s as SVP and chief people officer effective Nov. 2. She will oversee talent acquisition, human resources, employee development and organizational effectiveness, with responsibility for strengthening career pathways, leadership development and employee engagement. Phoenix Children’s also named...