This week CMS sent a series of legislative suggestions to Congress including changing how it pays for Part D and how plans are marketed to those eligible for both Medicare and Medicaid.
The ideas were proposed to Congress in its June 18,...National News
The Centers for Medicare & Medicaid Services (CMS) recently released guidelines to ensure that states have the necessary tools to properly address a nationwide epidemic—the opioid crisis.
The guidelines include information on resources available to states and the different approaches available to combat the crisis; it also...National News
Google’s ‘Medical Brain’ team is using artificial intelligence (AI) to predict when a patient will die according to over 150,000 key data points and an extensive history of health records. Bloomberg speculates these machines could open the gates for the internet to enter the healthcare market.
The search engine has approximately...News
Largely symbolic budget calls for block grants for Medicaid and repeal of the Affordable Care Act (ACA) through reconciliation.
In an effort to reduce the deficit by $302B over the next decade, the budget roadmap is called A Budget for a Brighter American Future. House budget chairman Steve Womack, the author of the budget document,...Arizona News
The Centers for Medicare & Medicaid Services (CMS) deferred the debut of the July 2018 Hospital Compare Star Ratings to a later date, yet to be announced.
Hospital star ratings have been postponed in the past. Just last year, the December 2017 updates came in five months later from the original release date along with a new...Arizona News
A federal appellate court ruled last week that the federal government does not have to pay health insurers billions of dollars owed.
These payments were built into the Affordable Care Act (ACA) as a way to offer insurers protection from gains or losses on an exchange that was uncharted territory for insurers, according to Fierce...National News
A state appeals court has ruled to resurrect a physician-assisted suicide law in California, giving terminally ill patients the right to an option.
Nationwide, doctor-assisted suicide has proved controversial, seeing extremists from both ends of the spectrum similar in issues like abortion laws. The rule applies to adults with...National News
On Tuesday, U.S. Department of Labor (DOL) released a new rule focused on making healthcare more attainable for small businesses. The rule allows small businesses and those self-employed to shop for joint health insurance depending on location or industry.
This final rule regulating association health plans is supported by Trump...Arizona News
This week, the AHCCCS Contractor Operations Manual (ACOM) and the AHCCCS Medical Policy Manual (AMPM) got a refresh.
Click here for the revisions and/or additions to the ACOM
and AHCCCS operations reporting guidelines including the Claims Dashboard Reporting Guide, Grievance System Reporting Guide and Provider Affiliation...Arizona News
The 85-bed facility ranks among the worst in the country, receiving a one-star rating from the U.S. Department of Veteran Affairs.
Providing short-term rehabilitation and stabilization, the Prescott Community Living Center demonstrated a lack in quality of care with 45 percent of patients claiming to have moderate to severe...Arizona News
Federal and state governments have geared themselves toward fighting a nationwide opioid epidemic that, according to the National Conference of State Legislatures, is responsible for 115 deaths daily. In Arizona, Gov. Doug Ducey declared opioid related overdoses a public health emergency in 2017—taking an aggressive position on the...Arizona News
The hospital's owner, New Vision Health, closes after creditors filed for involuntary Chapter 11 bankruptcy protection.
Court documents reveal creditors were owed about $13.1 million in unpaid loans and the hospitals' leases were terminated due to nonpayment. Reports say the bankruptcy receiver tried to secure capital to keep the...National Reports & Surveys
Based on data through 2018 and interviews with industry executive, health policy experts and health plan actuaries, the HRI report projects a 6 percent medical cost trend in 2019.
Medical cost trend is the projected percentage change of the costs for treating patients from one year to the next, assuming benefits remain the same....White Papers, E books, Reports and more
Based on an analysis by our friends at Milliman, this resource comes from America's Health Insurance Plans - spoiler alert, highest spend category: prescription drugs.
Take a look at the full premium breakdown by AHIP ...Arizona Bricks & Mortar
Confirming its commitment to be the major hospital company in the east valley, Banner Health will build a new 120 bed facility adjacent to its existing Banner Health Center at Loop 202 San Tan Freeway and Alma School Road. Expecting an opening in the fall of 2020, Banner will spend more than $150 million on the project.
“We want...News
Healthcare costs may look like they are stabilizing, but the numbers warrant a closer look as increases are reaching unsustainable levels, climbing to rates higher than inflation--according to the Medical Cost Trend report released earlier this month by PricewaterhouseCooper's (PwC) Health Research Institute.
"The economy, wages...Arizona News
In his dual role as senior VP at Change Healthcare and president and COO of ACO Partner, John Wallace spoke with HealthLeaders Media about the model, why it works, and how it will grow.
Learn more about ACO Partner in our June newsletter, but until then this interview will shed light on the value-based initiative that now includes...National News
The 20-states, including Arizona, are urging a federal district court in Texas to hold the Affordable Care Act’s (ACAs) individual mandate unconstitutional and to enjoin the entire law.
The brief, filed June 7 by the U.S. Department of Justice (DOJ), argues the individual mandate is unconstitutional and can't be extricated from...Arizona News
House Bill 2154, enacted earlier this year by Gov. Doug Ducey, has significantly expanded Arizona's current data breach notification law effective Aug. 1, 2018.
Changes include a more expansive definition of “personal information” that was formerly one of the narrowest in the country, according to Ballard Spahr’s Privacy and...Arizona News
An unannounced review of the Phoenix VA Healthcare System was conducted in early February 2018 by the Department of Veteran Affairs’ Office of Inspector General (OIG). These inspections occur approximately every three years and are evaluated according to the measures for that year.
The OIG’s concerns for February were centered...Arizona News
The Hertel Report is proud to celebrate our intern Veronica Graff, who shared a byline on this front page story in the Arizona Republic on Sunday about the emotional and physical damage suffered by ex-Cardinal players and their struggles with the NFL.
The news feature includes interviews from nine former players and explains how a...National News
Pharmaceutical companies Eli Lilly & Co. and AstraZeneca PLC are completely scrapping trials of an experimental drug they were co-developing for the treatment of Alzheimer's. It is an unsurprising announcement among various other disappointing efforts to close the gap to the finish line in the race against the debilitating...Arizona News
Financial consulting company Deloitte will open a U.S. Delivery Center in Gilbert, Arizona. The new 102,000 square foot facility is expecting to generate approximately 2,500 jobs in the region and will focus on developing and applying emerging technologies-based solutions to its clients.
To better adapt itself to the perpetually...Arizona News
The 2019 assessment at $287 million is $3 million less than the 2018 assessment.
For the contracting year October 1, 2018 through September 30, 2019 (CYE 2019), select AHCCCS-registered Arizona providers which meet agency established performance criteria will receive Differential Adjusted Payments (DAP).
AHCCCS will implement DAP...National News
The American Academy of Hospice and Palliative Medicine (AAHPM) proposed an alternative payment model (APM) that includes monthly payments for care teams, including nurses, social workers and spiritual care professionals.
The Patient and Caregiver Support for Serious Illness (PACSSI) model was developed to address the gaps in...
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