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The Hertel ReportThe Hertel Report

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AHCCCS Invites Rural Providers to Explore New RHTP Funding Opportunities July 24th

AHCCCS Invites Rural Providers to Explore New RHTP Funding Opportunities July 24th

Arizona News
CMS Launches Temporary 18-Month Medicare GLP-1 Pilot with $50 Monthly Copay

CMS Launches Temporary 18-Month Medicare GLP-1 Pilot with $50 Monthly Copay

CMS Rules
Sign up for a Fun Charity Golf Tournament - Sponsored by The Hertel Report & Titanium Healthcare and Benefitting Camelback Rugby and American Cancer Society

Sign up for a Fun Charity Golf Tournament - Sponsored by The Hertel Report & Titanium Healthcare and Benefitting Camelback Rugby and American Cancer Society

Available To All
HonorHealth Names Dr. John Neil Successor to CEO Todd LaPorte

HonorHealth Names Dr. John Neil Successor to CEO Todd LaPorte

Arizona News
Arizona News

Pima County & Cities Win Injunction Against 2027 ACA Marketplace Rules

Last Thursday, a U.S. District Court sided with a coalition of cities, interest groups and Pima County to issue an injunction against rules finalized by the Centers for Medicare and Medicaid Services (CMS) that would disrupt Affordable Care Act...
National News

UnitedHealth Raises 2026 Outlook, Pivots to Artificial Intelligence as Net Income Up 61%

UnitedHealth Group has raised its expectations for the year in response to strong improvements in its second-quarter earnings report. The high returns are attributable to strong showings from UnitedHealthcare and Optum. The report showed that net income jumped 61% year-over-year (YOY) to $5.48 billion, and quarterly revenue modestly...
Arizona News

Senate Bid to End WISeR Fails, Arizona Medicare Pilot Continues

The Wasteful and Inappropriate Service Reduction (WISeR) Model will continue operating in six states, including Arizona, after Senate Democrats failed late last week to end the widely criticized pilot, which uses artificial intelligence to support prior authorization decisions for traditional Medicare claims. The program uses AI to...
Arizona News

Maricopa County Measles Update - New Public Exposures Identified

Maricopa County has confirmed 25 measles cases among residents in 2026, far exceeding the county’s annual average of one case over the past 30 years, as health officials warn of continued local transmission and new public exposures across the Valley. The latest exposure alert involves an infected nonresident who visited several...
Arizona News

Arizona Now Leads Nation in Drug Death Rate as Fentanyl Goes From Pill to Powder

Arizona overtook West Virginia in 2025 to record the highest drug death rate even as overdose deaths continued to decline across much of the country. Arizona recorded 43.5 drug deaths per 100,000 residents, nearly twice the national rate of 22.1, according to a New York Times analysis of provisional federal mortality data. Arizona and...
Arizona News

Arizona Monitoring Cyclospora as Multistate Lettuce Outbreak Sickens 1,644

Arizona health officials are monitoring a nationwide rise in cyclosporiasis as federal investigators examine a multistate outbreak linked to shredded iceberg lettuce sourced from central Mexico. Arizona is also not among the states where distribution of recalled lettuce has been confirmed. Cyclospora is a microscopic intestinal...
Receiver Appointed to Oversee Healthcare Provided in Arizona's 9 State Prisons Arizona News

Receiver Appointed to Oversee Healthcare Provided in Arizona's 9 State Prisons

A federal judge appointed former Ohio corrections director Annette Chambers-Smith to oversee healthcare services in Arizona state prisons, a sweeping intervention intended to remedy constitutional violations that have persisted through 14 years of litigation. U.S. District Judge Roslyn Silver appointed Chambers-Smith July 17,...
National News

FQHC Claims 'Food is Medicine' OIG Responds it Won't Enforce Violated Statutes

A federally qualified health clinic (FQHC) reached out to the Department of Health and Human Services (HHS) Office of Inspector General (OIG), seeking approval for a Food Is Medicine-inspired experiment, to test a proposal to either give boxes of food valued at $30 to patients or $20 in food vouchers to buy produce from participating...
News

Congress, Drugmakers and Trump Administration Target $100 Billion 340B Program

As sales from the 340B Drug Pricing Program reach $100 billion, the Trump administration, Congress and pharmaceutical companies are moving quickly to modify the program and reduce flexibilities. Total costs of prescription drugs purchased under the 340B discount drug program increased 22.8% year-over-year, according to new data from...
Arizona News

ACA Enrollment Falls to 19.2 Million - Arizona Sees Nearly 30% Decline - 2027 Rate Increases

Affordable Care Act enrollment numbers are out for the first time since the expiration of tax credit subsidies spiked premiums at the beginning of the year. Arizona ranked as one of the top states in coverage losses. A new report from the Department of Health and Human Services (HHS) found that enrollment has fallen from 22.1 million...
Arizona News

From Repeal to Regulation: Trump Administration & Arizona Reshapes ACA Coverage Options

After a decade of failed attempts to destroy the Affordable Care Act (ACA) through legal challenges, the Trump administration is changing its approach to applying heavy modifications that favor employers and boosting plans that aren't required to meet ACA criteria. This time, the administration is reaching out to states like Arizona for...
National News

HHS Targets Fraud While Medicare Advantage Insurers Battle Over Billions

This week, the Department of Health and Human Services (HHS) announced that it will target fraud in the Medicaid and Medicare Advantage programs, and more MA insurers filed suit seeking to increase their star ratings bonuses. The HHS Office of Inspector General announced it had generated $5.6 billion  in "monetary impact" from...
REACH ACOs Delivered $2.5 Billion in Gross Medicare Savings in 2024 National News

REACH ACOs Delivered $2.5 Billion in Gross Medicare Savings in 2024

The ACO Realizing Equity, Access and Community Health (ACO REACH) Model, which is set to sunset at the end of 2026, generated nearly $1 billion in net savings in 2024 according to a new report from the Centers for Medicare and Medicaid Services. Last Friday, the agency released the performance results for the model and touted the year...
News

KaufmanHall: National Hospital Flash Report, May 2026

In May, America's hospitals saw higher net operating revenue and outpatient revenue compared with a year earlier, while inpatient volumes remained comparatively flat. Labor costs continued to rise, although workforce levels have largely stabilized. Drug, supply and purchased service expenses also remained above prior-year...
Arizona News

Select Medical to Close Tucson LTAC Hospital, Lay Off 99 Employees

Select Medical Corp. plans to close its 28-bed Select Specialty Hospital–Tucson East in September, eliminating 99 positions, according to a Worker Adjustment and Retraining Notification (WARN) filed with the state on July 9. The long-term acute care hospital, located on the Tucson Medical Center campus, specializes in the treatment...
National News

CMS Proposes Sweeping Medicare Physician Payment Reforms to Expand Accountable Care

The Centers for Medicare & Medicaid Services (CMS) has proposed sweeping updates to the Medicare Physician Fee Schedule (PFS) that would expand accountable care organizations (ACOs), sunset traditional Merit-based Incentive Payment System (MIPS) in 2029 and further shift physician reimbursement toward value-based care. The CMS...
National News

CDC Vaccine Study Published in JAMA After Being Blocked by NIH Director

Late last month, JAMA Network Open published a report on the effectiveness of the 2025-2026 COVID-19 vaccine after the paper was rejected for publication by the Center for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR) by acting CDC Director and National Institutes of Health (NIH) Director Jay...
SCOTUS Wraps Term With Decisions Affecting Healthcare Workforce, Liability National News

SCOTUS Wraps Term With Decisions Affecting Healthcare Workforce, Liability

Last week, the U.S. Supreme Court ended its 2025-2026 session, a session that included several decisions that could impact the future of healthcare. The ruling on temporary protected status (TPS) for Haitians and Syrians is likely to have severe effects on the nationwide healthcare workforce and another ruling limits the scope of...
CMS Rules

CMS Unveils Proposed Hospital Payment Increases Along With 340B Cuts, Site-Neutral Expansion - Home Health Systems Get a Bump

On July 1, the Centers for Medicare and Medicaid Services (CMS) issued proposed payment rules, including a provision that would substantially alter rates for the 340B drug discount program and implement site-neutral payments for certain imaging services beginning in 2027. The agency also proposed payment increases for Home Health Systems...
Arizona News

Arizona Prepares for Medicaid Work Requirements Affecting Up to 500,000 Members

Medicaid work requirements were included in the One Big Beautiful Bill Act of 2025 (OBBBA) as a means to offset the bill spending, meaning that the goal is for enrollees to lose coverage as a direct result of the program. In Arizona, up to 500,000 enrollees in the Arizona Health Care Cost Containment System (AHCCCS) will be...
Clover Health Ruling Triggers New Medicare Advantage Bonus Lawsuit - Including Anthem in Arizona Arizona News

Clover Health Ruling Triggers New Medicare Advantage Bonus Lawsuit - Including Anthem in Arizona

Elevance Health is following the lead of other Medicare Advantage insurers by filing suit against the Centers for Medicare and Medicaid Services (CMS), alleging that they refused to allow the same star ratings boost given to Clover Health after a recent court ruling. Plaintiffs include Elevance's Medicare Advantage (MA) plan affiliate...
White Papers, E books, Reports and more

Original Medicare & MA Part B Drugs: Improving Patient & Provider Experiences

As Medicare Advantage (MA) enrollment surpasses Original Medicare, a new Milliman white paper argues that life sciences companies should no longer view the two programs as interchangeable when developing market access strategies for physician-administered Part B drugs. Researchers found that each program creates markedly different...
Arizona News

Urban Institute: One in Three Arizona Women Missed Needed Reproductive Healthcare

A new Urban Institute report finds Arizona women are more likely than the national average to report barriers to reproductive healthcare, with one in three saying they needed but did not receive at least one reproductive health service during the past year. The survey of more than 2,700 Arizona women ages 18 to 49 found 33% reported...
U.S. Olympic & Paralympic Committee Selects Banner Health as Arizona Medical Partner Arizona News

U.S. Olympic & Paralympic Committee Selects Banner Health as Arizona Medical Partner

Under the partnership, Banner Health will serve as the regional partner for Arizona and the non-profit health system's physicians and specialists will provide eligible Olympic and Paralympic Team USA athletes with access to sports medicine, orthopedics, primary care, women's health and other specialty services as part of the USOPC...
Arizona News

OBBBA Rewrites Medicaid Waiver Rules, Raising the Bar for Future AHCCCS Innovation

The Trump administration is proposing a sweeping rewrite of how Medicaid Section 1115 demonstration waivers are financed, replacing decades of negotiated budget neutrality policy with new statutory requirements that will require certification by the CMS Chief Actuary before new waivers, renewals or amendments can be approved. While...
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