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...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...National News
A new KFF issue brief highlights the growing affordability pressures facing Medicare beneficiaries, even as Medicare remains the primary source of coverage for older Americans, reporting that half of Medicare beneficiaries lived on incomes below roughly $43,000 per person in 2024, and nearly a quarter rely on Social Security as many...
The Hertel Report’s 2026 Arizona Hospitals & Health Systems Data Edition examines the financial performance, strategic priorities and operational pressures shaping Arizona healthcare, with reporting on hospital margins, payer mix, Medicaid exposure, system expansion, leadership transitions and the growing debate over hospital...
Reviewing national data from 2012 through 2023, a new ASPE issue brief examined rural hospital closures, finding that the strongest predictors of whether a rural hospital will close or convert to an outpatient-only facility were significantly low occupancy rates, a for-profit status, and a location near urban counties. A rural hospital's...National News
The U.S. Supreme Court (SCOTUS) shot down cases from AstraZeneca, Johnson & Johnson, Bristol Myers Squibb, Novo Nordisk, Novartis and Boehringer Ingelheim in a summary of orders issued Monday.
The court's summary declined to state why it refused to hear the cases, though STAT notes that the implication of the sweeping rejection is...National News
The Trump administration announced an expansion of the prescription drug discount platform, TrumpRx, through a partnership with Cost Plus Drug Company, Amazon Pharmacy, and GoodRx.
Until the partnerships were announced, the TrumpRx platform was widely criticized for offering access to discounts on brand-name drugs, though many were...Arizona News
On Monday, Arizona Governor Katie Hobbs announced that a new artificial intelligence tool would be deployed to target offenders in the state's largest fraud scandal. The scheme targeting AHCCCS/Medicaid has defrauded the state of at least $2.5 billion and preyed on predominantly Native American individuals battling addiction.
The...Arizona News
Medicaid quality measure reform is gaining momentum in the Trump administration as Centers for Medicare and Medicaid Services (CMS) leaders are raising questions about the abundance of metrics.
Center for Medicaid and CHIP Services Director Daniel Brillman said that the high volume of quality measures is burdensome for states and...
The Centers for Medicare & Medicaid Services did its annual April refresh of the agency's star ratings rankings for skilled nursing facilities. The Hertel Report compiled the rankings of Arizona's 141 nursing homes so our members don't have to parse the data.
Ratings Use a 5-star Scale to Summarize Quality Performance
5 Stars:...
Medicare Advantage enrollment continues to grow and now covers 51.8% of all Medicare-eligible beneficiaries, yet despite 301 insurers participating in the market, enrollment remains heavily concentrated among a small group of national carriers. Nearly 78% of MA beneficiaries are enrolled in plans operated by just 10 insurers, with...News
The Supreme Court has extended access to mifepristone, a widely-used and clinically-determined safe drug that is used to induce abortion. The order, issued by Justice Samuel Alito on Monday, holds back restrictions on the drug imposed by the Fifth Circuit Court of Appeals.
The case at hand was originally filed by the State of...
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