In the November election, Arizona voters will be asked if they want abortion to be legal up to the point of fetal viability, which will clarify restrictions for both patients and providers caught in the confusion of a turbulent back-and-forth since...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) announced new proposed rules for the ACA Marketplace in 2026. The agency intends for the rules to control the quality of brokers and agents who enroll people in plans and updates the risk adjustment program.
Since June, CMS has suspended at least 200 brokers on suspicion...
The Government Accountability Office (GAO) wants the Centers for Medicare and Medicaid Services (CMS) to increase oversight and enforcement of its hospital price transparency rules, according to a new report.
The 2021 CMS hospital price transparency rule requires hospitals to post prices in machine readable format and make those files...
Last week, Eli Lilly announced that the shortage of its landmark weight loss medication Mounjaro was over. This caused a drug compounding industry group to sue the U.S. Food and Drug Administration (FDA). Regardless of the shortage, payers are still wondering how they'll keep up with paying for the expensive GLP-1 treatments.
Eli...
Changes to the Medicare Advantage star ratings calculation are already having major impacts for insurers and their shareholders as Humana saw its stocks plunge after announcing that only a quarter of its members are enrolled in plans rated four stars or higher for 2025.
The Centers for Medicare and Medicaid Services (CMS) awards star...
The largest health system in Arizona had a newsworthy start to fall, with multiple outlets reporting details ranging from Banner Health's growth and leadership changes to approval for a new medical office building in Scottsdale and a new medical facility near the Goodyear Civic Center. A local media outlet's investigation of Banner...
A leading digital, integrated payor and provider group, Antidote Health is introducing its on-exchange, individual plans along with plans for businesses with up to 50 employees in Maricopa and Pima counties during the Marketplace open enrollment November 1, 2024 through January 15, 2025.
With $0 copays for virtual visits, expanded...
According to numerous sources this week, healthcare is profitable, especially in the C-suite.
Overall annual earnings for healthcare CEOs may be down from an average of $13 million in 2022, but pharmaceutical companies and medical device firm leaders continue to reign as the top earners with those behind patented products reaping the...
The CMS Innovation Center is seeking feedback on the Medicare $2 Drug List (M2DL) voluntary model that would test whether standardized cost sharing for low-cost generics can improve medication adherence and health outcomes along with Medicare beneficiaries' and prescribers' satisfaction with the Part D program.
The model is designed...
Hospital margins and revenues improved in August as patient volumes subsided, according to recent analysis. Perhaps most notably, there are some indications that hospital labor volatility is stabilizing.
The Fitch Ratings analysis included jobs data from the U.S. Bureau of Labor Statistics, and showed that hospitals gained 9,600 jobs...
New analysis from Ernst and Young (EY) for the American Hospital Association (AHA) shows that non-profit hospitals provide benefits to their community at a rate an order of magnitude higher than what they're exempt from paying in taxes.
The analysis covered 2020 and includes data that "reflects the impacts of the COVID-19 pandemic."...
This week, the Centers for Medicare and Medicaid Services released its report on the Acute Hospital Care at Home Initiative (AHCAH) and found that while the program was popular for both patients and providers, improvements in other areas were few.
The AHCAH initiative allowed certain Medicare-participating hospitals to treat patients...
The Biden administration's Department of Health and Human Services (HHS) announced this week that 54 drugs will be less expensive for Medicare Part B enrollees from October 1 until the end of the year.
The price cut is provided as part of the Medicare Prescription Drug Inflation Rebate Program which was authorized in the Inflation...
On Monday, pharmaceutical giant Johnson & Johnson notified the U.S. Department of Health and Human Services (HHS) that it would pause its new rebate policy following threats to its participation in the 340B drug discount program by the Health Resources and Services Administration (HRSA).
Last month, Johnson & Johnson (J&J)...
CVS Health may be looking to split its retail and insurance branches following pressure from investors to improve performance. The company is also facing a hefty bill from an audit by the U.S. Department of Health and Human Services Office of Inspector General (OIG) that found it owes millions in overpayments.
CVS's profit margins at...
Medicaid is America's largest maternal health care payor, and most pregnant enrollees are covered by managed care organizations (MCOs). The Office of Inspector General found states are not leveraging managed care provider coverage requirements and network adequacy standards to promote access to maternal healthcare. The U.S. is...
On October 1, the Arizona Health Care Cost Containment System (AHCCCS) officially launched the Housing and Health Opportunities (H2O) program, which aims to provide housing services for AHCCCS members experiencing homelessness.
The innovative program targets AHCCCS members with a serious mental illness (SMI) who also face housing...
The Affordable Care Act is nearly 15 years old, has survived an onslaught of attacks in that time and remains fundamental policy that shapes regulation of the insurance industry. And yet, Republicans continue to try to undermine and overturn the law whenever possible.
The Biden administration's Justice Department filed a petition with...
The Arizona for Abortion Access campaign for Proposition 139, which would allow abortions up to 24 weeks in Arizona, is going strong in the weeks preceding election day.
The campaign is now spending more than $15 million on a targeted ad blitz this week on television and streaming platforms across the state, according to KJZZ. The...
One of the main provisions of the Inflation Reduction Act's Medicare reform package directly lowers out-of-pocket costs for beneficiaries by capping total individual spending at $2,000 per year. This is causing some issues in practice, which conservatives are seizing upon to criticize the program.
It also instructs insurers to cover...
Health data company Particle Health has filed an antitrust suit against Epic Systems, the largest electronic health record (EHR) vendor in the United States. Epic produces the software that manages the medical records of most Americans.
The lawsuit was filed Monday in the U.S. District Court for the Southern District of New York and...
On September 15 the National Committee for Quality Assurance (NCQA) published its 2024 ratings based on plans' combined HEDIS and CAHPS scores and NCQA Accreditation status. In Arizona's commercial market, Aetna (PPO/EPO), Banner|Aetna (PPO), Cigna (HMO/POS) and UnitedHealthcare (PPO/POS) all received 3.5 stars - or a tad better than...
Arizona's healthcare worker shortage is dire, and the state's rural regions are the hardest hit. This week, Governor Katie Hobbs took steps to address the issue.
Every county in Arizona is short on primary care physicians, and rural health centers are increasingly relying on flying in specialty doctors from California and Colorado to...
This week, the National Committee for Quality Assurance (NCQA) announced a partnership with the Arizona Health Care Cost Containment System (AHCCCS) to support participants in the Targeted Investments (TI) 2.0 Program.
The partnership pledges to support health equity accreditation by addressing health disparities on the population...
Mark Garvin has joined Banner Health as senior vice president for partnership and new venture development. In this role, Garvin will be charged with leading enterprise growth and venture development. Erika Wier is now the CFO in Sierra Vista at Canyon Vista Medical Center.
Previously COO of United Surgical Partners International,...
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