More than a million Arizonans enrolled in UnitedHealthcare's employer-sponsored, individual and Medicaid health plans will continue to have access to Phoenix Children’s facilities and employed physicians.
Phoenix Children’s Hospital's...Government
Hawaii Gov. David Ige signed into law last week a bill that ensures Affordable Care Act (ACA) benefits for residents of Hawaii.
The benefits protected include extending the coverage age to 26-years old, coverage for individuals with pre-existing conditions and prohibiting the determination of premiums or contributions by using...National News
The Healthcare Effectiveness Data and Information Set (HEDIS) is a popular performance improvement tool among health plans, for which four new measures were released by the National Committee for Quality Assurance (NCQA) for 2019.
According to the NCQA, the updates address "emerging health priorities and evolving processes in care...National News
Insurers claim the Trump administration's decision to withhold billions of dollars in risk adjustment payments could result in higher premiums for millions.
It was confirmed Saturday that $10.4 billion in payments to insurers under Obamacare is suspended due to a court's ruling over the risk adjustment program in New Mexico....Arizona News
Arizona's Medicaid agency reported numerous case management issues against the former provider of Arizona Long Term Care Services (ALTCS).
After working as an ALTCS provider since 2006, Bridgeway lost its bid to secure a new contract with the Arizona Health Care Cost Containment System (AHCCCS) in March 2017 and was responsible for...Arizona News
As of July 1, the 60-bed facility in Mesa is known as Encompass Health Rehabilitation Hospital of East Valley.
Jeff Roberts, CEO of HealthSouth East Valley announced the news,
Our new Encompass Health brand reflects more than the change of our name. It reinforces our commitment to working together to continuously improve the care we...National News
Fewer than 50,000 registered brokers and agents helped 3.6 million customers sign up for an ACA plan in 2018.
In 2017, 65,300 agents helped consumers; a YOY decrease of 24.8 percent, according to a CMS report.
Fewer agents didn't mean a significant drop in ACA plan sales - enrollment decreased less than 4 percent, from 3.7 to 3.66...Arizona News
The decrease in enrollment between 2016 and 2017 occurred largely among people who enrolled without Advance Payment Tax Credits (APTCs) with the average monthly non-APTC enrollment declining by 1.3 million (20 percent) compared to a decrease of only 223,000 (3 percent) APTC subsidized enrollees. Arizona's enrollment losses tops in the...National News
No big clifflhanger here. Small and rural practices will continue to face technology challenges under MIPS as they had under previous legacy Medicare payment incentive programs.
The U.S. General Accountability Office's May 2018 report to Congress was based on interviews they conducted with 23 healthcare stakeholders, including small...Arizona News
Beginning October 1, the new Value-Based Purchasing (VBP) model begins and Skilled Nursing Facilities (SNFs) will automatically lose two-percent of Medicare funding.
SNFs have the opportunity to receive incentive payments from the Centers of Medicare & Medicaid Services (CMS) based on the quality of their care rather than the...Arizona News
The Health Services Advisory Group (HSAG) produced the June 2018 report for Arizona Medicaid's acute care and Comprehensive Medical and Dental Program (CMDP).
Overview of the CYE 2017 External Review included the following MCOs
Care1st Health Plan Arizona, Inc. (Care1st)
Health Choice Arizona (HCA)
Health Net Access (Health...National News
A California court ruling on Friday determined that Humana will not be able to dodge a Medicare Advantage Plan breach of contract suit from Prime Healthcare claiming inadequate reimbursements--underpayments.
Prime Healthcare was an in-network provider for Humana between August 2012 to February 2016, during which it claims Humana...National News
Gov. of Kentucky Matt Bevin didn’t get the ruling he was hoping for in court for his Medicaid overhaul plan and now his administration is making dental and vision coverage cuts for almost 500,000 residents.
On Friday, U.S. federal judge James E. Boasberg rejected Kentucky’s proposal to enact work requirements in the Medicaid...News
In a research article in PLOS Medicine, this research paper found differences in health service utilization and outcomes between FFS and MA patients in SNFs following hip fracture hospitalization.
The objective of this study was to examine differences in rehabilitation service use, length of stay, and outcomes for patients following...National News
If adopted, The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration will allow select providers to drop Merit-Based Incentive Payment System (MIPS) requirements.
CMS is seeking public feedback on the proposal, through September 4, 2018.
Some Medicare Advantage plans are developing innovative...National News
On Thursday, the federal government introduced a new tool focused on giving skilled nursing a better database to exchange records between other members of the healthcare value chain.
Dubbed “Data Element Library,” (DEL) it is a “free, centralized resource” that allows the public to see and collect information and specific...Arizona News
Banner Health and Lyft announced a partnership Thursday, offering patients a transportation solution to and from medical appointments in the near future, available in most Arizona Banner hospitals.
A press release from Banner Health confirmed the service will also be provided at: "urgent care sites and many of its centers, clinics...Arizona News
MA covered 19 million lives in 2017 and ACA plans enrolled 12.2 million.
Beneficiaries in MA and ACA plans benefit from government subsidized coverage, a regulated market, guaranteed issue, community rating (or modified), benefit standards and risk adjustment.
This 2018, nine-page white paper from the Robert Wood Johnson...National News
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patient Communities Act received an overwhelming amount of support from representatives, passing in a 396-14 vote.
This legislation approved by the House on Friday will give various federal agencies the resources they need to combat...National News
To crack down on Medicaid fraud and waste, The Centers for Medicare & Medicaid Services (CMS) will conduct audits of state programs and private Medicaid managed care plans as part of an initiative announced Tuesday, June 26.
CMS administrator Seema Verma attributed these plans to the agency's reformation of Medicaid for "a...National News
California's El Camino Hospital located in the Silicon Valley just made it easier for consumers on the go to shop for medical services. According to Modern Healthcare, their online price estimator gives individuals personalized and reliable estimates for the services they are interested in or need.
The market comes from a digital,...National News
General Electric (GE) plans to spin-off its healthcare unit as a business in itself, selling 20 percent and distributing the rest to shareholders, according to CNBC.
Shareholders will receive 80 percent of GE Healthcare's value as a tax-free distribution in efforts to reduce company debts and increasing cash. This announcement is...Arizona News
An Arizona Daily Star community poll of 1,400 participants found about 1 in 4 Tucson-area residents are not seeking medical care on account of affordability issues.
The poll also reported 16 percent of participants claimed to skip out on filling prescriptions because they could not cover the cost of refills and another 16 percent...Arizona News
The Peoria pharmacists denied Nicole Arteaga her prescription for medication that would help manager her miscarriage and health, according to azcentral.
Recently learning that her pregnancy would result in a miscarriage, Arteaga made a decision to take medication to treat it rather than undergo an invasive surgical...National News
Medicare Payment Advisory Commission’s June 2018 Report to the Congress: Medicare and the Health Care Delivery System promotes value-based payment reform and the use of post-acute care to increase savings and patient outcomes.
Authors concurred the Hospital Readmission Reduction Program (HRRP) has since 2010 played a part in...
National News
The Hertel Report
