Originally created to ensure Medicaid beneficiaries with a serious mental illness (SMI) weren't warehoused in facilities by the government, the IMD exclusion means state Medicaid agencies can't pay for mental healthcare services received in a...National News
An internal study released Tuesday shows Humana’s shift from the traditional fee-for-service (FFS) model to value-based care is cutting costs and improving quality of care for seniors enrolled in its Medicare Advantage (MA) plans.
The study found medical costs were almost 16 percent lower for seniors enrolled in Humana MA plans...Arizona News
All eyes will most likely be on the Centers for Medicare and Medicaid Services (CMS) as the agency sparks conversation of possibly using Medicaid to pay for housing. Healthcare is continuing its move toward value-based care and judging by a speech delivered by Health and Human Services (HHS) Secretary Alex Azar last week, the government...National News
This past weekend, Nov. 10 - 13, the American Medical Association (AMA) held their annual House of Delegates 2018 Interim Meeting to talk policy changes including those on gender identification fluidity, public health data collection, identification for the homeless and the detention of migrant children.
AMA President Barbara L....Arizona News
Banner Health announced today its new Chandler hospital will be named Banner Ocotillo Medical Center. The news follows last week's approval from Chandler's City Council to move forward with the four-story 245,00 square foot development despite dissent from community members.
Objections to the project came from neighbors worrisome...National News
In a letter this week, the nonpartisan commission continued its criticism of the state's work requirement to Health and Human Services Secretary Alex Azar; Arkansas has no plans to pause the program, the first in the nation.
So far about 8,500 beneficiaries have been kicked off Arkansas' Medicaid program since its work requirement...Arizona News
Last week, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma released an update to her Merit-based Incentive Payment System (MIPS) original performance evaluation published in May. The November 8 blog post revealed 93 percent of participants merited a positive payment adjustment for their 2017...National News
Drugs with alternative drug codes, including hepatitis C treatments Epclusa (sofosbuvir/velpatasvir) and Harvoni (ledipasvir/sofosbuvir) will be among the first listed on the new formulary when released January 1. 2019.
The formulary is available for commercial plans only. It's a move the pharmacy benefit manager is betting will gain...Arizona News
Retiring AHCCCS Director Tom Betlach will join Missouri Medicaid Director Dale Carr and a senior leader from the Center for Program Integrity at CMS to discuss how states and the federal government are partnering to identify and address inappropriate or unnecessary spending in the healthcare system.
Department of Health & Human...Arizona News
A local and national leader on managed Medicaid and healthcare policy, Betlach spent nearly two decades with the Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency; Betlach served nine years as AHCCCS director and eight as its deputy director.
Governor Doug Ducey announced Betlach's retirement today,...National News
The minority staff of the U.S. Senate Committee on Finance released an unfavorable nursing home report last week titled, “Sheltering in Danger.” The report is an account of the way in which nursing home residents were put at risk during Hurricanes Harvey and Irma in 2017 due to poor emergency planning.
Senators claimed the...Arizona News
Last month, a global stock market sell-off sent the S&P 500 into dangerous waters, having analysts discussing potential bear market climates but stocks rallied this week and healthcare was leading the numbers following the midterm elections.
PricewaterhouseCoopers (PwC) released an analysis today regarding the effects midterm...Arizona News
New York-based startup health insurance company Oscar Health is expanding and hiring 400 new employees as it acquires new office space to establish a more robust presence in Arizona.
Oscar Health moved into its Tempe office in The Circuit complex just two years ago and is leasing another space in the complex, adding hundreds of...National News
According to a state audit released this past week, California’s Medicaid program, Medi-Cal, spent $4 billion between 2014 and 2017 on coverage for beneficiaries that may have been ineligible for Medicaid.
California’s $100B Medicaid program covers 13.1 million residents of the state (one-third of the state) and eligibility is...Arizona News
Anthem individual insurance plans bid goodbye to Affordable Care Act (ACA) markets across the nation to focus on the growth of its Medicare Advantage business, an experience more sweet than bitter; the insurance giant's third quarter profits were up 29 percent, year over year.
Enrollment in Anthem's insurance plans may have taken...National News
In the mid-term election, voters in Idaho, Nebraska and Utah voted to expand Medicaid eligibility to about 300,000; Montana voters rejected a new funding option for its expansion program.Medicaid expansion is now available in 37 states and the District of Columbia. Idaho's measure won by 22 points and is expected to extend Medicaid...National News
The U.S. District Court agreed with The Federal Trade Commission (FTC) request to temporarily shut down the operations of the South Florida company Simple Health Plans - a precursor to a permanent shut down.
Since October 2013, the health plan pitched consumers comprehensive health insurance or its equivalent - sometimes luring...National News
Published November 1, 2018, the rule updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
Physician payment rates are relatively flat with a 5-cent bump, year-over-year (YOY), but doctors will spend less time during visits...Arizona News
As the midterm elections are right around the corner, healthcare is on the minds of many; politicians and voters alike. The news cycle this week is marred with a slew of "he said, she said" pieces, Republicans pointing condemning fingers at the policies of Democrats and vice versa. The question is not "why healthcare", however, but "what...National News
The Trump administration approved Wisconsin's waiver request to impose Medicaid work requirements, marking the first "okay" granted for a state that has yet to expand its Medicaid eligibility.
The work requirement is based on achieving at least 80 hours a month working, in school, in job training or doing volunteer community...National News
The Office of the Inspector General's opined that when a Medicaid insurer provides financial incentives to network providers for increasing the number of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, such incentives would not violate the Anti-Kickback Statute.
In the proposed arrangement, network providers...National News
The proposed rule released Friday, October 26 would give 2020 MA plans the option of offering government funded telehealth benefits to all MA members regardless of their rural or urban zip code.
Also included in the pitch from The Centers for Medicare & Medicaid Services (CMS) is a plan to unify the appeals processes across...Arizona News
The Maricopa County Special Health Care District Board approved the bond sale in September. The bond's subsequent pricing and high investment grade ratings was received well by investors on October 11. The transaction closes October 30, 2018.
Maricopa County Special Health Care District board member Mark Dewane said MIHS’s...Arizona News
The Joint Commission identified the first and only designated Advanced Comprehensive Stroke Center in Arizona--Banner University Medical Center Phoenix (BUMCP) now holds two stroke certifications from the commission.
In 2003, a partnership originated between The Joint Commission and the American Heart Association (AHA) and together...Arizona News
Maricopa isn't the only county seeing more choice in the Affordable Care Act (ACA) exchanges this year; Pima County residents have their choice from three health plans, an abundance compared to last year's singular choice, Ambetter from Health Net.
Blue Cross Blue Shield of Arizona (BCBSAZ) along with Bright Health will be joining...
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