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COVID-19 Update March 16, 2023

COVID-19 Update March 16, 2023

Open
The Battle of Medicare Advantage 2024 Advance Notice Rages On

The Battle of Medicare Advantage 2024 Advance Notice Rages On

CMS Rules
CMS Rule: Nursing Homes to Disclose Private Equity and REIT Ownership, Affiliations

CMS Rule: Nursing Homes to Disclose Private Equity and REIT Ownership, Affiliations

CMS Rules
CMS Finalizes Medicare RADV Rule, Insurers Pledge to Put Up a Fight

CMS Finalizes Medicare RADV Rule, Insurers Pledge to Put Up a Fight

CMS Rules
National News

AMA Physician Survey: PA Controls Lead to Unnecessary Waste & Avoidable Patient Harm

Almost half of the physicians surveyed (46%) reported prior authorization policies led to urgent or emergency care for patients. According to the American Medical Association's most recent physician survey, more than four in five clinicians (86%)...

Calling for Applicants: $40M Award Program to Strengthen HCBS in Arizona

Starting April 17, 2023, providers can apply for up to $500,000 for programmatic or infrastructure projects to improve the health, safety, and member experience of individuals who receive Home and Community Based Services (HCBS) in Arizona. All applications must be submitted by 5 p.m. on May 16, 2023. The Arizona Health Care Cost...
Scottsdale Physician's Group in Bankruptcy, Founder Accused of Fraudulently Transferring Millions to Personal Accounts

Scottsdale Physician's Group in Bankruptcy, Founder Accused of Fraudulently Transferring Millions to Personal Accounts

Founder Dr. Nima Ghadimi is now facing nearly 20 financial claims in bankruptcy court against Scottsdale Physician's Group and its affiliates, SPG Hospice LLC and United Telehealth Corp. In addition to a claim of $589 million from the Department of Justice, a deep dive into the company's financials uncovered Ghadimi had both his mother...
Arizona Legislative Update March 23, 2023

Arizona Legislative Update March 23, 2023

In the Arizona Legislature this week, the Senate Health and Human Services Committee passed a slew of health-related bills and the community weighs in on some bills that could directly impact health care providers. The Senate Health and Human Services Committee had a busy docket this week, with six bills under close watch by the...
National News

End of Covid-19 Emergency Will Usher in Changes Across the US Health System

The Biden administration’s decision to end the Covid-19 public health emergency in May will institute sweeping changes across the health care system that go far beyond many people having to pay more for covid tests. In response to the pandemic, the federal government in 2020 suspended many of its rules on how care is delivered. That...
LeadingAge Publishes White Paper on Medicare Advantage White Papers, E books, Reports and more

LeadingAge Publishes White Paper on Medicare Advantage

Last week, LeadingAge published a white paper that describes the difficulties Medicare Advantage members face accessing payment for post-acute care services. The white paper, "Fulfilling the Promise: Medicare Advantage," identifies the issues that many beneficiaries face when attempting to access benefits, such as delays, unnecessary...
National News

Nuance Dragon Gets an AI Update, Cleveland Clinic Goes Quantum

Nuance Communications, a Microsoft-owned company that manufactures speech-to-text transcription services for medical settings, announced that it would include GPT-4 to its latest application. The application, Dragon Ambient eXperience Express, should now be able to summarize and enter conversations between clinicians and patients...
MedPAC Releases 2023 Report to Congress

MedPAC Releases 2023 Report to Congress

The Medicare Payment Advisory Committee (MedPAC) submitted its March 2023 Report to Congress which included its 2024 payment recommendations for Medicare fee-for-service (FFS), Medicare Advantage (MA) and the Medicare prescription drug program (Part D). This year's report is likely to please no one as the committee took aim at claims of...

UNOS to be Replaced by New Administrator for Organ Donation

State and federal actors are investigating and adding new regulations to organ donation and transplants. On Wednesday, the Biden administration announced that it intends to "put out for bid" the work of the national nonprofit United Network for Organ Sharing (UNOS), which coordinates organ procurement organizations with transplant...

Banner Opens Gilbert Tower, Ready for Scottsdale Expansion & Dignity Health Has Eyes on Surprise

This week Banner Gateway Medical Center doubled the size of its Gilbert hospital when it opened its $243 million five-story tower and will expand its market footprint to Scottsdale with a new $400m hospital and cancer center on the corner of Hayden Road and Loop 101 opening in 2026. Dignity Health is eyeing a 22 acre parcel in Surprise...
Arizona News

NAU Expands Accelerated Nursing Program, Other Nursing News

Northern Arizona University is expanding its accelerated nursing program at its North Phoenix campus to help Arizona address its dire nursing shortage. But many other challenges are discouraging potential nurses from entering or staying in the field. The NAU-North Valley Bachelor of Science in Nursing program is only three semesters,...
News

Texas and Florida Move Forward on Gender Affirmative Care Bans

For three years, states have been passing and enacting laws that target gender affirming care for transgender children and adults. This week, states and employers continue to curb access to gender affirming care. More than 20% of transgender children lost access to gender-affirming health care because of state laws prohibiting medical...
Arizona News

Medicaid Redetermination - Terminations Begin April 1 - Google Steps Into Help Navigate

With more than 650,000 Arizona Medicaid members at risk of losing coverage, existing beneficiaries need all the help they can get. Google announced it was adding a feature to help users re-enroll in Medicaid. The continuous enrollment provisions end March 31. On April 1, states will begin disenrolling Medicaid members no longer...
CMS Rules

MA Prior Authorization Rule Comment Period Ends and Algorithmic Claims Denials

In December, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require all health plans, including Medicare Advantage plans, to limit prior authorization deliberations to seven days. On Monday, the public comment for that rule closed. Many providers believed that the rule doesn't go far enough,...
New Arizona PHI Data Breaches Reported: DES & Hospice of the Valley National News

New Arizona PHI Data Breaches Reported: DES & Hospice of the Valley

The Arizona Department of Economic Security reported more than 800 members' protected health information (PHI) was exposed in the January 19 breach. Hospice of the Valley reported a February cyber attack that exposed the PHI of 3,840 patients. According to a July IBM industry report, the average cost of a healthcare data breach was an...
Employers Increasingly Moving Retirees to Medicare Advantage National News

Employers Increasingly Moving Retirees to Medicare Advantage

Employers are increasingly moving retirement plans to Medicare Advantage health coverage, but the retirees in question are often upset with these moves. The City of New York recently attempted such a pivot, which led to a high-profile fight in the courtroom and public politics. Perhaps most surprisingly, the City and some unions...
Arizona Legislative Update March 16, 2023 Arizona News

Arizona Legislative Update March 16, 2023

Arizona lawmakers made progress on several bills related to healthcare and COVID-19 this week. Last Tuesday, the Arizona Senate Health and Human Services Committee approved HB 2474, which would prohibit schools from requiring immunizations issued by the U.S. Food and Drug Administration (FDA) under emergency use authorization for...
National News

VA Approves Anti-Alzheimer's Drug for Coverage

The U.S. Department of Veterans Affairs (VA) has agreed to pay for the Alzheimer's drug Leqembi, putting pressure on the Medicare program to follow suit. Leqembi, produced by Japanese pharmaceutical manufacturer Eisai Co. in cooperation with Biogen Inc., was approved by the U.S. Food and Drug Administration (FDA) earlier this year....
Arizona News

What SVB Failure Means for the Health Sector

The collapse of Silicon Valley Bank over the weekend spells a new type of disruption for venture capital firms invested in healthtech, biotech and digital health companies. On Sunday, the Federal Reserve, U.S. Treasury Department and the Federal Deposit Insurance Corporation (FDIC) announced that all Silicon Valley Bank (SVB)...

CMS Releases Details on Medicare Drug Price Negotiation Program for 2026

This initial program guidance details the requirements and procedures for implementing the Medicare Drug Price Negotiation Program in 2026, the first year negotiated prices will apply. The guidance is one of a number of steps CMS laid out in the Medicare Drug Price Negotiation Program timeline for the first year of negotiation. The...

President Joe Biden Unveils Plan to Save Medicare

On Tuesday, the White House released a plan that it says will keep the Medicare Trust Fund solvent for at least 25 more years. In an op-ed, the President made the case for his plan, stressing that tax hikes on high earners would be crucial for the plan to work. The plan will increase taxes on people who make more than $400,000 per...
COVID-19 Update: March 9, 2023

COVID-19 Update: March 9, 2023

Maybe it was a lab leak after all? Or maybe not. This week the U.S. Energy Department announced that it determined that the COVID-19 pandemic most likely arise from a laboratory leak. Governor Katie Hobbs proclaims COVID-19 Memorial Day. According to the Wall Street Journal, the announcement was made after a classified report was...
National News

KFF Report: Health Insurance Financial Performance in 2021

In the Kaiser Family Foundation's analysis, 2021 Medicare Advantage earned the highest per-person, average gross margin of $1,730 per enrollee in 2021, similar to the pre-pandemic years 2018 and 2019 and more than double the gross margins reported across the individual, group and Medicaid managed care markets. Medical Loss Ratios (MLR)...

Navajo County Ranks High for Health Inequity and Dignity Tackles Social Vulnerability

Navajo County, Arizona is one of the least insured regions in the country, has poorly maintained infrastructure and a shockingly low-level of healthcare professionals to meet the needs of residents. Also, the private sector attempts to address health equity concerns. According to data compiled by Modern Healthcare, Navajo County ranks...

Valleywise & Mayo Capital Projects & Yuma Hospital Reports $26M in Migrant Medical Care Costs

The new 10-story Valleywise Health Medical Center is on budget with the building nearly 75% complete and Mayo Clinic submitted its zoning application to the city of Phoenix for Discovery Oasis, a 120-acre medical and research campus near its Phoenix hospital. Yuma Regional Medical Center is reporting a surge of migrant patients has cost...
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