Virginia “Ginny” Rountree announced yesterday that she will resign as director of the Arizona Health Care Cost Containment System (AHCCCS), citing personal health concerns. Her final day with the agency will be Friday, Feb. 13.
After deep...
The notion that a Republican administration would be inherently favorable to Medicare Advantage (MA) is being tested. From CMS’ decision to hold MA rates flat for next year, to the DOJ's continued enforcement actions related to MA billing and the OIG's heightened scrutiny of upcoding practices, MA stakeholders are preparing for a bumpy...
CommonSpirit Health is moving to end its revenue cycle management relationship with Conifer Health Solutions, a subsidiary of Tenet Healthcare. Instead, the nonprofit health system is breaking its contract to move the work in-house.
CommonsSpirit is the nation's largest nonprofit health system, known best locally by its subsidiary...Arizona News
As ICE efforts to deter illegal immigration increases in the US, legal immigrants and US citizens in mixed-status families are avoiding and even some are skipping health appointments as patients fear what might happen if they show up. Despite Federal law that forbids undocumented individuals from receiving coverage under the low-income...
On Tuesday, February 3, the House narrowly passed an appropriations minibus ending a three-day partial government shutdown that began on Saturday. The $1.2 trillion legislation addresses five spending bills and reauthorizes popular telehealth services, revises funding for Federally Qualified Health Centers, sets new PBM measures and...
The Rural Health Transformation Program (RHTP), which was initially proposed to offset rural health system losses due to Medicaid cuts, has become the centerpiece of the Trump administration's approach to innovating healthcare solutions on a geographic basis. A new report from Georgetown's Center on Health Insurance Reforms (CHIR) shows...
Not updated since 1999, the new guidance applies to all individuals and entities involved in the healthcare industry and serves as the Office of Inspector General's updated and centralized source of voluntary compliance program guidance for Medicare Advantage (MA). Entities and individuals can use the ICPG to help identify risks and...Arizona News
Arizona Complete Health, a subsidiary of Centene and one of Arizona’s largest AHCCCS insurers, has awarded $950,000 in capital grants to 32 nonprofit and public-sector organizations statewide.
According to the insurer, the grants are intended to strengthen community infrastructure supporting healthcare access, housing stability,...Arizona Comings & Goings
Arveson brings more than 25 years of healthcare finance experience to Banner Health. She was formerly the chief financial officer of the South Division of Providence, California's $9.3 billion non-profit Catholic integrated health system. At Providence, she served in various local operational and corporate roles, including chief...Arizona News
Northern Arizona Healthcare (NAH has received a $248,500 competitive grant from the American Cancer Society, supported by Pfizer, to improve cancer care coordination for Native American patients across northern Arizona and the Colorado Plateau.
The two-year initiative, known as Connected Care, focuses on patients receiving radiation...Arizona News
Arizona’s 2026 governor’s race is expanding beyond the two major parties, with a longtime healthcare executive stepping into an already competitive field as an independent candidate.
Hugh Lytle, founder and former CEO of Scottsdale-based Equality Health, announced this week that he is running for governor with the backing of the...National News
The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) was widely criticized for discussing revisions to the childhood immunization schedule. This week, the committee's new chairman, Kirk Milhoan, M.D., Ph.D. went on a podcast and appeared to suggest an openness to reviewing...CMS Rules
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposal for the 2027 Medicare Advantage (MA) and Part D Advance Notice. The agency proposed a slight increase of 0.09%, shocking shares of publicly traded insurance companies.
The meager increase proposal comes after the Trump administration granted a generous...National News
Last Thursday, the United States formally withdrew from the World Health Organization in a move that many in the scientific community are calling "dangerous." Historically, the United States had been the most influential member of the 194-member organization and was its largest financial contributor.
The withdrawal was announced in a...National News
Six annual spending bills for the budget year need Senate approval this week, including an appropriations bill that would fund the Department of Health and Human Services through September. But following the murder of Alex Pretti by Customs and Border Patrol agents on Saturday, Democrats have vowed to oppose the bill without changes to...National News
Earlier this month, the Centers for Disease Control and Prevention (CDC) announced significant modifications to the childhood vaccine schedule, cutting the total number of recommended vaccinations from 17 to 11. On Monday, the American Academy of Pediatrics released its own immunization guidelines to recommend that children continue to...Arizona News
Arizona’s autism therapy network is under fresh strain this week after UnitedHealthcare began terminating contracts with Action Behavior Centers, prompting new concerns about access to care for children receiving Applied Behavior Analysis therapy under Medicaid managed care plans.
Parents told AZ Family they received notices that...White Papers, E books, Reports and more
As pharmacy benefit managers (PBMs) are once again poised to fall under regulatory constraints, the Paragon Health Institute has published an explainer on PBMs, how they work and why they've received so much public scrutiny.
The explainer by Paragon, "PBM 101: What They Are and How They Affect Drug Prices" explains that PBMs work as a...National Reports & Surveys
UnitedHealth Group (UHG) released its 2025 end-of-the-year report, which begins with double-digit revenue growth, then pivots to signaling a deliberate pullback in 2026 and pledges to prioritize margin repair over membership expansion, a shift with outsized implications for Medicare Advantage, Medicaid and pharmacy markets, including...National News
The agency estimates that there were $28.83 billion in improper payments to traditional Medicare, which it estimates are down from $31.7 billion in 2024. The Center for Medicaid & Medicare Services acknowledges improper payments are not indicative of fraud or abuse but are typically the result of clerical error.
The agency looked...
An Arizona Medicaid contract dispute involving one of the state’s largest autism therapy providers and one of the largest Medicaid health plans is escalating into litigation, raising questions about network adequacy, reimbursement pressure, and continuity of care for children receiving applied behavior analysis services.
According...
On Tuesday, senior members of Congress announced a deal to fund the government for 2026. The bill would resurrect a number of bipartisan measures that were poised to pass in late 2024 but were undermined by then-President-elect Donald Trump.
The new bill would extend Medicare telehealth and hospital-at-home waivers for two and five...
Last week, President Donald Trump introduced "The Great Healthcare Plan," a policy framework that aims to lower drug prices and cut medical costs for consumers.
In a video address, President Trump called on Congress to enact his Great Healthcare Plan and consolidate the various Trump-era health-adjacent initiatives into a single law....
A Senate report shows that UnitedHealth Group (UHG), the parent company to the nation's and Arizona's largest Medicare Advantage (MA) insurer, UnitedHealthcare (UHC), is artificially inflating the risk adjustment scores of its MA members in order to achieve higher reimbursement from the Medicare program.
The report is based on 50,000...
All eyes are on UnitedHealth Group's last quarterly financial report of 2025 (Q4). The insurance giant's financials are expected to signal the relative strength of the economic sector's effort to prop up much of the job growth in the American economy and respond to aggressive threats from the Trump administration.
UnitedHealth Group...
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