Over the weekend, Senate Democrats came together to pass the massive Inflation Reduction Act, which includes a proposal to give Medicare the power to negotiate certain drug prices, as well as a three-year extension of Affordable Care Act (ACA)...CMS Rules
The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act's enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for...
Medicare Advantage plans are a staple in the Medicare market, and as they grow to eclipse the total number of beneficiaries represented by Traditional Medicare, the position MA plans play will need to become more refined. This week, a number of MA plans announced moves into new markets.
The critical distinction between MA and Medicare...
This week, the Medicare Payment Advisory Commission (MedPAC), the independent legislative branch agency tasked with analyzing the Medicare program for the purpose of offering insight and advice into the program for policymakers, published its annual Data Book.
The MedPAC Data Book, "Health Care Spending in the Medicare Program," is a...Arizona News
With more than 7,000 confirmed cases of monkeypox across the country, the U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced a public health emergency (PHE) for the monkeypox epidemic. The PHE declaration may help to streamline vaccination efforts, but stockpiles of vaccine are low and a drug that could...
The Annie E. Casey Foundation's annual report focuses this year on youth mental health and provides a look at the health, economic and other challenges affecting American children. Arizona ranked 44th in the country.
One positive note from the study, which measures between 2016 and 2020: Arizona stood out among the...
The Centers for Medicare & Medicaid Services have logged more than 3,000 comments regarding its proposal of mandatory staffing minimums for America's nursing homes. Nursing home operators also learned from AHCA and NCAL that if nursing homes continue to gain jobs at the current, modest pace, a potential recovery to pre-pandemic...
The lawsuit filed August 5 features an Arizona plaintiff and alleges the insurer has used a "churn-based strategy" that leveraged its role as a Medicaid insurer to boost enrollment in its Marketplace plans, which were allegedly in violation of network adequacy regulations, supplied beneficiaries with inaccurate provider directories, and...National Reports & Surveys
In 2022 insurer participants grew 21% YOY in the individual market, which displayed stable premiums thanks to additional subsidies from the American Rescue Plan. The market featured more product choices for consumers and one stand-out brand: Blue Cross Blue Shield, which since 2014 has been available to 80% of consumers shopping for a...
Gains were concentrated in Medicaid and enrollment increased in every state, but Arizona's enrollment grew faster than the average at 28.5% from February 2020 to April 2022. National enrollment in Medicaid & the Children's Health Insurance Program grew to 88.3 million enrollees in April 2022. Enrollment was declining in the two years...
COVID-19 cases have now plateaued at an unusually high level in Arizona, and research demonstrates that rural people of color were hit the hardest by the surge in cases related to the Omicron variant earlier this year. The Biden administration has announced that it has procured vaccines specifically designed to combat the BA.4 and BA.5...
The data usually is released in April but was delayed due to a calculation error. Updated July 27, 2022, the Overall Hospital Quality Star Rating summarizes 47 quality measures across five categories to create a single, star rating for hospitals across the nation. Most Arizona hospitals, like the majority in the United States, earned...
In a surprising turn of events, the Centers for Medicare and Medicaid Services issued the FY 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule which contains a 2.7% increase in Medicare rates to nursing homes. When the proposed payment rule was published in April, the agency had proposed cutting Medicare Part...
Medicare Advantage prior authorization reform has strong support as legislation passed through the U.S. House Ways and Means Committee last Wednesday with unanimous support.
Representative Suzan DelBene (D-Wash.), who introduced the Improving Seniors Timely Access to Care Act, said the committee vote sets the stage for a floor vote...
Last Wednesday, Senate Majority Leader Chuck Schumer (D-N.Y.) announced a reconciliation package that includes drug pricing reforms, a three-year extension of the Affordable Care Act (ACA) tax credits enacted under the American Rescue Plan (ARP), in addition to deficit reduction and investments in climate and energy security. Senator Joe...
Employer-sponsored insurance is the backbone of the American healthcare system. It pays for the majority of medical needs for employed adults and their families and has been lauded as a necessary negotiator for patients and providers, in order to deliver high-quality, patient-specific care. But according to a new study,...
America's Health Insurance Plans published an issue brief with several key policy recommendations to deliver a "strong, stable market that works for all Americans."
After assurances from lawmakers that the reconciliation package will extend American Rescue Plan subsidies for the next three years, AHIPs first recommendation is a quick...CMS Rules
The rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals (LTCH) and builds on key priorities to advance health equity, including better measurements for healthcare quality disparities and improving the safety and quality of maternity care by establishing a...
After striking down the ACA in 2018, Federal District Judge Reed O'Connor is no friend of the Affordable Care Act and last week heard arguments in the case Kelley v Beccera with Texas Solicitor General Jonathan Mitchell arguing against the guaranteed preventive services. A ruling in favor of the plaintiffs puts millions of Americans at...
This week in Medicare Advantage news, the home-based care industry is gearing up to assert itself amid concerns that home care services are being inadequately compensated. A new bill modeled on existing Texas law tries to limit the harms caused by prior authorization in Medicare Advantage plans. Also, Centene is concerned about its star...
At this time two years ago, the future of alternative payment models (APMs) and accountable care organizations (ACOs) was uncertain and to some degree the entire landscape of value-based care hung in the balance while the Trump administration sorted out the details of the Direct Contracting payment models. But now, under the Biden...
On Monday, the Biden administration's Department of Health and Human Services (HHS) issued a proposed rule that would prohibit discrimination in healthcare programs on the basis of sexual orientation or gender identity, including reproductive healthcare services. Despite this move, LGBTQ-community advocates remain concerned about...
Amazon has announced plans to buy One Medical, a primary care provider, in a move that illuminates the tech distribution giant's goals for the medical industry. One Medical is a membership-based practice that offers virtual services and currently covers 767,000 members. The deal is reportedly worth $4 billion.
In 2018, Amazon acquired...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) published a set of quality metrics for home and community-based services (HCBS) to assess patient health outcomes. According to CMS, the ratings will provide insight into HCBS programs and will enable states to determine the success of long-term services and support programs offered...
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