As technological tools advance, patients struggle to keep up with the evolution of medical software required to monitor, communicate and secure their health information. International consultancy Milliman published a white paper on facilitating...Arizona News
Banner Health has appointed healthcare strategist Mark Whalen as executive VP, chief enterprise growth officer, adding another senior executive focused on expansion, partnerships and value-based care as the Arizona-based system continues to invest in its next phase of growth.
Whalen joins Banner from Jefferson, one of the nation's...Arizona News
On Saturday, the Arizona State Legislature adjourned sine die and Governor Katie Hobbs signed an $18.3 billion budget bill into law with strong bipartisan support. The bill includes tax cuts and major curbs on spending while funding critical health and community services. The budget compromise also includes increases in eligibility...Arizona News
From the start, hospital price transparency rules, dating back to the first Trump administration, have presented compliance issues for the Centers for Medicare and Medicaid Services (CMS). This week, Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz announced on social media that the...
Medicare Advantage organizations (MAOs) may be improperly issuing denials for skilled nursing and post-acute care, according to two related reports by the Department of Health and Human Services Office of Inspector General.
In the first, MAOs were found to have overturned nearly all prior authorization denials for skilled nursing...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) targets new oversight of Medicaid demonstration project spending authorization through Section 1115 waivers. Nearly all states use demonstration waivers, including Arizona.
Late last week, CMS issued the new guidance for upcoming demonstrations beginning January 1, 2027. From that...
A new report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) suggests that Medicare Advantage plans may have overbilled significantly for unsupported stroke diagnoses.
The OIG audit looked at health information for a sample of 97 Medicare Advantage members out of a pool of over 200,000 who were...
The next phase of value-based care may depend on specialists. A new industry toolkit from the National Association of Accountable Care Organizations (NAACOS) argues that healthcare organizations must move specialists from peripheral participants to active partners in managing cost, quality and patient outcomes, offering a framework for...
A federal judge has vacated most of the provisions in a Centers for Medicare and Medicaid Services (CMS) rule that intended to significantly alter eligibility and enrollment requirements for the Affordable Care Act (ACA) health insurance exchange. Elsewhere, the agency is requesting feedback for the ACA's essential health benefits...Arizona News
In a report released yesterday, Protect Our Care, a nonprofit advocacy group focused on expanding healthcare coverage and defending the Affordable Care Act, identified seven Arizona hospitals at risk of cuts or closure and nine Arizona clinics that have closed or announced closure since the passage of Trump's flagship legislation, The...Arizona News
As details come into focus of the federal work requirements that will be imposed on state Medicaid programs next year, health systems are preparing for how the cuts will undermine their bottom line.
The new rules, released earlier this month, detail a much stricter work requirement program than initially predicted, and many recipients...
A group of cities and Pima County, Arizona, has filed suit against the Centers for Medicare and Medicaid Services (CMS) for alleged violations of the Affordable Care Act of 2010 and the Administrative Procedure Act of 1946 when the federal agency made rule changes to health insurance exchanges effective next year.
The city plaintiffs...Arizona News
Criticism continues to mount against the Trump administration's plan to use AI-based prior authorization for Medicare claims. The Wasteful and Inappropriate Service Reduction (WISeR) model, now active in Arizona and five other states, has already generated reports of delayed care for seniors since its January launch. On Tuesday, a House...
The Centers for Disease Control and Prevention (CDC) has assessed that the ongoing outbreak of the Ebola virus in Central Africa could grow to 20,000 cases or more. As the disease continues its relatively unabated spread, the Trump administration's severe cuts to global public health response are brought into stark light.
The...
The Medicare Advantage star ratings system, which determines an insurer's annual bonus for participation in the federal program, may face significant challenges because of a recent court ruling requiring the Centers for Medicare & Medicaid Services (CMS) to recalculate the 2026 star ratings for one insurer, Clover Health. The scope...
Contexture, Arizona’s designated health information exchange, confirmed it was approached regarding a federal health data initiative championed by HHS Secretary Robert F. Kennedy Jr., but declined to participate in the national effort seeking access to large-scale health data from state health information exchanges to support federal...
Arizona's largest non-profit health system is elevating artificial intelligence to the executive suite, appointing Dr. John Rares Almasan as senior vice president and chief artificial intelligence, data and infrastructure officer, a newly created leadership position responsible for advancing AI strategy across the organization's clinical...
Anyone who has circled a hospital parking lot on a 110-degree Arizona afternoon can appreciate HonorHealth's latest addition at Scottsdale Shea, a new 400-space patient and visitor parking garage designed to improve access and navigation across the growing campus.
As Arizona's population continues to grow and healthcare systems...
A new West Health series examines one of healthcare's most persistent challenges: how to expand access to mental healthcare despite workforce shortages, long wait times, and a fragmented delivery system that often places treatment behind referrals, narrow networks, and months-long delays.
The series focuses on the Collaborative Care...
Nearly 165 million Americans receive health coverage through employer-sponsored insurance, yet the average annual premium for family coverage has climbed to nearly $27,000, more than doubling over the past decade and far outpacing inflation, according to a new issue brief from Georgetown University's Center on Health Insurance...CMS Rules
The provision getting the most attention in the interim final rule is that HHS declined to give states flexibility to create additional categories of "medically frail" Medicaid beneficiaries exempt from the new work requirements. The agency said the five exemption categories established in federal law are broad enough to cover...CMS Rules
Last week, the Departments of Health and Human Services (HHS), Treasury and Labor in partnership with the White House Office of Personnel Management (OPM) finalized a rule that would overhaul the dispute resolution framework for the No Surprises Act.
The rule will reduce administrative fees for disputes from $115 to $15 per dispute,...
Doctors may be routinely performing high risk vascular procedures unnecessarily, according to a new report from the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS). The report counts almost 140 doctors across the country with suspicious billing patterns related to the treatment.
Rates of...
Last week, the White House Office of Management and Budget (OMB) released proposed regulations that would give political appointees final say on federal research grants and centralize authority inside the OMB.
The OMB is headed by Russell Vought, a conservative strategist formerly with the Heritage Foundation, where he took a leading...National News
Last month, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) issued a report finding that unclear Medicare requirements may have led to overpayments to inpatient rehabilitation facilities (IRF). Industry representatives have shot back at the report and urged lawmakers to ignore it.
The OIG...
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