Melanie MacEachern, Author at The Hertel Report

Melanie MacEachern

Freelance writer with skills and knowledge in healthcare policy, reproductive justice and art history. Skilled administrative assistant. Graduated from University of Michigan.

Author's Posts

Arizona News

Work Requirements, Provider Tax Changes Threaten Hospital Funding & AHCCCS Enrollment

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,...

Arizona News

Pima County Joins Lawsuit Against CMS Challenging ACA Exchange Rule Changes

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

Congress Moves to Halt Medicare AI Prior Authorization Program Active in Arizona

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...

National News

Ebola Outbreak Could Rival Deadliest Epidemic on Record

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...

National News

Medicare Advantage Bonuses Face Uncertainty After Major Court Ruling

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...

CMS Rules

HHS Narrows Medical Exemptions as Medicaid Work Requirement Rollout Looms

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

CMS Announces Rule Changes to No Surprises Act

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,...

National News

OIG Investigating Overbilling for Unnecessary Vascular Treatment

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...

National News

White House Proposes Greater Political Oversight of Federal Research Grants

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

Industry Groups Reject OIG's Report of $5B in Overpayments to Inpatient Rehabilitation Facilities

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...

National News

Eli Lilly Threatens 340B Discounts for Hospitals That Refuse Claims Data Requests

On Monday, pharmaceutical manufacturer Eli Lilly issued an ultimatum to 50 hospitals nationwide to submit comprehensive claims data over the next five days or be severed from discounts through the 340b prescription drug discount program. In January, the company announced a new policy that would require hospital data in an effort to...

CMS Rules

CMS Publishes Rules That Will Reduce Medicaid Payments

Last summer, Congressional Republicans rallied to pass the One Big Beautiful Bill Act (OBBBA), which funded the Trump administration's agenda largely through cuts and alterations to the Medicaid program. Now, the administration is crafting rules to follow through on the directives in the bill, and is met with protest from provider groups...

Arizona News

Healthcare Workforce Shortage Dire in Arizona

Arizona's provider shortage is dire, failing to keep up with the high numbers of new residents the state acquires every year. Both locally and nationally, recruitment and education programs are falling short of what is needed to meet the high demand for healthcare workers. Arizona's doctor shortage is getting worse, according to...

White Papers, E books, Reports and more

Report: MA I-SNP Plans Linked to Better Outcomes Than Medicare FFS

Institutional Special Needs Plans (I-SNPs), a special type of special needs plans offered through Medicare Advantage that serve qualified patients who reside in community settings or living facilities, are correlated with better outcomes for mortality and certain quality outcomes compared to Medicare fee-for-service (FFS) and non-I-SNP...

National News

Medicare Advantage Industry Faces Growing Backlash From Providers, Researchers and Patients

As the Centers for Medicare and Medicaid Services (CMS) weighs the expansion of Medicare Advantage (MA) coverage through automatic enrollment, it's worth asking if the program is meeting the needs of U.S. seniors at a responsible cost to the American taxpayer. Providers say no, and are calling for Congressional action to solve some of...

White Papers, E books, Reports and more

Milliman Publishes White Paper on Child Wellbeing

A new white paper from Milliman demonstrates areas for state child welfare agencies to use Medicaid more effectively to support clinical services while easing burdens on state and local budgets. State child welfare agencies face external pressure to balance rising costs while increasing outcomes of child wellbeing under increased...

National News

Ebola Outbreak and USAID Cuts, NIH Leadership Vacancies

An outbreak of the Ebola virus in the Democratic Republic of Congo has international health agencies concerned that local medical response entities and hospitals are not up to the demand without the assistance of the U.S., which largely withdrew its international public health presence after President Donald Trump took office in...

CMS Rules

Prior Authorization Troubles Persist as WISeR Model Faces Scrutiny

Almost one year ago, 50 major health insurers met with U.S. health department leadership and pledged to rein in their use of prior authorization, which patients and providers complain severely disrupts the continuity of care. Now, despite industry studies demonstrating that the practice has been curbed by a little over 10%, the practice...

National News

SCOTUS Rejects Drugmaker Challenge to Medicare Drug Price Negotiation Policy

The U.S. Supreme Court (SCOTUS) shot down cases from AstraZeneca, Johnson & Johnson, Bristol Myers Squibb, Novo Nordisk, Novartis and Boehringer Ingelheim in a summary of orders issued Monday. The court's summary declined to state why it refused to hear the cases, though STAT notes that the implication of the sweeping rejection is...

National News

TrumpRX Expands Partnerships & Inventory

The Trump administration announced an expansion of the prescription drug discount platform, TrumpRx, through a partnership with Cost Plus Drug Company, Amazon Pharmacy, and GoodRx. Until the partnerships were announced, the TrumpRx platform was widely criticized for offering access to discounts on brand-name drugs, though many were...

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