Medicare Advantage is entering a more contested phase, with federal scrutiny intensifying, insurers pulling back from markets and plans moving to stabilize provider relationships as payment policy shifts. That tension has direct implications in...CMS Rules
As insurance companies raise flags about the cost of GLP-1 weight loss drugs in coordination with government payer programs, the Trump administration has rescinded its plan to have insurance companies fund coverage of the obesity drugs and will have Medicare pay the cost instead.
Last year, the White House announced a landmark deal...
As drug prices continue to rise and seniors struggle to keep up with inflated costs, a new Senate bill seeks to change the way Medicare Part D plans cover cheaper options.
Senators James Lankford (R-Okla.) and Maggie Hassan (D-N.H.) introduced the Ensuring Access to Lower-Cost Medicines for Seniors Act, which would require Part D...Arizona News
The City of Phoenix is considering an ordinance that would inhibit nonprofits and support services from providing food or medical care to homeless people in city parks. Advocates vociferously oppose the potential measure, stressing that unhoused people could die if they lose access to these critical services.
The draft ordinance under...
As Arizona continues to align Medicaid and Medicare for dual-eligible members, new research is sharpening focus on how those integrated plans are paid. About 130,000 duals are enrolled in nine plans across the state, with UnitedHealthcare’s Dual Complete accounting for roughly half of that enrollment, according to April CMS...White Papers, E books, Reports and more
One in five American children has a chronic health condition, with even higher rates among those enrolled in Medicaid and the Children’s Health Insurance Program. The trend raises questions about how to address underlying systemic drivers and whether value-based care models can help improve outcomes for children and youth.
The...
Under severe public scrutiny, health insurers have scaled back the use of prior authorization by 11% since 2024. Meanwhile, the new WISeR model faces struggles, but the Centers for Medicare and Medicaid Services (CMS) appears set on applying the practice to the Medicare program.
The Wasteful and Inappropriate Service Reduction Program...
A bill in the Arizona State Legislature that would allow patients from across the state to be admitted to the Arizona State Hospital for psychiatric care regardless of their county of residence could still pass through the legislative process.
The bill, Senate Bill 1813, is sponsored by Senator David Gowan (R-Sierra Vista) and would...
The Trump administration is continuing its push towards electronic health record adoption and centralization through a new "Kill the Clipboard" initiative that pledges to streamline data sharing through biometric security and QR codes.
The "Kill the Clipboard" initiative is headed by Amy Gleason, a U.S. DOGE Service appointee and...National News
Last week, the Centers for Medicare and Medicaid Services (CMS) announced its proposal for the 2027 Inpatient Prospective Payment Systems (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System. The rules contain a proposed 2.4% rate increase for inpatient services and a nationwide test of an episode-based payment...National News
A new proposed rule from the Centers for Medicare and Medicaid Services (CMS) targets prior authorization (PA) of pharmacy benefits by shortening the turnaround deadline for certain requests and requiring the disclosure of denial rates.
The regulation would require Medicaid and Children's Health Insurance Program (CHIP) insurers and...Arizona News
A new analysis from the Urban Institute, funded by the Robert Wood Johnson Foundation, finds that recently enacted federal Medicaid policy changes could significantly reduce coverage, with Arizona facing substantial enrollment losses depending on how the state implements the law.
The report examines the impact of work requirements and...Arizona News
If you’re trying to understand how corporatization is reshaping healthcare in your state, particularly in fast-consolidating markets like Arizona, a new brief from the Georgetown University Center on Health Insurance Reforms lays out a practical roadmap.
The report is designed as a step-by-step guide for policymakers and market...
A new issue brief from the American Hospital Association, the Federation of American Hospitals, and the National Association of Long-Term Hospitals reports mounting financial and access pressures for long-term care hospitals, with researchers concluding that recent Medicare payment policies have contributed to declining capacity and...
The new AHCCCS Solutions Center is a centralized platform designed to make it easier for providers and their staff to connect with AHCCCS and submit requests. The agency scheduled several April webinars to introduce users to the new platform.
Arizona's Medicaid agency, the Arizona Health Care Cost Containment System, is hosting a...
Last Thursday, the Centers for Medicare and Medicaid Services finalized a rule that overhauls the Star quality rating system for Medicare Advantage programs, cutting several measures, including the health equity index. The changes are anticipated to net insurers $18.6 billion over the next ten years.
In lieu of the health equity...
The Trump administration's 2027 budget proposal requests $111.1 billion in discretionary funding for the Department of Health and Human Services, slashing the department's budget in exchange for extended tax cuts and spending hikes for the military and immigration enforcement.
The vision outlined in the budget proposal is one of high...
A coalition of over 130 hospitals has filed suit against the U.S. Department of Health and Human Services over methodology used to calculate risk payments to hospitals that treat a higher number of Medicare patients.
As it stands now, the Centers for Medicare and Medicaid Services estimates the number of low-income patients served by...
On April 2, the Centers for Medicare and Medicaid Services (CMS) proposed three of the four provider types, SNFs, hospices, and inpatient rehabs, are slated to receive a 2.4% pay increase, and inpatient psychiatric facilities are up for 2.3% in 2027. In the SNF proposed rule, CMS requested information for potential updates to the Patient...
The report finds that more than 14 million seniors rely on Medigap to fill gaps in fee-for-service Medicare, which does not cap out-of-pocket spending and requires cost sharing for hospital and physician services. Enrollment in Medigap has grown steadily in recent years, with 43% of fee-for-service Medicare beneficiaries purchasing...Arizona Comings & Goings
Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services, traveled to Arizona this week as part of his national “Take Back Your Health” tour, meeting with healthcare, recovery, and community leaders to promote a prevention-focused approach to care.
The visit included stops across the state, from...
Kennedy visited Banner Health on Tuesday to review the system’s prevention and early detection programs, including mobile screening initiatives aimed at expanding access to care across Arizona.
During a stop at Banner’s Sports Medicine High Performance Center, Kennedy toured the system’s BIG Pink Bus mobile mammography unit and...Arizona News
LaPorte has led HonorHealth since 2017 and oversees the health system's nine hospitals, a large outpatient network, and a range of clinical and community-based services across the greater Phoenix area. His tenure has included major strategic moves, including the acquisition of assets from Steward Health Care, the addition of Evernorth...
The Centers for Medicare and Medicaid Services (CMS) published a series of revisions for survey procedures in hopes of streamlining procedure for surveys, enforcement and dispute resolution.
The changes update Chapters 5 and 7 of the State Operations Manual (SOM) and consolidate oversight and investigations rules. The agency will now...Arizona News
El Rio acquired most of the assets of the bankrupt North Country HealthCare, assumed operations at 12 clinic locations serving more than 50,000 patients, and appointed veteran healthcare executive David Rogers to lead the newly rebranded Elk Ridge Community Health clinics.
El Rio hired approximately 99% of North Country’s remaining...
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