A case of a highly pathogenic avian influenza (HPAI) was confirmed in Texas and in dairy cattle but the Centers for Disease Control and Prevention (CDC), as well as the U.S. Food and Drug Administration (FDA) and the United States Department of...Open
The agency found that none of the four states it examined, Arizona, New Jersey, New York, and Texas, conducted parity analyses across their delivery systems nor did their state contracts with Medicaid managed care organizations (MCOs) contain the required parity provisions set forth by the Centers for Medicare and Medicaid Services (CMS)...Arizona News
This week, the Arizona Legislature killed two major bills that would have introduced tighter regulations and accountability to entities that provide both medical and residential services to the state's addicts and elderly.
A bill brought by Navajo tribal member and Senator Theresa Hatathalie (D-Coal Mine Mesa) failed in the House...Government
Congress narrowly avoided shutting down the U.S. Department of Health and Human Services (HHS) and other government programs by passing a $1.2 trillion bill at 2 a.m. on Saturday morning, including $117 billion for HHS.
Modern Healthcare explains that Congress struggled to pass the annual appropriations bills necessary to keep the...Available To All
This week the U.S. Supreme Court heard oral arguments for a case that could not only overturn the U.S. Food and Drug Administration's authorization of the abortion pill mifepristone but also open the door for the courts to question decisions made by government agencies.
Even the justices appointed by former President Donald Trump...
The Lown Institute, a nonpartisan think tank that studies hospital spending and community health, released a new analysis of nonprofit hospital spending based on 2021 Internal Revenue Service data and found that the majority of hospitals receive more in tax break benefits than they spend in community support.
Of the nearly 2,500...
Last week, UnitedHealth Group announced that Change Healthcare would resume claims processing operations for the $14 billion backlog following a cyberattack on the company last month. The effects of the cyberattack are still coming to light, but community health centers and private practices have suffered from weeks without reimbursement...
The Republican Study Committee (RSC), of which most House Republicans are members, unveiled its budget proposal for fiscal year 2025 this week. The budget doubles down on the decade-and-a-half long campaign to repeal the Affordable Care Act (ACA) in addition to ending Medicare drug price negotiations, implementing block grants for...National News
Last Friday, the Medicare Payment Advisory Committee (MedPAC) sent its recommendations to Congress, including updates for the 2025 Medicare payment systems. In its recommendations, the committee warned that Medicare Advantage policies are increasingly costly to the Medicare program.
At the top, it recommended a 1.5% raise for hospital...Top of The Day
Accountable care organizations (ACOs) and their practices have taken on the full focus of Medicare's value-based care initiatives through the Medicare Shared Savings Program (MSSP) and the ACO Realizing Equity, Access and Community Health (ACO REACH) programs.
A new study published in the JAMA Health Forum looks at survey results from...Arizona News
The Arizona State Legislature has advanced rules that could tighten regulations on sober living homes and rehab facilities in the wake of a massive fraud scandal that targeted Native Americans.
Senator Theresa Hatathalie (D-Navajo Nation) introduced bill 1655, which was approved unanimously by the Senate. According to Fronteras...Arizona News
The for-profit health system that operates 31 hospitals in eight states, including four in Arizona is facing a lot of bad press as reports continue over vendors who haven't been paid for items such as artificial knees, surgical supplies, garbage collection, and even pest control services to free one hospital of Brazilian free-tailed...
UnitedHealth Group (UHG) this week is scrambling to remain the victim in the cyberattack that knocked subsidiary Change Healthcare offline for over three weeks, preventing payment for services to providers and disrupting prior authorization requests and pharmacy business nationwide.
On Tuesday, the company announced that it is now in...
Last week, the Assistant Secretary for Planning and Evaluation (ASPE) for the U.S. Department of Health and Human Services (HHS) published an issue brief on the changes over time in the demographics of Marketplace insurance coverage.
The brief, Marketplace Enrollee Demographics, Plan Generosity, and Plan Premiums in HealthCare.gov...
Judge Rosalyn Silver has once again found that the Arizona Department of Corrections, Rehabilitation and Reentry has failed to comply with her ordered changes to healthcare staffing and provision of care in in Arizona's prison system.
The 12-year long lawsuit culminated last year with Judge Silver finding ADCRR in contempt for failure...
And medical device manufacturers and durable medical equipment suppliers accounted for more civil settlements and judgments for medical and support services Medicaid fraud in FY 2023, according to Medicaid Fraud Control Units (MFCUs) that investigate and prosecute Medicaid provider fraud and patient abuse or neglect.
Settlements &...
The Medicaid and CHIP Payment and Access Commission (MACPAC) report focuses on improving the Medicaid beneficiary experience through Medical Care Advisory Committees (MCACs), increasing the transparency and improving the monitoring of the denials and appeals process in Medicaid managed care, and a review of hospital payment policy for...
Open to low-revenue accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP), the CMS Innovation Center will test the five-year voluntary new model focused on primary care delivery starting in 2025.
The goals of the ACO PC Flex Model are to:
Expand access to high-quality, accountable care...
A new study shows that nursing homes are hiding the bulk of their profits in order to bolster arguments for increased funding despite being unable to meet proposed quality standards or accept Medicare payment cuts.
The study, Tunneling and Hidden Profits in Health Care, was conducted by the University of California, Los Angeles...
A valley law firm has sued the Arizona Health Care Cost Containment System (AHCCCS) for the wrongful death of two Navajo men who were targeted in the sober living home fraud scandal. Also, an Arizona legislator is pushing regulations that would increase oversight of sober living facilities in the state.
The lawsuit alleges that...Arizona News
Arizona's rate of cancer diagnoses is expected to climb over the next year, and although the industry has made strides in cancer care, partially supported by President Biden's Cancer Moonshot, physician retention issues pose a significant threat to providing adequate treatment for an increasing volume of patients.
Arizona is expected...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will end the Hospice Benefit Component of the Value-based Insurance Design (VBID) Model at the end of the year.
The hospice carve-in was designed to test coverage of hospice, palliative and transitional care coverage through the Medicare Advantage program. According to Hospice News,...
This week saw further fallout from the Change Healthcare cyberattack, this time affecting local Arizona providers and the Merit-based Incentive Payment System (MIPS) data submission window. On Wednesday, the HHS Office of Civil Rights (OCR) launched an investigation of Change Healthcare and UnitedHealth Group (UHG) focused on whether a...
President Joe Biden released his budget proposal this week which centers Medicare-boosting policies, lowering prescription drug prices and continuing subsidies to Affordable Care Act exchange insurers.
The president is pitching his $7.3 trillion budget for 2025 on the argument that it will curb national debt and reduce the deficit by...
According to researchers, from 2011 to 2020 Part D plans grew significantly more restrictive, rising from an average of about 32% of compounds restricted in 2011 to about 44% restricted in 2020. The prevalence of formulary exclusions also spread fast with Part D plan formularies excluding an average of nearly 45% of brand-name-only...