The former director of the Office of Policy Planning at the Federal Trade Commission under President Joe Biden is leading the charge for a ban on prior authorizations with a new policy paper.
Hannah Garden-Monheit worked at the FTC on efforts to...White Papers, E books, Reports and more
Arizona eliminated its broad certificate-of-need program more than three decades ago, placing the state ahead of a deregulatory policy now gaining renewed attention as states adjust to Medicaid funding changes under the One Big Beautiful Bill Act and implement projects supported by its $50 billion Rural Health Transformation...White Papers, E books, Reports and more
Noting the similarities inherent in the Ryan White HIV/AIDS Program (RWHAP), which provides federal funding for services for low-income people living with HIV and the Ending the HIV Epidemic in the United States (EHE) Initiative, the Assistant Secretary for Planning and Evaluation published a report on initiatives to end the HIV epidemic...Arizona News
AHCCCS has opened two Requests for Grant Applications (RFGAs) under the Arizona Rural Health Transformation Program (RHTP). The funding totals $13.5 million and the grants are designed to help rural healthcare organizations share operating costs and expand access to behavioral health and substance-use services.
Arizona received nearly...
Medicare Advantage enrollment is shifting rapidly as Humana and other major insurers withdraw from subpar markets en masse. This could spell coverage losses for up to hundreds of thousands of Medicare beneficiaries.
Across the board, Medicare Advantage (MA) enrollment has continued to rise into 2026 with an additional 1.1 million...
Five of the six insurers seeking to return to Arizona’s Affordable Care Act Marketplace in 2027 are requesting average premium increases of at least 24%, according to The Hertel Report’s review of rate filings submitted to the state.
The proposed increases remain subject to review and approval by the Arizona Department of...
The Medicare payment model for joint replacement care is back and mandatory for nearly all acute care hospitals, resurrected in the now final Hospital Inpatient Prospective System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS).
The final rule includes a pay boost for hospitals of 2.3%, which the Centers for...
Steadfast Medicare Advantage insurer Humana will change direction and pull back from the program, according to an announcement made by the company in its second quarter earnings call. It is anticipated to withdraw from underperforming markets that will affect 600,000 beneficiaries. In 2025, Humana offered MA plans in three Arizona...
A federal judge has rejected the effort from a coalition of 25 states, including Arizona, to enjoin a rule by the Centers for Medicare and Medicaid Services (CMS) that would require patients to prove "medical frailty" in order to obtain an exemption from the federally mandated Medicaid work requirement authorized by the One Big Beautiful...
This week, the Trump administration announced new guidelines for Medicaid's oversight of autism therapy, a rapidly growing medical business that has been criticized for a lack of standards and oversight. The recommendations focus primarily on applied behavior analysis (ABA),
Earlier this year, the Office of Inspector General (OIG) at...News
Medicare improperly paid physicians an estimated $15.2 million for sacroiliac joint injections that failed to meet program requirements, according to a nationwide audit released by the Department of Health and Human Services Office of Inspector General.
Sacroiliac joint injections are Medicare Part B pain-management procedures used to...
Arizona has eliminated more than $1 billion in medical debt for residents, passing the halfway point toward Gov. Katie Hobbs’ goal of canceling as much as $2 billion for up to one million Arizonans.
The cumulative total reflects several rounds of relief provided through a partnership between the state and the national nonprofit...
The Senate confirmed Erica Schwartz as director of the Centers for Disease Control and Prevention (CDC) Wednesday, giving the troubled public health agency its first permanent leader in nearly a year.
The 51-44 vote fell largely along party lines, with Sen. Tim Kaine of Virginia the only Democrat supporting Schwartz. She becomes the...Arizona Comings & Goings
Mimi Coomler was promoted from EVP and COO to the role of TMC Health President and CEO, replacing Former TMC Health President and CEO, Jennifer Mendrzycki, who left the leadership role for personal reasons.
According to Becker's Hospital Review, Coomler joined TMC Health in 2006 and previously served as chief hospital executive and...Arizona Comings & Goings
Phoenix Children’s appointed Joshua D. Koch, MD, senior vice president and hospital-based in chief, a newly created executive position intended to strengthen coordination across the pediatric health system’s hospital-based clinical services.
Reporting directly to President and CEO John R. Nickens IV, Koch will oversee critical...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) continues its efforts to curb the use of provider taxes as directed by the One Big Beautiful Bill Act of 2025 (OBBBA, H.R. 1). In a proposed rule issued last week, CMS announced it would go beyond what the law requires to further restrict the financing mechanism states use to increase...
The Department of Health and Human Services has appealed a federal court ruling that struck down portions of a Centers for Medicare and Medicaid Services rule restricting enrollment in Affordable Care Act plans, siding with Pima County and a coalition of cities and advocacy groups.
In addition to the Arizona county, the cities of...Arizona News
AHCCCS has released two grant opportunities through the Arizona Rural Health Transformation Program designed to expand access to care and strengthen the financial and operational stability of rural healthcare organizations.
The Rural Health Innovative Care Pilot Program will support new approaches to delivering preventive, primary and...National News
Beneficiaries of color, disabled beneficiaries and rural beneficiaries are underrepresented in Medicare value-based payment models, according to a new study, raising concerns about health equity impacts projected by the models.
The Centers for Medicare and Medicaid Services (CMS) has tested over 50 value-based payment models for their...
In a new report, the Congressional Budget Office projects that Medicare Advantage will cover 57% of eligible beneficiaries by 2036. The shift could be bolstered by Trump administration policies like the implementation of prior authorization in traditional Medicare and the end of subsidies for Medicare Part D plans.
Medicare Advantage...
HCA Healthcare and Tenet Healthcare, the nation’s two largest hospital operators, are revising their forecasts and assumptions as former Marketplace enrollees become uninsured after the expiration of enhanced premium subsidies.
HCA Healthcare said that the rate of people losing ACA Marketplace coverage is much higher than it...
Last week, the Senate Health, Education, Labor and Pensions (HELP, health) committee voted to advance the "Patients Deserve Price Tags Act," a bipartisan effort to require providers, plans and pharmacy benefit managers to publicly post prices they charge. But industry stakeholders are raising concerns that efforts to advance price...
Skilled nursing facilities will receive an estimated $882.7 million increase in Medicare payments under the fiscal year 2027 payment rule finalized by the Centers for Medicare and Medicaid Services.
CMS approved a 2.4% increase in Skilled Nursing Facility Prospective Payment System rates, reflecting a 3.3% increase in the cost of...News
Like Centene, Molina Healthcare lost members across its major insurance businesses during the second quarter. Unlike Centene, which returned to profitability, Molina reported steep declines in earnings and revenue as medical costs consumed a larger share of premiums.
As of June 30, 2026, Centene reported approximately 4.9 million...
The improved financial results came despite broad declines in membership. According to Centene, Medicaid enrollment fell 5.5% year over year to 12.1 million, Marketplace enrollment dropped 40% to 3.5 million and Medicare membership declined about 5% to 980,000. Growth in stand-alone Medicare drug plans, up 12% to 8.8 million members,...
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