The Trump administration is proposing a sweeping rewrite of how Medicaid Section 1115 demonstration waivers are financed, replacing decades of negotiated budget neutrality policy with new statutory requirements that will require certification by the...Arizona News
Over 450,000 Arizonans have lost access to the Supplemental Nutrition Assistance Program (SNAP) as the state was hit the hardest by rules implemented in accordance with the One Big Beautiful Bill Act of 2025 (OBBBA). Further, Arizona was also hit with a $208 million penalty for food stamp overpayments that exceed the acceptable...National News
Elevance Health paid the government over $342 million to settle allegations of overpayments by the Medicare Advantage program, marking the first time in the program's history that the Centers for Medicare and Medicaid Services (CMS) has successfully recouped as a result of audits for overbilling.
Medicare Advantage (MA) insurers are...Arizona News
Prior to the passage of the One Big Beautiful Bill Act of 2025, which authorized the creation of national rules for Medicaid work requirements, Arizona was primed to implement a work requirement for eligibility on its own. In the finalized rule, the Centers for Medicare and Medicaid Services suddenly altered the guidance for exemption...Arizona News
A new report says the No Surprises Act of 2020, which established consumer protections and billing rules for providers, isn't resulting in lower premiums as initially expected. But certain providers are netting a windfall through creative workarounds of the rule.
The Congressional Budget Office (CBO) can't say for sure if the No...
On July 1, the Centers for Medicare and Medicaid Services (CMS) launched a temporary program to cover GLP-1 agonist drugs for obese Medicare beneficiaries. The program is called the Medicare GLP-1 Bridge and will allow eligible beneficiaries to access the drugs for a $50 monthly copayment.
The program is slated to run from July 2026...
A broader vision for the future of home- and community-based services (HCBS) authorized under the Medicaid program is taking shape as the Trump administration expands its investigations into state-level programs and the U.S. Department of Justice (DOJ) issuing a memo undermining a landmark Supreme Court decision that provides critical...
The Medicare Payment Advisory Commission (MedPAC), in its June Report to Congress, concludes that Medicare Advantage's (MA) financial impact on hospitals and post-acute care providers is more nuanced than many stakeholders suggest.
The MedPAC Report to Congress - Medicare & the Health Care Delivery System - offers readers six full...
The Arizona Health Care Cost Control System (AHCCCS) the state's Medicaid agency, is rolling out a new analytics tool this summer designed to improve claims accuracy, strengthen program integrity and support providers through more efficient claims review.
The system, part of the agency's broader Alivia 360 platform, uses advanced...Arizona News
As Parkinson's disease becomes the world's fastest-growing neurological disorder, Arizona researchers are helping lead an international effort to help improve how Parkinson's disease is diagnosed, monitored and ultimately treated.
Banner Sun Health Research Institute has received a $6 million, three-year grant through Aligning Science...Arizona News
The Valleywise Health Board of Directors selected Michael White, MD as the system's next president and chief executive officer, succeeding Steve Purves following his retirement later this year. White, who joined Valleywise Health in 2019, currently serves as the health system's executive vice president and chief clinical officer and will...Available To All
The One Big Beautiful Bill Act (OBBBA) of 2025 made heavy cuts to the bottom line of state Medicaid programs through a number of small directives aimed at curbing federal spending. Most obvious is the implementation of work requirements for Medicaid eligibility, but state-directed payments and provider taxes are also under reform. A new...Arizona News
Artificial intelligence software is rapidly changing all aspects of the healthcare industry but some are advocating for caution in the face of insurmountable change. This week, people are increasingly turning to AI and social media for health information and House Democrats are turning up the scrutiny of a Medicare demonstration model...National News
The Federal Trade Commission has filed a lawsuit against an interdisciplinary nonprofit organization that promotes transgender healthcare, the World Professional Association for Transgender Health (WPATH), alleging that the organization has made false claims to sell pediatric medical services. A federal judge intervened against a...National News
Opposition is mounting against a rule proposed by the White House Office of Management and Budget (OMB) that would make federal research grants subject to the approval of a political appointee.
House Democrats on the Energy and Commerce Committee wrote a letter to National Institutes of Health Director Jay Bhattacharya on Tuesday...White Papers, E books, Reports and more
National health spending is accelerating according to a new report from the Centers for Medicare and Medicaid Services' (CMS) Office of the Actuary. The rate of growth is expected to propel total spending to $9 trillion and 20.6% of gross domestic product by 2034.
Health spending is estimated to have increased 7.3% to 5.7 trillion in...National News
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 digital health literacy as a "meaningful determinant of health outcomes."
In short,...
Dr. Neil is scheduled to take over the leadership role at one of Arizona's largest non-profit health systems on March 1, 2027. The transition comes during a period of significant growth for HonorHealth. Under LaPorte's two decades of leadership, the system expanded its footprint through acquisitions, including Steward Health Care...
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...National News
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...National News
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...
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