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...CMS Rules
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...
A new KFF issue brief highlights the growing affordability pressures facing Medicare beneficiaries, even as Medicare remains the primary source of coverage for older Americans, reporting that half of Medicare beneficiaries lived on incomes below roughly $43,000 per person in 2024, and nearly a quarter rely on Social Security as many...
The Hertel Report’s 2026 Arizona Hospitals & Health Systems Data Edition examines the financial performance, strategic priorities and operational pressures shaping Arizona healthcare, with reporting on hospital margins, payer mix, Medicaid exposure, system expansion, leadership transitions and the growing debate over hospital...
Reviewing national data from 2012 through 2023, a new ASPE issue brief examined rural hospital closures, finding that the strongest predictors of whether a rural hospital will close or convert to an outpatient-only facility were significantly low occupancy rates, a for-profit status, and a location near urban counties. A rural hospital's...
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...
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...
On Monday, Arizona Governor Katie Hobbs announced that a new artificial intelligence tool would be deployed to target offenders in the state's largest fraud scandal. The scheme targeting AHCCCS/Medicaid has defrauded the state of at least $2.5 billion and preyed on predominantly Native American individuals battling addiction.
The...
Medicaid quality measure reform is gaining momentum in the Trump administration as Centers for Medicare and Medicaid Services (CMS) leaders are raising questions about the abundance of metrics.
Center for Medicaid and CHIP Services Director Daniel Brillman said that the high volume of quality measures is burdensome for states and...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will implement new policies next year including eligibility restrictions and expanded access to non-traditional health plans.
The rules will allow plans that otherwise would not qualify for the Affordable Care Act's (ACA) insurance exchange,...
The Centers for Medicare & Medicaid Services did its annual April refresh of the agency's star ratings rankings for skilled nursing facilities. The Hertel Report compiled the rankings of Arizona's 141 nursing homes so our members don't have to parse the data.
Ratings Use a 5-star Scale to Summarize Quality Performance
5 Stars:...
Medicare Advantage enrollment continues to grow and now covers 51.8% of all Medicare-eligible beneficiaries, yet despite 301 insurers participating in the market, enrollment remains heavily concentrated among a small group of national carriers. Nearly 78% of MA beneficiaries are enrolled in plans operated by just 10 insurers, with...
The Supreme Court has extended access to mifepristone, a widely-used and clinically-determined safe drug that is used to induce abortion. The order, issued by Justice Samuel Alito on Monday, holds back restrictions on the drug imposed by the Fifth Circuit Court of Appeals.
The case at hand was originally filed by the State of...
The general public may review and submit comments regarding proposed changes to provisions of the AHCCCS Contractor Operations Manual (ACOM) and the AHCCCS Medical Policy Manual (ACOM), the governing agreements for plans and providers contracted with the Arizona Health Care Cost Containment System (AHCCCS).
Among the most significant...
With the Medicaid work requirement guidance deadline looming, the advisory panel that reports to Congress on Medicaid voted to recommend that the Centers for Medicare and Medicaid Services (CMS) should develop a plan for monitoring and evaluating Medicaid work requirements and how these policies affect eligibility, enrollment, spending,...
Industry leaders and health sector lobbies are lining up to support the Medicare Advantage Improvement Act (MAIA) of 2026, a bipartisan bill that addresses structural issues within Medicare Advantage.
The bill focuses on critical issues with billing and coverage like prior authorization, payment timing, and billing transparency. The...
Humana will move forward on cutting supplemental benefits offered in its Medicare Advantage in response to a lower-than-expected base payment increase in federal reimbursement and a difficult first quarter due to a lower 2026 Medicare Advantage Star Rating.
Earlier this month, the Centers for Medicare and Medicaid Services (CMS)...
Dignity Health's East Valley hospitals, Arizona's Mercy Gilbert Medical Center and Arizona General Hospital in Mesa joined the 5-star lineup along with HonorHealth Scottsdale Thompson Peak and Banner Goldfield Medical Center in Apache Junction, the Mayo Clinic in Phoenix, and VA Medical Centers in Phoenix, Prescott and Tucson. Valleywise...
New analysis from Families USA shows that hospitals are charging commercial plans far more than what Medicare pays for services, highlighting the hospital industry's role in rising medical costs.
The four largest hospital systems in the country use their market dominance to overcharge customers relative to the Medicare rate, Families...
The Affordable Care Act health insurance exchange has taken a major hit in the first quarter of the year, according to earnings reports from large insurers, largely due to the expiration of enhanced premium subsidies that kept plans affordable for many enrollees.
In aggregate, health insurers expect enrollment will shrink by at least...CMS Rules
The Centers for Medicare & Medicaid Services is temporarily halting approvals of new hospice and home health agencies nationwide for six months, an unusually aggressive anti-fraud action that carries particular relevance in Arizona, one of the nation’s fastest-growing hospice markets in recent years.The six-month moratorium marks...
Aetna stabilized in the first quarter (Q1) of the year after a rocky 2025, bolstering parent company CVS Health's report. The improvement was directly related to the company's government-affiliated businesses, including Medicare Advantage (MA), Medicare Supplement plans and Medicaid managed care.
In a quarterly report released this...White Papers, E books, Reports and more
A new study published investigated federal oversight of Medicare Advantage (MA) plans and the scope of enforcement actions taken against insurers that violate federal standards. It found that enforcement actions were limited, raising concerns for regulatory effectiveness.
The study, published in JAMA Internal Medicine, was prompted by...
President Donald Trump has selected a new nominee for Surgeon General after pulling another after backlash to the another MAHA movement candidate.
President Trump initially nominated Casey Means, a wellness entrepreneur, physician and published author associated with the Make America Healthy Again (MAHA) movement that believes...National News
The Centers for Medicare and Medicaid Services (CMS) accidentally posted the Social Security data for 100 healthcare providers in the National Provider Directory.
The issue was initially noticed by the Washington Post, which reported that the publicly accessible database contained Social Security numbers linked to providers' names....
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