The Hertel Report

Federal Review Finds Many of the Nation’s Lowest-Performing Nursing Homes Backslide After Leaving CMS Quality Oversight Program

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Arizona Comings & Goings

Nicholas Theodore, MD

Nicholas Theodore, MD, MS, a nationally recognized expert in brain and spinal cord injury has been appointed chairman of the University of Arizona College of Medicine – Phoenix’s department of neurosurgery at Banner – University Medical Center Phoenix. Dr. Theodore was formerly the director of the Neurosurgical Spine Center and...

Arizona Comings & Goings

Barb Zwiener

Barb Zwiener, vice president of payor contracts at HonorHealth is retiring after many years in the health sector as an influential leader. Congratulations on your retirement, Barb!...

SNAP Benefits Set to Expire, Jeopardizing the Health of Millions of Americans - Arizona AG Joins Suit Against Administration

Nearly one million Arizonans are set to lose food assistance at the end of the week due to the Trump administration's refusal to use the U.S. Department of Agriculture's contingency fund for the Supplemental Nutrition Assistance Program (SNAP). At least 25 states have informed SNAP recipients that they won't receive checks for the...

Arizona News

Medicare Advantage Provider Networks Far More Limited than Traditional Medicare

A new study shows that Medicare Advantage physician networks pale in comparison to traditional Medicare, but the Centers for Medicare and Medicaid Services (CMS) is pushing ahead with plans to make traditional Medicare look more like Medicare Advantage. Medicare beneficiaries enrolled in both programs report that physician...

Learning Collaborative for Medicaid Managed Long-Term Care Services and Supports

The National Academy for State Health Policy (NASHP) recently ran a learning collaborative for 10 participating states as an opportunity to explore and strengthen policies for improving care in Medicaid Managed Long-Term Care Services and Supports (MLTSS) programs. The program allowed states to collaborate through roundtables, monthly...

Medicaid Work Requirement Rules and Tech Tools Remain Elusive As States Prepare for Changes

States must enforce Medicaid work requirements by January 1, 2027, but the Centers for Medicare and Medicaid Services (CMS) have yet to issue guidance for compliance for states eager to start planning its implementation. The One Big Beautiful Bill Act (OBBBA) cuts nearly $1 trillion in Medicaid spending over a decade in part by adding...

Arizona News

ACA Premium Hikes Will Hurt Arizona Workers, Seniors, Health Systems

The federal government shutdown is now approaching a month as Senate Democrats continue to hold out for negotiations to renew subsidies that would bring down 2026 Affordable Care Act (ACA) plan premiums. Premiums are expected to rise by an average of 30% when the open enrollment period begins this Saturday and according to data from...

Healthgrades Recognizes 19 Arizona Hospitals for Specialty Excellence

The annual recognition highlights hospitals that rank among the top 10% nationwide for clinical outcomes in 16 specialty areas, including stroke care, orthopedics, gastrointestinal surgery, and more. Several Arizona hospitals are honored for the first time this year while others are repeatedly high performers in selected...

Arizona News

Commonwealth Fund: 2025 State Medicare Scorecards

Earlier this month, the Commonwealth Fund published its State Scorecard for Medicare Performance, which evaluates each state's infrastructure, access to hospitals, beneficiary access to non-medical supports, regional variety in plan availability, out-of-pocket costs and other critical access of Medicare delivery. The State Scorecard...

Report: Return of ACA Subsidy Cliff Predicted to Make Healthcare Unaffordable for Middle-Class Families

As Congress debates federal spending and the fate of enhanced premium tax credits (EPTCs), the Urban Institute warns that allowing the current subsidy enhancements to expire in 2026 would sharply raise coverage costs for millions of middle-income Americans. Without congressional action, the Affordable Care Act’s 400% federal poverty...

Commonwealth Fund State Medicare Scorecard: Arizona Ranks 20th

This week, the Commonwealth Fund published its annual State Medicare Scorecard, in which it tallies the strengths and weaknesses of each state's Medicare healthcare infrastructure and beneficiary experience. The scorecard uses the most recent data from the Centers for Medicare and Medicaid Services, in addition to vital statistics...

Milliman Brief: Six Takeaways from 2026 Medicare Advantage and Prescription Drug Bids

Actuarial consultant Milliman published a post on its major takeaways for the 2026 Medicare Advantage and prescription drug bids. The brief was written in order to elucidate industry and policy changes to key stakeholders, including life sciences companies, since the Inflation Reduction Act (IRA) implemented changes to prescription...

Government Shutdown Update: ACA Premiums Set to Spike

As the government shutdown continues with no clear end in sight, the extension of subsidies to stabilize skyrocketing ACA premiums approaches a November 1 deadline, when the open enrollment period (OEP) for 2026 goes live. Meanwhile, other areas of the industry are suffering as the government remains closed. Enhanced subsidies for...

AMA Launches Center for Digital Health and AI

On Monday, the American Medical Association announced a new Center for Digital Health and AI in a push for standards governing the use of AI in healthcare. The AMA, which refers to AI as "augmented intelligence," said that the center intends to tap the "full potential" of new technologies throughout the lifecycle of technological...

Medicare Advantage Market - More SNPs, Less in-Home Supports & Problem Provider Directories

The Medicare Advantage field is changing as costs of care challenge payor and provider participation, and as provider directories on Medicare Plan Finder prove problematic. Wall Street is reportedly disillusioned with the prospect of market growth since the MA industry eclipsed 50% of the Medicare market share. According to Modern...

Arizona Health Systems Receive Nearly $500K to Expand Children’s Care

In Flagstaff, Northern Arizona Healthcare’s Children’s Health Center received a $270,000 donation from UnitedHealthcare Community Plan of Arizona to upgrade pediatric rehabilitation and diagnostic services. Also this week, the Scottsdale Saguaros granted $250,000 to the Banner Health Foundation to support Banner Children’s...

ALTCS Emergency Rule & Policy for Minor Children - DES to Delay Hour Reductions for DDD Families

Arizona Governor Katie Hobbs has ordered the Arizona Health Care Cost Containment System (AHCCCS) to create an extraordinary care exception process for children with intellectual and developmental disabilities whose families need more direct care or habilitation hours than allowed under the state’s new standardized assessment...

Fact Sheet: The Crucial Role of $0 Premium Plans in the Affordable Care Act Marketplaces

Nearly four in ten Arizonans enrolled through HealthCare.gov this year paid nothing for their monthly health insurance premiums, a direct result of enhanced federal subsidies that expanded the reach of $0 premium plans across the Affordable Care Act Marketplace. That dynamic—how free coverage keeps enrollment high and stabilizes...

Policy Brief: How to Reform the CMS Innovation Center with a Choice and Competition Approach

A new policy brief from the influential Washington-based Paragon Health Institute warns that Congress should either reform or shut down the CMS Innovation Center, arguing the program has failed to deliver meaningful savings or quality improvements despite costing taxpayers billions. The report concludes that, after more than a decade of...

Arizona Rural Health Association Toolkit for Rural Health Transformation Program

As part of the One Big Beautiful Bill Act of 2025, the federal government has pledged to allocate $10 billion per year for five fiscal years to support rural healthcare services. This week, the Center for Rural Health published informational materials on the upcoming Rural Health Transformation Program (RHTP). The initiative, which...