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...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...CMS Rules
The provision getting the most attention in the interim final rule is that HHS declined to give states flexibility to create additional categories of "medically frail" Medicaid beneficiaries exempt from the new work requirements. The agency said the five exemption categories established in federal law are broad enough to cover...Arizona News
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...Arizona News
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...
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...
Left with few places to cut federal spending, the Trump administration has set its sights on home- and community-based services, which officials accuse of being rife with "waste, fraud and abuse."
Home- and community-based services (HCBS) provide for the daily care and activity of elderly people or people with disabilities who are...Arizona News
The new AHCCCS Solutions Center is a centralized platform designed to make it easier for providers and their staff to connect with AHCCCS and submit requests. The agency scheduled several April webinars to introduce users to the new platform.
Arizona's Medicaid agency, the Arizona Health Care Cost Containment System, is hosting a...
Copa Health of Mesa filed a civil lawsuit March 23 against former CEO Sharareh (Shar) Najafi-Piper, her husband Brian Piper and Roya Health, a startup created and operated by the Pipers that Copa Health claims competed with Copa Health. The non-profit alleges misuse of funds.
On January 22, Copa Health board members fired Najafi-Piper...
Arizona is advancing a major overhaul of its Medicaid infrastructure, with new milestones in its AHCCCS MES modernization effort focused on data exchange and program integrity. AHCCCS also plans to roll out a new customer service system next month. The modernization effort is part of a broader initiative to replace legacy systems,...
For Arizona policymakers and Medicaid plans, the Office of Inspector General's Colorado findings highlight a growing tension between program oversight, the rapid expansion of private equity-backed applied behavior analysis (ABA) providers and the ability of families to access consistent therapy for children with autism.
The issue drew...
Despite the sweeping investigation that revealed a massive fraud scandal billing Arizona's Medicaid program, new investigations into behavioral health fraud and fake sober living homes targeting Indigenous communities continue to turn up illegal activity.
At the scandal's height in 2023, the number of ongoing investigations into...
A new RAND analysis of the Medicaid provisions in the One Big Beautiful Bill Act suggests Arizona could face some of the largest fiscal and enrollment impacts in the country over the next decade.
The research report published last week finds that expansion states with heavy use of state-directed payments and provider...
Virginia “Ginny” Rountree announced Feb. 2 that she would resign as director of AHCCCS, citing personal health concerns. Rountree had a short tenure, she was appointed October 6 and her final day was Feb. 13.
Roberta Harrison, a longtime Arizona Department of Economic Security official, now serves as interim AHCCCS...
The Republican-led Arizona legislature has sent a number of politically-loaded healthcare-related bills to Governor Katie Hobbs's desk so far this session, and may deliver more in the coming weeks.
Arizona Governor Katie Hobbs vetoed nine bills on Friday, one of which would have required hospitals that accept Medicaid to request...
Virginia “Ginny” Rountree announced yesterday that she will resign as director of the Arizona Health Care Cost Containment System (AHCCCS), citing personal health concerns. Her final day with the agency will be Friday, Feb. 13.
After deep consideration and conversations with my family, I have made the difficult decision to step down...
An Arizona Medicaid contract dispute involving one of the state’s largest autism therapy providers and one of the largest Medicaid health plans is escalating into litigation, raising questions about network adequacy, reimbursement pressure, and continuity of care for children receiving applied behavior analysis services.
According...
The 2026 Arizona legislative session will begin shortly, and Republican Senator Wendy Rogers has again introduced a bill that would require Arizona hospitals to ask patients about their immigration status during intake.
This is the second year that Rogers has introduced the bill, arguing that the state needs to know how much is spent...Arizona News
Arizona now allows eligible justice-involved youth to access certain Medicaid and Children’s Health Insurance Program services up to 30 days before release from incarceration, marking a shift toward limited prerelease coverage aimed at improving reentry transitions.
The change, implemented Oct. 1 by the Arizona Health Care Cost...CMS Rules
On December 8, the Centers for Medicare and Medicaid Services (CMS) posted preliminary guidance for the Medicaid work requirements mandated by the One Big Beautiful Bill Act (OBBBA), which passed into law on July 4 this year.
The law requires the creation of new rules by June 2026 and CMS notes in the guidance overview that further...
