On September 8, 2024, The Arizona Health Care Cost Containment System (AHCCCS) dismissed the recommendation of an administrative law judge and denied the appeal of Mercy Care, Health Choice Arizona and Banner-University Family Care after all three local non-profits contested the agency's award of its Arizona Long Term Care EPD contracts...
The Issue brief defines prior authorization and how this process used by Medicaid fee-for-service programs and managed care organizations (MCOs) requires approval before providing specific items, services, or medications.
Prior authorization (PA) aims to prevent unnecessary utilization, limit improper, fraudulent, and wasteful...
An Administrative Law Judge on August 9 decided against Arizona's Medicaid agency and in favor of insurers protesting the agency's choice of Arizona Complete Health Complete Care Plan and UnitedHealthcare Community Plan to provide long-term care services to about 26,000 AHCCCS members who are enrolled in the Arizona Long Term Care System...
This week in Medicaid a judge sides with the Centers for Medicare and Medicaid Services (CMS) against work requirements, the North Carolina Medicaid expansion remains on pace for over 600,000 additional members and the status of 1115 Waiver renewals nationwide.
The Georgia Pathways to Coverage program was the only one in the nation...Arizona News
Against all odds, the Arizona State Legislature sent a budget to Governor Katie Hobbs that would reconcile a budget deficit over two years and she signed it.
The budget cut state programs and instructed most state agencies to tighten their belts, including a 3.45% "lump sum" cut to the Arizona Department of Health Services (ADHS) and...Arizona News
Arizona's Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS) created the dashboards to visually communicate trends and information about AHCCCS members emergency department visits and hospital inpatient admissions.
The Emergency Department (ED) Visits Dashboard uses AHCCCS ED claims and encounter data plus...Arizona News
Arizona's Medicaid agency added four new positions to its leadership circle including two new positions in clinical operations, two in business operations and a new chief of population health. AHCCCS also announced the Division of Health Care Services is now split into two divisions: Division of Managed Care Services and the Division of...Arizona News
Two wrongful death lawsuits have been filed against the state of Arizona for alleged mismanagement of sober living homes that led to the deaths of Indigenous men.
Investigators into the sober living home fraud scandal have said that Indigenous people were targeted for their unique payer status and social vulnerability. Under the...Arizona News
The Arizona State Legislature has advanced rules that could tighten regulations on sober living homes and rehab facilities in the wake of a massive fraud scandal that targeted Native Americans.
Senator Theresa Hatathalie (D-Navajo Nation) introduced bill 1655, which was approved unanimously by the Senate. According to Fronteras...Arizona News
UnitedHealth Group (UHG) this week is scrambling to remain the victim in the cyberattack that knocked subsidiary Change Healthcare offline for over three weeks, preventing payment for services to providers and disrupting prior authorization requests and pharmacy business nationwide.
On Tuesday, the company announced that it is now in...Arizona News
A valley law firm has sued the Arizona Health Care Cost Containment System (AHCCCS) for the wrongful death of two Navajo men who were targeted in the sober living home fraud scandal. Also, an Arizona legislator is pushing regulations that would increase oversight of sober living facilities in the state.
The lawsuit alleges that...Arizona News
This week Mesa police arrested a couple that was the target of an Internal Revenue Service (IRS) investigation into fraud against the Arizona Health Care Cost Containment System (AHCCCS) and related money laundering.
The Mesa police organized crime unit worked closely with the IRS field office, which currently has 13 open cases...Arizona News
Community Health Workers (CHWs) can now register as providers with the state's Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS), and be reimbursed for providing Medicaid services. Community Health Workers serve as important liaisons between health and social services and the community to facilitate access to...
Last week, UnitedHealth Group's (UHG) health care technology subsidiary Change Healthcare was hit by a cyberattack that disrupted services for pharmacies and patients.
UHG said that once the attack was detected, Change was forced to disconnect some of its digital network from client access and shut down services including programs...
Last year, the Arizona Attorney General's Office in coordination with Arizona's Medicaid program uncovered a massive scandal that victimized thousands of vulnerable addicts through fraudulent sober living homes.
Some critics have noted that the term "sober living home" in the context of reporting on the scandal has been misconstrued...Arizona News
With rents reaching their most unaffordable levels in history and high rates of homelessness compounded by complex medical illnesses, the federal government has initiated a public-private partnership project to facilitate housing and rental assistance through Medicaid programs.
Although, as Vox points out, Congress has long resisted...
We are now on week three of the Arizona Legislative Session for 2024 and bills related to the health sector are garnering attention to address some of the state's more pressing needs.
Representative Selena Bliss (R-Prescott) introduced House Bill 2171 to create a Health Care Workforce Advisory Council and an investment fund that would...
Last week, legislators returned to the Capitol for the start of the 2024 Arizona Legislative Session and Governor Katie Hobbs gave her annual State of the State address.
Lawmakers have a significant challenge before them when it comes to balancing the budget this year, as the state is projected to end the fiscal year this summer in...Arizona News
On December 28, the Arizona Center for Investigative Reporting found that the state's Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS) was informed in August 2022 that the agency's billing reforms for behavioral health providers "will have the unintended consequence of adding a significant amount of homeless to...Arizona News
The Targeted Investments Program Quality Improvement Collaborative supports AHCCCS providers who participate in the Targeted Investments Program and receive incentive payments for achieving quality measures over a five-year period.
In its first 5-year cycle from 2017-2023, the Targeted Investments program incentivized 17 hospital...
