Last Wednesday, the Medicare Payment Advisory Commission (MedPAC) published its biennial report to Congress which included recommendations to streamline alternative payment models (APMs) within the Medicare program. It also recommended a strategy to improve accuracy in Medicare Advantage (MA) payments and correct a major contributor to...
Following the devastating report from the Arizona Auditor General in May, Arizona lawmakers held ADHS interim director Don Herrington's feet to the fire for nearly three hours last Thursday, searching for answers to the damning questions raised by the report.
The Arizona Department of Health Services is accused of not following...
As nursing homes across the country are grappling with staff shortages exacerbated by the COVID-19 pandemic, the Biden administration is considering a rule that nursing homes spend most of their Medicaid payments on direct care for residents rather than operations or capital improvements.
According to Modern Healthcare, the rule would...
The hospital price transparency rule, which was issued by the Centers for Medicare and Medicaid Services and went into effect on January 1, 2021, is largely being ignored by hospitals who would prefer to absorb any financial penalty than comply. CMS has only started to impose fines as of last Wednesday, according to an agency email, but...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a report that reviewed the Medicare Supplementary Medical Insurance (SMI) Trust Fund for 2023 and determined that cost-savings from unexpectedly low Medicare Part B spending in 2022 could be recommended to drive premium cuts for Part B coverage next year.
The...National News
Value-based care is now a ubiquitous term across the medical industry, primarily led by Medicare payment models that prioritize quality of care above overall cost. But some are questioning the concept's utility and expanse over the Medicare market.
Legislation proposed in both the U.S. House of Representatives and Senate would...Arizona News
Arizona joined seven other states in a lawsuit initially filed by the state of Mississippi which asks a federal court to throw out an anti-racism rule by the Centers for Medicare and Medicaid Services (CMS). The final rule, released in 2021, reimburses physicians more when they create anti-racism plans.
The lawsuit was initially...National News
This week, value-based care (VBC) is frequently seen as a method for primary care providers to best serve patients, but increasingly more facets of the healthcare industry are investigating how technology, data analytics and value-based insurance design can help swap volume for value and deliver results for their patients.
Hospitals...Arizona News
Arizona may still have a chance to extend the time frame of postpartum Medicaid coverage from 60 days to one year after birth. The bill, SB 1272, passed the Arizona Senate and the House Health and Human Services Appropriations Committees with nearly unanimous support.
However, the bill has stalled while the Legislature negotiates the...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
In February,...
Last Friday, April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposal to rectify a few of the issues many Americans face with Medicare enrollment.
The CMS press release says the proposed rule will implement provisions from the Consolidated Appropriations Act of 2021 and President Joe Biden's executive...
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the Hospital Inpatient Prospective Payment (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule, which will update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for fiscal year 2023. The rule includes a 3.2% increase...
Last week was Black Maternal Health Week in the U.S., and with it came a number of announcements on support services through both public and private programs to improve health outcomes for pregnant or postpartum women of color and their children across the country and in Arizona.
In a short blog post for the Arizona Department of...
The BA.2 variant, also known as the "stealth Omicron," is now the dominant coronavirus version in the U.S. and more than 60 other countries. This week, Philadelphia became the first major city in the U.S. to announce that it would return to mandating masks in public spaces due to the spread of BA.2. Meanwhile, Arizona, the Centers for...
This week in Medicare Advantage (MA), the program is on track to account for 54% of Medicare spending by 2030 and the Centers for Medicare and Medicaid Services (CMS) finalized the plan rates for 2023. Also, Humana takes a look at social needs in Medicare Advantage before COVID and eHealth looks at the rise in premiums and deductibles...CMS Rules
On Monday, the Centers for Medicare and Medicaid Services (CMS) filed the Fiscal Year 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule. The reimbursements include a 3.9% increase to industry reimbursements, but in aggregate the impact of payment policies would result in a decrease of $320 million in...
March 23 was the 12th anniversary of the Affordable Care Act's (ACA) . The U.S. Department of Health and Human Services (HHS) published a report to highlight the ways in which the ACA is "the strongest it has ever been" due to the American Rescue Plan (ARP) and other efforts by the Biden administration to strengthen Americans' access to...
The success of Medicare Advantage (MA) can't be understated. In the last 11 years, the program has grown to represent nearly 50% of the Medicare-eligible market, a benchmark it will likely pass within the next year.
Arizona MA growth reflects the program's national success. At the Hertel Report's 2020 Winter State of the State, Dan...
This week in value-based care, CMMI director Elizabeth Fowler defends criticism of the ACO REACH payment model, CMS improves ACO quality care reporting and data aggregation, the White House moves to support a value-based program for skilled nursing facilities, FQHCs struggle to keep up with systemic transformation and MedPAC moves to...
