The Centers for Medicare and Medicaid Services (CMS) launched its nursing home staffing campaign to support compliance with the nursing home staffing minimum rule. The support includes new websites designed to facilitate recruitment and education for new nurses.
The websites aren't a provision of the staffing mandate but an additional...
UnitedHealthcare has won its lawsuit against the Centers for Medicare and Medicaid Services (CMS) over its star ratings calculations for 2025. The agency must now recalculate its rating and immediately publish a revised score.
UnitedHealthcare (UHC) sued in September and petitioned for an expedited ruling so that revised ratings would...
The Centers for Medicare and Medicaid Services (CMS) has published new data from the 2025 Health Insurance Marketplace Open Enrollment Period (OEP). The OEP on HealthCare.gov runs from November 1 to January 15. The pace of enrollment is slower year-over-year.
Last year, 21.4 million signed up for health insurance through the ACA...
Humana's rough patch continues as it sues the U.S. Department of Health and Human Services over star ratings and revisits a potential merger with Cigna.
This month, Humana reached a $90 million settlement with the United States over allegations of fraudulent bids submitted to the Centers for Medicare and Medicaid Services (CMS) for...
Advances in artificial intelligence (AI) and other tech innovations continue to find applications throughout the medical industry, including in Arizona.
As more AI applications enter the biomedical industry, the Food and Drug Administration has investigated how it should go about regulating the programs, platforms and devices that use...
On Monday, the Biden administration announced a new proposed rule by the U.S. Department of Health and Human Services (HHS) together with the Labor Department (DOL) and the U.S. Department of Treasury, that would expand access to contraceptive products by making them free to all women of reproductive age with private health...
The Hertel Report compiled the Medicare Advantage Prescription Drug Plans competing in Arizona during this year's open enrollment period beginning October 15, 2024. Get all the highlights here; CMS published star ratings on October 10, 2024.
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The Government Accountability Office (GAO) wants the Centers for Medicare and Medicaid Services (CMS) to increase oversight and enforcement of its hospital price transparency rules, according to a new report.
The 2021 CMS hospital price transparency rule requires hospitals to post prices in machine readable format and make those files...National News
Changes to the Medicare Advantage star ratings calculation are already having major impacts for insurers and their shareholders as Humana saw its stocks plunge after announcing that only a quarter of its members are enrolled in plans rated four stars or higher for 2025.
The Centers for Medicare and Medicaid Services (CMS) awards star...National News
This week, the Centers for Medicare and Medicaid Services released its report on the Acute Hospital Care at Home Initiative (AHCAH) and found that while the program was popular for both patients and providers, improvements in other areas were few.
The AHCAH initiative allowed certain Medicare-participating hospitals to treat patients...CMS Rules
The Centers for Medicare and Medicaid Services did not come to play this week when they filed 75,000 pages of records in response to a lawsuit brought against the nursing home staffing mandate.
This was the opening move by CMS since the American Health Care Association (AHCA) filed suit against the mandate earlier this year. According...
The Centers for Medicare and Medicaid Services (CMS) has finalized a landmark rule that will require insurers to provide parity between their coverage for mental health and medical or surgical benefits. The rule also aims to expand access to mental and behavioral health services.
The rule fulfills a proposal from last summer and will...
A recently published Milliman white paper discusses how the Inflation Reduction Act (IRA) will alter government funding for Medicare Part D in 2025, including increased Part D direct subsidies (DS) and benefit redesigns.
The 2025 average direct subsidy will increase to $142.67 per member per month, marking the highest level...
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...
On Tuesday, the Biden administration released guidance on rules for the Medicare Prescription Payment Plan, a key aspect of the healthcare initiatives laid out in the Inflation Reduction Act of 2022 that aims to lower out-of-pocket costs for seniors with Medicare Part D prescription drug coverage.
The program is slated to launch in...Arizona News
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...
Earlier this year, two judges ruled that the Centers for Medicare and Medicaid Services (CMS) had improperly calculated Medicare Advantage scores and subsequent bonuses under the Star Ratings program last October. This week, CMS issued revised quality ratings for 2024, with a number of plans receiving far higher ratings and bonuses than...
Last week, a federal court in Texas issued a stay on a Centers for Medicare and Medicaid Services (CMS) final rule that would have increased oversight of agents and brokers contracting by Medicare Advantage plans. The stay will remain in effect for the duration of the lawsuit unless lifted by an appellate court.
The stay follows the...
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced last month that it would investigate the use of prior authorization in denials for post-acute care by Medicare Advantage plans.
In the new audit, OIG plans to look into processes for reviewing prior authorization requests for post-acute...
Last Friday, the Supreme Court of the United States (SCOTUS) issued a ruling that will radically curb the ability for the federal agencies to oversee entities as a regulator, which could have a major impact on federal healthcare authorities like the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services...
