Earlier this month, the Government Accountability Office (GAO) published a report on market concentration of private dental and vision insurers by state. The House Energy committee requested the report to determine how availability affects consumer choice. In 2024, Arizona had 44 dental insurers with Delta Dental claiming the most market...Arizona News
Federal spending on Medicaid demonstration waivers nearly doubled between 2013 and 2023, according to a new Government Accountability Office report. Most states, including Arizona’s Medicaid program, operate under spending caps set by the Centers for Medicare and Medicaid Services (CMS) to ensure budget neutrality. Arizona's...Arizona News
Last week, President Donald Trump issued an executive order aimed at the Departments of Health and Human Services (HHS), Treasury and Labor that would create an enforcement mechanism for the 2019 executive order on hospital price transparency.
The executive order modifies the demands of the original 2019 directive, including an...National News
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
On May 29, the U.S. Government Accountability Office (GAO) released a report on the oversight of Medicaid managed care plans (MCOs) and the use of prior authorization (PA) for children's health care services under these plans.
Managed care plans, like other privately managed insurance plans, require prior authorization for a range of...
It was a big week for studies and reports on Medicare Advantage, both positive and negative for the industry as a whole.
The Better Medicare Alliance recruited ATI Advisory to conduct a study on how much Medicare Advantage beneficiaries save by comparison to beneficiaries with traditional Medicare. It found that MA enrollees save a...
The healthcare workforce shortage is dire and pushing providers, hospitals and health systems to make difficult choices and innovate new solutions to fill gaps in care and recruitment. In rural Arizona attracting a workforce that reflects the community is challenging; only about 1% of the Arizona healthcare workforce is Native American,...News
CMS recently made efforts to enhance oversight and has others planned, but information gaps remain; for example, CMS requires states to estimate the number of directed payments prior to approval, but CMS does not have information on the actual amounts paid. Arizona made the list of states with 5-9 direct payment proposals to managed care...National News
This week, Congressional Democrats are sparring amongst themselves to bring President Joe Biden's infrastructure bill to a vote and the most public figure against the package as it stands now is Arizona's own Senator Kyrsten Sinema. What she wants is unclear, but what's in the balance includes closing a Medicaid loop hole and expansion...White Papers, E books, Reports and more
According to a new report from the Government Accountability Office (GAO), Medicare Advantage beneficiaries in their last year of life transition to fee-for-service coverage at least twice as often as those who are expected to live longer. Healthcare costs associated with those patients were an estimated $422 million higher in 2016 than...National News
A study this week published by the JAMA Network compared spending on generic drugs between Costco members and Medicare. The study analyzed the 200 most common generic drugs prescribed by Medicare Part D claims at Costco pharmacies across the county. It found Medicare pays billions of dollars more for those drugs than Costco for over 40%...National News
Last week, Aduhelm, a controversial new Alzheimer's drug from drugmaker Biogen, was given accelerated approval from the Food and Drug Administration, meaning that it will need to complete another trial upon public release. Now, the Centers for Medicare and Medicaid Services (CMS) needs to determine if it will cover the unproven...
The GAO recently conducted a study which found that most nursing homes had multiple COVID-19 outbreaks and weeks of sustained transmission from May 2020 through January 2021.
The GAO analysis of data from the CDC showed that from May 2020 through January 2021, nursing homes commonly experienced multiple COVID-19 outbreaks. According...
Today the Government Accountability Office (GAO) released a report evaluating the spread of COVID-19 in nursing homes across the United States.
It's clear that COVID-19 has had a disproportionate impact on the 1.4 million residents who live in nursing homes in America.
The GAO looked at the frequency and...
Change and reform are in the air for AHCCCS and the Medicaid program at large. The Biden administration is eyeing moves to undo major Trump administration reforms to the program and AHCCCS has announced some important changes for Arizona beneficiaries.
The Medicaid and CHIP Payment Access Commission (MACPAC) voted late last week to...National News
The United States Government Accountability Office (GAO) published a report on Monday stating that the Centers for Medicare and Medicaid Services (CMS) needs to increase communications between the federal agency and state agencies regarding the financing and payment arrangements of Medicaid in order to improve oversight.
The GAO found...Arizona News
Unemployment insurance may have short-term health effects through at least three pathways, as benefit income can meet health-related social needs (food and housing), cover health care access expenses (insurance premiums, co-pays, transportation), and reduce stress - improving mental health.
During the COVID-19 pandemic, more than 30...News
According to a report released by the Government Accountability Office (GAO), enrollment in private health insurance plans remained concentrated among a small number of issuers across the country, including in Arizona.
Several companies may be selling health insurance in a given market but most people usually enroll with one of a...Health Related Groups
According to an undercover audit completed by the nonpartisan Government Accountability Office, some health insurance brokers provided misleading or false information to potential customers about whether their plans covered preexisting conditions.
The audit was requested by Senate Democrats with the intention of determining whether...Arizona News
A new Government Accountability Office (GAO) report calls out the Centers for Medicare & Medicaid Services (CMS) for failing to comply with recommendations issued in another, recent GAO report on nursing home abuse.
The original report, released in July 2019, stated that nursing home abuse cases had doubled between 2013 and...
