Last week, the Centers for Medicare and Medicaid Services (CMS) proposed two new rules that would require private entities that manage Medicaid and Children's Health Insurance Plan (CHIP) plans to enforce national maximum standards for appointment wait times and will require managed care organizations (MCOs) to monitor compliance.
The...National News
The Republican-led U.S. House of Representatives passed House Speaker Kevin McCarthy's (R-Calif.) proposal to raise the national debt ceiling. The deal includes a requirement that certain Medicaid beneficiaries work or volunteer at least 80 hours per month to continue receiving health insurance.
Roughly 21 million Medicaid...
The U.S. Supreme Court heard arguments last week on an issue regarding retail pharmacies overcharging government health plans that could compromise the False Claims Act.
The case dates from 2006, when Walmart offered unsustainably low drug prices to cash customers and charged Medicare and Medicaid plans far higher than the original...
This week offered dueling visions for access to Medicaid coverage with House Speaker Kevin McCarthy wanting Medicaid work requirements to be part of the debt ceiling debate and the Biden administration's plans to expand Marketplace and Medicaid coverage for DACA recipients. Meanwhile in Arizona, CMS approved state plan amendments...Top of The Day
In 2021, 42% of Medicaid enrollees aged 19-64 were employed and 15% of working enrollees reported having both Medicaid and employer-sponsored health insurance.
The Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy estimated that in 2021 there were 327,000 employed Medicaid members in Arizona, most (91%)...
A crisis of mental health continues to grip the U.S. and Arizona, with a special focus on young people struggling with mental and behavioral health issues.
In Arizona, the patients with serious mental illness (SMI) at the Arizona State Hospital (ASH) may fall under the care of new management if a bill passes Arizona's legislature this...
With the Great Unwinding looming at the end of spring, insurers are now speaking up about their role in Medicaid redeterminations and a special enrollment period (SEP) for enrollees who may lose coverage in the process.
In a memo released at the end of January, the Centers for Medicare and Medicaid Services (CMS) announced that the...Arizona News
It's the time of year for insurers to file their fourth quarter (Q4) earnings reports for 2022. This week, Molina, Kaiser Permanente and Oscar Health posted financial metrics.
Oscar Health beat the odds in 2022 by improving its medical loss ratio from 88.9% in 2021 to 85.3%, Modern Healthcare reports. But the healthtech company still...
Industry stakeholders and patient advocacy organizations are urging Congress to pass legislation that would solidify telehealth waivers passed by the CARES Act during the COVID-19 public health emergency (PHE).
The vast majority of providers see telehealth as an opportunity to improve patient services and 94% of patients who have had...
Nursing homes continue to experience the worst job loss of any other healthcare sector according to new analysis from the Bureau of Labor Statistics (BLS), but Congress is cautioning against the use of skilled nursing facility (SNF) staffing minimums planned by the Centers for Medicare and Medicaid Services (CMS). Also, CMS is working to...
The Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid program, announced last week that it would initiate member eligibility reviews and renewals in accordance with the Consolidated Appropriations Act of 2023, beginning April 1.
AHCCCS plans to complete the renewal process for all 2.4 million enrolled members...National News
Last week, the Medicaid and CHIP Payment and Access Commission (MACPAC) published findings in a review of Medicaid payment rates for nursing facility services across states and found major inconsistencies in reimbursement.
Nursing facilities are payed through base payments, which are usually per diem, and supplemental payments, paid...
Last Friday, the U.S. House of Representatives passed the $1.7 trillion omnibus spending bill ahead of the Christmas deadline. The legislation includes big news for the healthcare sector, which responded to the bill with mixed feelings.
One major health policy provision in the package extends key Medicare telehealth flexibilities and...
On Tuesday morning, Congressional lawmakers unveiled a titanic omnibus spending bill that includes a 2% cut to Medicare reimbursement rates for doctors, an extension of the telehealth and hospital-at-home waivers, and several other measures that would unwind policies enacted during the COVID-19 public health emergency (PHE) prior to the...
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that includes revisions to network adequacy standards for Marketplace plans and paths to transitioning Medicaid members to the Marketplace. The proposed rule adds behavioral healthcare, including substance use disorder facilities and providers, to the...
Arizona cases of COVID-19 are spiking again, heralding the long-awaited winter surge warned of by experts and epidemiologists. But vaccine uptake, especially of the new bivalent booster, remains low as experts cite "vaccine fatigue" among Americans.
Tucson Mayor Regina Romero has tested positive for COVID-19 and experiencing mild...
A federal lawsuit in Texas is challenging a core tenet of the Affordable Care Act that requires insurers to cover preventive health services.
Back in September, a district court judge ruled that the way the federal task force charged with determining which services were covered is unconstitutional and that the requirement for...
This week, Los Angeles-based law firm Manatt published guidance for state Medicaid agencies on working with community-based organizations for addressing social determinants of health (SDOH) for Medicaid program enrollees.
Working With Community Care Hubs to Address Social Drivers of Health: A Playbook for State Medicaid Agencies was...
Last week, the Health Care Payment Learning and Action Network (LAN) published its 2022 Methodology and Results report, which is the result of a data collection survey of health plans and states for an account of how money moves through alternative payment models and how these programs function in terms of barriers and access.
In...
The U.S. Department of Health and Human Services (HHS) has signaled that it will delay the end of the public health emergency (PHE) related to the COVID-19 pandemic until April, quelling fears from stakeholders that not enough time was given to review Medicaid eligibility for everyone enrolled since the pandemic began.
In Arizona,...
