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...Arizona News
This week, trade associations ask regulators to reform requirements for participation in value-based care initiatives and improving alternative payment models to drive adoption of value-based care.
The American Medical Association, the Association of Medical Colleges, the Medical Group Management Association, and the National...National News
Medigap, the Medicare supplement insurance that helps cover Part A and Part B cost-sharing, may be due for some reforming in the near future as several aspects of the program are causing issues that lower regulatory infrastructure can't fix on their own.
As medical debt is a major concern for one in five older adults, the Medicare...
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...
On Thursday, the Senate Homeland Security Permanent Subcommittee on Investigations (PSI) published a report on Medicare Advantage denials for post-acute care services. The study showed that the three largest Medicare Advantage insurers, UnitedHealthcare, Humana and CVS Aetna, significantly raised the rate of prior authorization denials...
Reports have shown Arizona is falling far behind the pack on adult mental healthcare and ranks among the lowest in the country because of its prevalence of mental illness and limited access to mental healthcare. According to CMS data, the nation's highest psychiatric readmission rate was 35% in contrast to a 13.4% readmission rate at...Open
After submitting intent to not renew its contract with the local insurer, Wickenburg Community Hospital has agreed to rates proposed by Blue Cross Blue Shield of Arizona (BCBSAZ). The 19-bed community-owned Critical Access Hospital and health system, along with its three rural health clinics in Wickenburg, Congress, and Wittmann,...Arizona News
The only children’s hospital in Arizona ever recognized by U.S. News & World Report rated the pediatric health system the No. 1 children’s hospital in Arizona again this year and third in the Southwest region. Earlier this month, Phoenix Children's appointed four new division chiefs in pathology and laboratory medicine,...National News
More than 67 million Americans are Medicare-eligible. This month, as Medicare Advantage (MA) plans promote low co-pays and extra benefits to potential enrollees, plan sponsors are pushing back against CMS's cuts to star rating bonuses. Meanwhile, a former CMS official advises stricter regulation of MA plans as they continue to woo...Arizona News
Medicaid and Children’s Health Insurance Program (CHIP) will now cover traditional healthcare practices provided by Indian Health Service (IHS) facilities, Tribal facilities, and urban Indian organizations in Arizona, California, New Mexico and Oregon after approving the four states' section 1115 demonstration waivers. Since 2015 the...National News
Election day is drawing near and the candidates for president are distinguishing themselves with healthcare policy proposals.
Vice President Kamala Harris's campaign released several health-related potential policies over the past several weeks, including a plan to boost long-term care at home. According to Axios, up to a third of...Arizona News
Arizona hospitals are facing a shortage of intravenous (IV) fluid bags due to a national disruption in the supply caused by Hurricane Helene.
Banner Health is delaying certain elective surgeries, has received some partial shipments of IV bags and implemented other "conservation measures" after the hurricane damaged a Baxter...National News
The transition to value-based care (VBC) continues and the American Medical Association (AMA) and the CPT Editorial Panel published an issue brief this week on the acceleration of its adoption through the CPT code set.
As more providers transition to accountable care organizations (ACOs) and other team-based care relationships, the...CMS Rules
A coalition of 20 Republican-led states filed a lawsuit against the Biden administration's nursing home minimum staffing mandate, but the rule could end up saving thousands of lives each year once implemented.
The lawsuit was led by the attorneys general of Iowa, South Carolina and Kansas, and filed in the District Court for the...National News
UnitedHealthcare appears to have overcome financial issues related to the Change Healthcare cyberattack that took place earlier this year, but the company is lowering its expectations for 2025.
UnitedHealthcare's (UHC) third quarter (Q3) net income came in just over $6 billion or $6.51 per share, up from $5.84 for the same quarter in...
Individual health insurance rate changes for Arizona Marketplace insurers both on and off the Health Insurance Marketplace ranged from a drop of 6.10% from Centene to an increase of 10.35% from Banner|Aetna. Small group insurance rates didn't fall at all with increases ranging from about 5% for a Cigna HMO product to a high of nearly 14%...
The performance audit and sunset review of the Arizona Department of Insurance and Financial Institutions (DIFI) found numerous flaws within the department statutorily responsible for regulating the insurance industry and financial institutions in Arizona, such as banks and credit unions as well as financial service professionals and/or...National News
The election is just around the corner, and the Trump and Harris campaigns are clarifying their health policy positions to court voters in the home stretch.
A major concern for the Republican campaign is the perception that given a second term, former President Donald Trump would continue the pursuit of overturning the Affordable Care...
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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In the November election, Arizona voters will be asked if they want abortion to be legal up to the point of fetal viability, which will clarify restrictions for both patients and providers caught in the confusion of a turbulent back-and-forth since the 2022 Dobbs decision.
The state currently has a 15-week abortion ban in effect, but...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) announced new proposed rules for the ACA Marketplace in 2026. The agency intends for the rules to control the quality of brokers and agents who enroll people in plans and updates the risk adjustment program.
Since June, CMS has suspended at least 200 brokers on suspicion...
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...
Last week, Eli Lilly announced that the shortage of its landmark weight loss medication Mounjaro was over. This caused a drug compounding industry group to sue the U.S. Food and Drug Administration (FDA). Regardless of the shortage, payers are still wondering how they'll keep up with paying for the expensive GLP-1 treatments.
Eli...
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...