The Arizona State Legislature passed a bill that will increase oversight of sober living homes following a major statewide scandal over a Medicaid fraud scheme targeting Native Americans seeking drug and alcohol treatment.
Senate Bill 1655,...
We know that Medicaid cuts are on the table for the upcoming Trump budget negotiations, but until recently, the form that those cuts would take was unclear. Now, consensus among supporters of the cuts appears to be coalescing around work requirements for state Medicaid programs, despite decades of data demonstrating that they are...White Papers, E books, Reports and more
A new study shows the vast differences in health status and demographics for dual-eligible Medicare and Medicaid beneficiaries in different Medicare Advantage plans.
The study was published in JAMA and examines the data of 147,923 dual-eligible beneficiaries. It sought to compare the health and demographic characteristics of full...
A leaked draft of the Trump administration's goals for budget cuts at the Department of Health and Human Services is the first real look into the administration's disruptive plans for the agency, and the U.S. healthcare industry writ large.
The budget draft illustrates the priorities of President Donald Trump's Office of Management...
Key members of the U.S. Supreme Court appeared unlikely to overturn a key provision of the Affordable Care Act during a hearing on Monday. Plaintiffs argued that the requirements for preventative care coverage under the ACA are unconstitutional because the volunteer board that oversees recommendations on the services should be...
UnitedHealth Group, which owns the health insurance titan UnitedHealthcare, has reported some fiscal turbulence over the past year, culminating in a first quarter (Q1) earnings report to investors that was decidedly disappointing.
In its Q1 report last Thursday, UHG decided to downgrade its annual net earnings guidance from $29.50-$30...White Papers, E books, Reports and more
Rural communities are seeing a rapid decline in independent physicians and practices as corporate ownership expands, according to new research from the Physicians Advocacy Institute and Avalere. The report builds on recent national data to offer a focused analysis of how healthcare consolidation is reshaping the rural practice...White Papers, E books, Reports and more
According to a recent study in Health Affairs, the pace of private equity acquisitions in physician practices has accelerated, raising concerns about workforce instability and care continuity. Researchers examined changes to physician employment and turnover after PE acquisition of 200 ophthalmology practices with 1,980...National Reports & Surveys
The Medicare Payment Advisory Commission admits the inconsistency is "hard to reconcile with rural hospital administrators' strong preference for fee-for-service (FFS) Medicare over Medicare Advantage (MA)" as it reports "no statistically significant effects on rural hospital finances through 2023."
The commission's staff visited...
President Trump went big last week, signing an executive order packed with measures to cut prescription drug costs, targeting Medicare price negotiations, PBM broker fees, hospital outpatient drug pricing, and 340B discount enforcement, all aimed at delivering savings for American patients and taxpayers.
Several of the EO’s...
Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. is settling into his new role as firings within the agency continue to disrupt the agency.
The Reduction in Force (RIF) initiative was announced to have reduced the U.S. Department of Health and Human Services (HHS) by 10,000 earlier this spring, and National Law Review...CMS Rules
The Centers for Medicare and Medicaid Services issued a proposed rule for the Medicare inpatient prospective payment system (IPPS) for fiscal year (FY) 2026. The rule includes a proposed pay bump of 2.4% for hospitals.
CMS said that the rate reflects a 3.2% projected hospital market basket increase with a 0.8% productivity adjustment...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) has proposed a rule under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) and the IRF Quality Reporting Program (QRP) for Fiscal Year (FY) 2026.
The agency proposes updating the payment rates by 2.6% based on the IRF market basket update of 3.4%, minus...CMS Rules
The Centers for Medicare and Medicaid Services announced its proposed Hospice Wage Index and Payment Rate Update proposed rule for FY 2026.
The proposed reimbursement update will raise the base payment rate by 2.4%, lower than the 2025 increase of 2.9%. The increase represents $695 million rise in total hospital payments, Hospice News...CMS Rules
The skilled nursing industry was elated by the Centers for Medicare and Medicaid Services (CMS) proposed Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, which included a 2.8% pay bump for FY 2026 and some other breaks that could reduce SNF costs.
The rate hike falls far short of the 4.2% raise that SNFs...
Countless critics of pharmacy benefit managers (PBMs) have raised the alarm about the sector's excessive profits, but despite the best efforts of lawmakers at all levels, they still operate relatively unchecked. This week, a bipartisan coalition of dozens of attorneys general submitted a letter to Congress urging them to pass a law...
To date, there is no set plan to cut Medicaid yet industry stakeholders and political analysts continue to speculate on the potential targets and magnitude of potential funding changes for the program that now insures 79 million Americans or 24% of the U.S. population.
The Trump administration launched its radical overhaul of the...
Mehmet Oz, MD, the new administrator of the Centers for Medicare & Medicaid Services (CMS), laid out his vision on April 10 for the $1.7 trillion agency—the largest under the Department of Health and Human Services. He pledged alignment with President Trump’s “Make America Healthy Again” agenda and a focus on modernizing...Arizona News
The waiver application aligns with Arizona legislation passed in 2015 that requires AHCCCS to request (annually) the federal agency's approval to institute a work requirement for all “able-bodied adults” receiving Medicaid services, place a lifetime limit of five years of Medicaid benefits on “able-bodied adults” and develop and...Arizona News
During Wednesday's State Medicaid Advisory Committee (SMAC) quarterly meeting, the Arizona Health Care Cost Containment System announced it had submitted a waiver to enact work requirements for an estimated 190,000 Arizona Medicaid members.
In 2017 AHCCCS submitted a 1115 waiver for AHCCS Works which was approved by CMS in 2019. The...
Funding cuts from the Department of Health and Human Services (HHS) are already having consequences nationwide and across Arizona.
The temporary halt on the cancellation of $11 billion in public health funding will keep the $239 million allotted to Arizona in the state for now, but the threat has already cost some crucial jobs....Government
The "DOGE"-led restructuring of the Department of Health and Human Services (HHS) continues this week with multiple agencies reporting instructions to cut billions in contracts. But confusion reigns as court cases over firing procedure loom and critical public health laboratories are shuttered.
Both the Centers for Medicare and...
The Congressional Budget Office (CBO) has released a new report with some optimism for the Medicare trust fund, with new projections estimating that it could remain solvent for an additional 17 years beyond what the office anticipated last year.
The CBO's projections takes into account the federal budget including public debt, the...
This presentation from MedPAC provides all the basics on Medicare agents and brokers, including compensation for initial sales and renewals as well as agent incentives that lead agents to pitch one plan over another when working with Medicare beneficiaries seeking a Medicare Advantage or Medigap plan. In 2022, about one in three Medicare...
The authors of this report conclude that while emergency departments (EDs) provide significant value to a range of stakeholders, the increasing pressures they've faced over the past decade now threaten the sustainability of America's current emergency care system.
The report evaluates the current value of emergency care in the U.S.,...
CMS Rules
