The new Rural Health Transformation Program funding opportunities are designed to recruit and retain healthcare providers in rural communities.
The Arizona Office of Economic Opportunity released requests for grant applications for:
Provider...
Arizona’s Medicare Advantage (MA) market will include 148 plans in 2027, up from 133 this year, while the average monthly plan premium falls from $4.47 to $2.81, according to CMS. Arizona has more than 1.56 million eligible Medicare beneficiaries, and all will have access to a $0-premium MA plan when annual enrollment opens Oct....
State Medicaid agencies already have extensive tools to address managed care plans that fail to meet quality, access, financial or contractual requirements. The bigger challenge may be ensuring states identify and address poor performance by using tools to measure whether interventions produce results.
A September Commonwealth Fund...
The Centers for Medicare & Medicaid Services (CMS) is launching a new initiative Investing in Health Outcomes with 37 states to shift Medicaid quality measurement away from process and paperwork and toward measurable improvements in patients' health.
Inside Health Policy reported that participating states are expected to focus on:...National News
UnitedHealthcare, Cigna Healthcare and Centene are joining CertifyOS, a new national provider credentialing model designed to reduce the repetitive administrative work physicians and health plans face when verifying provider credentials.
CertifyOS announced Sept. 23 that the three insurers, who are founding partners, will...News
The Department of Health and Human Services (HHS) faces continued disruption to its workforce and programs as legal challenges, a union settlement and a new administration effort to reclaim federal funding reshapes how the department operates.
The developments come as HHS continues a rebuild of its workforce after a series of...Video Interviews
As commercial payors lag behind Medicare in addressing reimbursement for those diagnosed with cognitive impairments under the age of 65, more than 200,000 Americans under the age of 65 live with Alzheimer's.
This episode, titled 'Designing a Better Managed Care Benefit for Alzheimer's Disease,' featured he expert neurology and...Arizona News
Elevance Health is changing how it evaluates and pays certain hospital claims, putting greater scrutiny on where care is delivered as the insurer moves to address higher hospital rates for services provided at off-campus locations.
A common practice for Medicare, Elevance Health said it was the first commercial market payer to...Arizona News
Banner Health earned the title for the second consecutive year, and it's the only Arizona-headquartered health system among the 250 organizations recognized.
The ranking is based on an independent survey of more than 30,000 healthcare professionals and more than 1 million employer evaluations collected over three years. Respondents...National News
Health Care Service Corporation (HCSC) will reduce its HealthSpring Medicare Advantage (MA) footprint in 2027, joining a growing number of insurers discontinuing plans, leaving markets and cutting benefits to improve margins.
HealthSpring-branded MA plans will be available in approximately 450 counties next year, down from 580 in...National News
Audits by the U.S. Department of Health and Human Services Office of Inspector General found that the two major Medicare Advantage (MA) insurers received an estimated $177.8 million in improper payments from Medicare after submitting diagnosis codes that were not supported by patients' medical records.
The audits are part of a broader...National News
Molina Healthcare said on Sept. 18 that it will withdraw completely from the Medicare Advantage market in Connecticut, Mississippi and Nevada in 2027. The insurer is narrowing its focus to dual-eligible special needs plans (D-SNPs).
The move goes beyond Molina's February announcement that it would stop offering standard individual...Arizona News
Ascension is selling its ownership stake in Mercy Care to Aetna, shifting full ownership of the Arizona managed-care plan to a company that has administered its day-to-day operations for more than two decades.
The transaction, which remains subject to regulatory review and approval, would give Aetna full ownership of Mercy Care. Terms...News
Artificial intelligence is moving deeper into clinical practice, but physicians should use it to augment, not replace, their clinical judgment; according to a new position paper from the American College of Physicians (ACP).
The paper, published in Annals of Internal Medicine argues that the rapid adoption of AI requires physicians to...National News
The Centers for Medicare & Medicaid Services (CMS) is expanding its ACCESS Model beyond Original Medicare, bringing its technology-enabled approach to Medicaid, Medicare Advantage and private insurance while adding payments for physicians who participate in patients’ digitally supported care.
Major insurers, including...Arizona News
CMS has canceled approximately 315,000 Affordable Care Act Marketplace enrollments covering more than 760,000 people after determining the enrollments were unauthorized. The federal crackdown will also temporarily close the door to new Marketplace agents and brokers.
Under the new interim final rule, agents and brokers without an...Arizona News
Stakeholders argue the new policy improperly narrows an exemption for medically frail people from the new Medicaid work requirements. The lawsuit, filed Sept. 18 in the U.S. District Court for the District of Maryland, is the second legal challenge to the Centers for Medicare & Medicaid Services’ (CMS) interim final rule...White Papers, E books, Reports and more
The Georgetown Issue Brief focuses on a set of reforms to the major medical commercial market health insurance–the coverage provided to an estimated 161 million Americans through their employer or directly purchased through ACA Marketplaces.
The authors make the case for change, contending that health insurance for Americans is...Arizona News
Arizona scientists have secured a five-year federal grant expected to total nearly $22.5 million to advance the early detection, treatment and prevention of Alzheimer’s disease and related disorders. The five-year renewal supports the continued work of the Arizona Alzheimer’s Disease Research Center, or ADRC, which has been advancing...Arizona News
Walmart is making another move into Medicare Advantage, partnering with fast-growing SCAN Health Plan to develop co-branded plans that could link insurance coverage with the retailer’s pharmacy, vision, food and over-the-counter services. The companies said the plans will launch in two states and could be available to more than 2...Arizona News
The Centers for Medicare & Medicaid Services (CMS) provided a new roadmap for deciding which Medicaid beneficiaries are too medically impaired to meet 2027 work requirements. However, they leave much of the clinical and administrative decision-making to states.
Issued Sept. 8, CMS' guidance outlines an optional...Arizona News
Arizona is turning federal Rural Health Transformation Program (RHTP) funding toward telehealth hubs, a strategy that could expand access to care in communities where provider shortages and long travel distances remain persistent challenges.
A new Bipartisan Policy Center report identifies technology innovation and workforce...Arizona News
Arizona is set to receive $167 million in the first year of a five-year federal rural health program intended to transform care, but questions are emerging over whether the funding can address the financial pressures facing rural providers as Medicaid cuts take effect.
The program is also facing questions about transparency, according...
Subsidized ACA Marketplace coverage among Arizona young adults could fall 79% as enhanced federal subsidies expire and new restrictions take effect.
An analysis by Urban Institute projects that 1.8 million adults ages 19 to 24 would have subsidized Marketplace coverage in 2028 if the enhanced premium tax credits had remained in place....
Medicare’s ACCESS chronic-care model will add four new condition tracks next spring, doubling down on its effort to tie payments to patient outcomes rather than volume of care.
The Advancing Chronic Care with Effective, Scalable Solutions, or ACCESS, voluntary model is designed to give Medicare beneficiaries more options for managing...
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