The Trump administration unveiled a new $25 million whistleblower initiative designed to encourage the public to report fraud involving federal programs, offering cash rewards for tips that lead to criminal charges or significant enforcement...
A federal appeals court has temporarily paused a court-ordered takeover of Arizona’s prison healthcare system, delaying what would be one of the most significant interventions in the state prison system's history while a broader legal battle plays out.
The 9th U.S. Circuit Court of Appeals ruled Oct. 16 that Arizona may retain...
The Trump administration is launching a new federal women's health initiative that will create a Women's Health Division within the National Institutes of Health (NIH) and establish a White House task force aimed at accelerating research, improving diagnosis and treatment, and translating scientific discoveries into clinical care. The...
More than a decade after the Affordable Care Act (ACA) guaranteed most privately insured Americans access to birth control without out-of-pocket costs, many women continue to face coverage denials, unexpected bills and administrative hurdles that can delay or prevent care. In 2021, an estimated 61.4 million women ages 18 to 64 had...National News
The National Association of Benefits and Insurance Professionals (NABIP) is suing the Centers for Medicare & Medicaid Services (CMS) over a new moratorium that blocks thousands of agents and brokers from registering to sell Affordable Care Act marketplace coverage for the 2027 plan year, intensifying a dispute over how the...National News
The Centers for Medicare & Medicaid Services (CMS) proposed new rules designed to improve the accuracy of Medicare Advantage provider directories, strengthen oversight of pharmacy benefit managers and expand financial protections for beneficiaries.
The proposed rule would require Medicare Advantage (MA) plans to:
...Arizona Comings & Goings
Wanda Shoer will join Phoenix Children’s as SVP and chief people officer effective Nov. 2. She will oversee talent acquisition, human resources, employee development and organizational effectiveness, with responsibility for strengthening career pathways, leadership development and employee engagement. Phoenix Children’s also named...
A new American Hospital Association report warns that longstanding pressures on rural hospitals, including low patient volumes, workforce shortages, geographic isolation and inadequate reimbursement, are intensifying as policy and payer changes increase the risk of service reductions and hospital closures.
Medicaid financing...
NAACOS and Innovaccer partnered on a survey to better understand how provider organizations and value-based care leaders are evolving their technology strategies and responding to the CMS ACCESS model. Rather than evaluating the model in isolation, the report examines it within the broader context of the technology investments, data...Arizona News
State-directed payments (SDPs) allow states like Arizona to increase payments to specified providers. For the 2025-26 contract year, AHCCCS plans distributed up to $95.4 million in supplemental payments to eligible nursing facilities. Those payments are expected to change as provisions regarding SDPs in the One Big Beautiful Bill are...Arizona News
Value-based care is becoming less optional for orthopedic and spine specialists as Medicare and commercial insurers push financial accountability further into musculoskeletal (MSK) care. Specialists face an increasingly urgent choice: Help design the models now or work within systems shaped largely by others.
The stakes are...
Arizona’s AZRx prescription discount program has saved residents more than $1 million, or an average of $249 per prescription, according to a Wednesday press release from Gov. Katie Hobbs’ office.
The free card is available to all Arizona residents, regardless of age, income or insurance status, and is accepted at 98% of...
The Centers for Medicare and Medicaid Services (CMS) released star ratings for Medicare Advantage plans ahead of the 2027 annual enrollment period that begins today, October 15, 2026 and runs through December 7, 2026.
CMS publishes the MA (Medicare Part C) and Part D Star Ratings each year to measure the quality of health and...
Congress is considering a bipartisan overhaul of Medicare physician payments that would establish annual inflation-based updates, reduce quality-reporting burdens and provide new payment options for independent primary care practices.
The American Medical Association notes that the proposal comes as Medicare physician payments have...
Arizona will receive $166.99 million in the first year of a federal rural healthcare initiative (more than $30 million less than state officials requested) as rural providers prepare for Medicaid eligibility changes that could increase demand for uncompensated care.
The funding gap comes as Arizona's rural healthcare safety net...
The American Hospital Association and five co-plaintiffs have once again sued the federal government to block a second version of a 340B Drug Pricing Program rebate pilot, arguing that the policy could impose more than $1 billion in costs on hospitals and strain providers’ cash flow. The lawsuit marks the second challenge to the rebate...
Humana is bringing in a new private equity partner to fuel the growth of its senior-focused primary care business, announcing a $2.8 billion transaction that will give BlackRock a majority stake in nearly 150 CenterWell Senior Primary Care clinics, 12 of those are in the Phoenix metropolitan area.
Humana announced the deal on Oct. 13...CMS Rules
Federal regulators have expanded their enforcement toolkit by granting the Centers for Medicare & Medicaid Services (CMS) authority to exclude providers and entities from Medicare and Medicaid, a significant shift that could expose Arizona healthcare organizations to heightened oversight and sanctions.
The new authority,...
The Treasury Department and IRS proposed regulations Wednesday that would tighten eligibility for Affordable Care Act subsidies and prevent people who lose Medicaid solely for failing work-reporting requirements from receiving federal assistance to purchase Marketplace coverage. The proposal implements premium tax credit provisions in...
A federal program that rewards hospitals for coordinating joint replacement care saved Medicare $180 million over three years without sacrificing quality, according to a new report. The findings are helping pave the way for a nationwide expansion of the model in 2028.
The results are especially significant for healthcare...
As part of the Trump administration’s broader effort to combat fraud, waste and abuse in federal healthcare programs, The Centers for Medicare and Medicaid Services (CMS) announced Wednesday that it had ended Affordable Care Act subsidies for 189,000 HealthCare.gov enrollees identified as having other public coverage or listed as...
A new Milliman white paper examines what the Medicare GLP-1 Bridge program could mean for ACOs whose attributed beneficiaries qualify for the medications.
The temporary program, which runs from July 2026 through December 2027, provides certain anti-obesity medications to qualifying Medicare Advantage and traditional Medicare...
Valleywise Health received two federal grants to expand behavioral health services for adults with opioid use disorder and young people showing early signs of psychosis.
A five-year, $3.75 million grant from the Substance Abuse and Mental Health Services Administration will support Valleywise’s MOSAIC program, which integrates...Available To All
A new review from the Medicaid and CHIP Payment and Access Commission (MACPAC) suggests that fragmented oversight, unclear accountability and disconnected data systems are creating challenges for Medicaid home- and community-based services (HCBS), potentially affecting providers, caregivers and beneficiaries who rely on self-directed...Available To All
Five states are urging federal officials to delay implementation of new Medicaid work requirements, citing mounting evidence that administrative hurdles, rather than a lack of work activity, are causing eligible beneficiaries to lose coverage.
In an Oct. 1 letter to the U.S. Department of Health and Human Services, the governors of:...
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