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),...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:...White Papers, E books, Reports and more
Better Medicare Alliance (BMA) has released a 10-point policy roadmap urging Congress and the Centers for Medicare and Medicaid Services to strengthen Medicare Advantage oversight while providing greater stability for plans, providers and Medicare-eligible beneficiaries.
BMA is a nonprofit advocacy and research organization that...Arizona News
CommonSpirit Health is accelerating a sweeping cost-cutting and restructuring effort even as the nonprofit health system posted stronger patient volumes, revenue growth and operational improvements. The Chicago-based system operates in Arizona primarily under the Dignity Health brand.
CommonSpirit reported fiscal 2026 revenue of...National News
The Food and Drug Administration has approved the first pulmonary heart valve designed to be expanded after implantation as a child grows, potentially reducing the need for repeated open-heart surgeries.
The surgically implanted Autus Size-Adjustable Valve is approved for pediatric patients with congenital pulmonary valve disease. It...Arizona Comings & Goings
Phoenix Children’s has promoted four physicians from within its pediatric health system to lead pediatric critical care, cardiovascular intensive care, nephrology, and physical medicine and rehabilitation. The appointments include two physicians who earned medical degrees in Arizona and a third who completed her residency in Phoenix,...White Papers, E books, Reports and more
The analysis by Wakely Consulting Group, commissioned by America’s Health Insurance Plans, concludes that underlying healthcare costs and a less healthy risk pool, rather than higher administrative expenses or profit margins, have been the primary driver of recent ACA premium increases.
That national trend provides context for...
All 50 states met a Sept. 30 deadline to participate in the federal government’s GENEROUS MODEL designed by the CMS Innovation Center to test whether “most favored nation” pricing can reduce Medicaid prescription drug costs. The voluntary model is expected to save states $27.6 billion and the federal government $36.6 billion over...
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 Retention & Well-Being Microgrants, which will support efforts to reduce burnout,...
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...
National News
