UnitedHealthcare (UHC) announced Tuesday that it will eliminate prior authorization requirements for approximately 1,700 medical procedure codes beginning Oct. 1, advancing its pledge to reduce the amount of care requiring approval by 30% by the end...
Arizona has become a national hot spot for disputes over out-of-network medical payments, raising questions about whether the federal system designed to resolve surprise billing disputes is adding to healthcare costs.
The federal independent dispute resolution (IDR) system was created under the No Surprises Act of 2022 to...
Arizona is preparing to impose new Medicaid work requirements on some adults, raising concerns that the state could face another difficult rollout of public-benefit reporting rules after recent changes to the Supplemental Nutrition Assistance Program.
Under the One Big Beautiful Bill Act of 2025 (OBBBA) beginning Jan. 1, 2027,...Arizona News
As physicians and lawmakers weigh whether private equity’s capital and promised efficiencies outweigh risks to cost, access and clinical autonomy, the closure of two investor-backed urology practices in Tucson provides a cautionary Arizona example.
The practices joined United Urology Group in 2021 as part of Arizona Urology...Arizona News
As Medicaid costs for autism therapy continue to increase, the Trump administration is attempting to address concerns about rising treatment costs. The feds are urging states to tighten their oversight of autism therapy providers to ensure therapies are based on medical need, not financial incentives.
In Washington, a...Arizona News
According to a new Issue Brief from Georgetown University, new Medicaid work-reporting requirements are likely to confuse low-income parents. Parents who qualify for AHCCCS under Arizona's caretaker relative category are not subject to impending 2027 Medicaid work-reporting requirements.
According to research from ...National News
New CMS guidance puts America’s Critical Access Hospitals (CAHs) on notice: Starting Sept. 20, their CAH status will automatically come under review when a newly certified acute-care hospital opens nearby—a trigger the agency calls “proximal ACH identification.” The guidance also extends routine CAH eligibility reviews from three...
Two unvaccinated residents of Pennsylvania have died following an infection with measles, marking the first deaths of the year attributable to the virus. Arizona now ranks among the lowest in the U.S. for kindergarten vaccination rates.
Only Idaho, Minnesota, Utah and Wisconsin have lower levels of the measles, mumps and rubella (MMR)...
On Saturday, August 29th, friends, family and colleagues will remember Joseph “Joe” Peter Anderson, an Arizona healthcare leader who helped rebuild and stabilize the state’s fledgling Medicaid program during the 1980s. Anderson died Aug. 4 at age 76.
The Arizona native was born in Prescott and died at Santa Rosa Memorial...White Papers, E books, Reports and more
A new report warns that national defenses against a biological attack are at a natural disadvantage, as the country would need to be actively prepared to confront any number of biological agents, but even then a novel pathogen could easily evade preparations. AI-enabled biotechnology could reduce some of the challenges to defending...National News
Healthcare is business, meaning that its susceptible to all the dangers of typical market activity, especially from the aggressive merger-acquisition strategy of private equity firms. But as the infrastructure of medical care delivery constricts, the market has slowed its spread through higher interest rates as utilization rates weigh on...White Papers, E books, Reports and more
In this benefits brief, Milliman recommends routine audits of pharmacy benefit managers (PBMs), as prescription drugs have become one of the fastest-growing, most expensive, and least transparent components of employer health plans.
The firm identifies three primary benefits. Audits help plan sponsors fulfill fiduciary and oversight...National News
Earlier this month, President Donald Trump signed an executive order instructing the Department of Health and Human Services to pare down immunizations and split up the MMR vaccine in an effort that falsely tied the childhood vaccine schedule to rising levels of autism diagnoses in American children. Now, the Trump administration is...Arizona News
A much-touted venture-backed startup that promised to revolutionize the delivery of healthcare through its AI software platform is under scrutiny following an investigation into its marketing practices, which may violate federal anti-kickback laws for Medicare and Medicaid.
Commure is a company that may be familiar to those in the...Arizona News
A new federal audit found AHCCCS failed to adequately ensure three Medicaid managed care organizations were analyzing whether prior authorization requirements for mental health and substance use disorder services complied with federal parity rules.
The findings did not establish that the plans imposed more restrictive requirements on...
Employers remain committed to providing health coverage but are turning to value-based strategies and tougher vendor oversight as healthcare costs become increasingly difficult to predict, according to the most recent survey from the Business Group on Health.
Respondents to the survey project a median healthcare cost increase of 9.2%...
The One Big Beautiful Bill Act of 2025 (OBBBA) funded most of its ambitious program through a series of Medicaid cuts, not only through work requirements but also through curbing state methods of provider compensation designed to boost the federal match while maintaining provider participation.
The Assistant Secretary for Planning and...National News
Last month, MedPAC published a slew of data, including an update on the commission's analysis of the growing role of value-based care in the lives of Medicare FFS beneficiaries. About 200,000 Arizona Medicare beneficiaries received care through an accountable care organization in 2024, according to the latest state-level enrollment data...White Papers, E books, Reports and more
In the 2027 Inpatient Prospective Payment System (IPPS) rule, the Centers for Medicare and Medicaid Services finalized a new payment model that its calling the Comprehensive Care for Joint Replacement Expansion (CJR-X), which resurrects a formerly sunset payment model for Medicare joint replacement reimbursement and expands it as a...Arizona News
Voting is underway among Banner Health doctors to determine if they will form Arizona's first physician's union at the state's largest private employer.
Working with the Union for American Physicians and Dentists (UAPD), which has worked to form more than 30 bargaining units across 100 healthcare settings nationwide, Banner's doctors...National News
As calls to end the practice of prior authorization mount, the Centers for Medicare and Medicaid Services (CMS) are scrambling to assuage public concerns by offering new guidance for plans to publicly report prior authorization data and accompanying requirements for posting the reporting.
CMS posted the new guidance in compliance with...
Requests for Rural Health Transformation Program (RHTP) funding applications are live and providers have a short window to apply for program funds as reporting deadlines already loom large. States remain optimistic that the program's funding will facilitate much needed improvements to health delivery in rural areas.
In Arizona,...
Hospital operating margins remained stable through June, but Kaufman Hall found growing financial pressure beneath the surface, particularly for smaller and rural facilities with limited cash reserves.
Bad debt and charity care increased both in dollars and as a share of hospital revenue during the first half of 2026. Emergency...National Reports & Surveys
With the Annual Enrollment Period for Medicare Advantage right around the corner, Brookings researchers argue that traditional Medicare’s 61-year-old benefit structure is increasingly uncompetitive with Medicare Advantage and leaves beneficiaries vulnerable to catastrophic healthcare expenses.
Unlike Medicare Advantage, traditional...Arizona Comings & Goings
Banner – University Medicine has named Charles Socci, RN, MBA, chief operating officer for its Tucson operations, effective Sept. 14.
Socci will oversee daily operations at Banner – University Medical Center Tucson and Banner – University Medical Center South, with responsibility for quality, patient safety, service, employee...
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