The Ohio House passed House Bill 220 – legislation aimed at improving the prior authorization process and reducing delays in patient care by requiring insurers and Medicaid to honor certain existing approvals for prescription medications. If enacted, House Bill 220 would: Require health insuring corporations, sickness and accident insurers, public employee benefit plans (collectively, 'health insurers'), and the Department of Medicaid (ODM) to honor a prior authorization approval if a provider prescribes a change in dosage of the approved drug. Require that the specialty and relevant qualifications of the clinical peer, who is required by continuing law to review prior authorization appeals, be identified. Prohibit health insurers from charging a fee for appealing an adverse prior authorization determination. Prohibit health insurers and ODM from retroactively denying a prior authorization for mental health or substance use disorder treatment. Specify that the bill's provisions apply to private insurance policies issued on or after the first day of January following the effective date of the bill. House Bill 220 now advances to the Ohio Senate for consideration.
Hennepin County lawmakers plan to urge state legislators Wednesday morning to save Hennepin Healthcare, the state's busiest Level 1 trauma center, which officials say could close this year without immediate action. The hospital has already cut five departments but is maintaining its Level 1 trauma center, hyperbaric chamber and renowned burn center. State lawmakers must pass a sales tax, known as the ballpark tax because it helps fund Target Field, to keep the hospital operating. The county cannot enact the tax without state approval. Multiple leaders said that if the state does not act this legislative session, the hospital would likely close as soon as this year. The county will present its case to lawmakers on Wednesday morning.The CEO of North Memorial Hospital will also attend the presentation to explain how HCMC's closure would affect their hospital as well.
Tenet closed an asset sale tied to Conifer's revenue-cycle contract with CommonSpirit that delivers $2.65 billion in cash, liability reductions and an added 23.8% equity stake), priced at a just-under-14x multiple on 2025 adjusted EBITDA less NCI (about $190 million); CommonSpirit will pay roughly $1.9 billion in installments (including $540 million in Q1 2026 and $453 million in early Q1 of 2027–2029 while Tenet will pay $540 million to redeem CommonSpirit's 23.8% stake, with the equity transfer retroactive to Jan 1, 2026 and a $100 million reduction in NCI expense in 2026. The deal returns full strategic control of Conifer to Tenet to push offshoring, automation and AI initiatives to lower 'cost to collect,' and management said the transaction strengthens cash flow and could accelerate capital deployment with share repurchases as an important priority alongside ambulatory M&A and organic growth while keeping a deleveraged balance sheet.
Trinity Health is laying off employees in its revenue cycle department. The healthcare system is laying off 10.5% of employees in the department, which includes employees in 15 states, Trinity Health said in an email to News 8. That includes Michigan, but a spokesperson for the hospital could not say exactly how many Michigan employees are impacted. Trinity Health in a statement cited "significant challenges" including low reimbursements, staffing shortages and the "rising cost of care" for patients who are underinsured or uninsured.
A CBS News analysis of about 1.3 billion federal health insurance claims across three years shows that, in 2024, insurers denied 19% of in-network claims – about 1 in 5.
CMS has released a request for information seeking input on replacing its Medicare claims processing system with a real-time, cloud-based platform. Under the program, called ClaimsCore, CMS is seeking vendors already capable of supporting more than 2 million active members on a single production instance and processing more than 100,000 claims per day. CMS said the program would provide faster, more transparent claims, strengthen fraud protection and provide near real-time explanations of benefits, among other improvements.