Research Roundup - April 2020


Virus Tsunami Could Swamp Alabama's Healthcare, Particularly in Rural Areas
By Sam Prickett | WBHM | April 8, 2020

Alabama’s rural areas are at particular risk for not being prepared for disasters, given that the large number of rural hospital closures since 2010, according to WBHM. Many of the hospitals that remain open are struggling with financial problems – 88 percent of rural hospitals in the state have negative operating margins, making the necessary spending during a disaster more challenging. Alabama is among the states with the most rural hospital closures, according to a study from the Chartis Center for Rural Health, which describes the difficulty of maintaining hospital revenues when they have large uninsured populations but their state has not expanded Medicaid.


Integrating Health and Human Services in California's Whole Person Care Medicaid 1115 Waiver Demonstration
By Emmeline Chuang, et al. | Health Affairs | April 2020

A study published in Health Affairs provides an overview of early progress with California’s Whole Person Care Pilot Program, a Medicaid demonstration project focused on improving the integrated delivery of healthcare, behavioral health and social services for Medicaid beneficiaries. The pilot demonstrated significant progress in developing partnerships, data-sharing infrastructure and services needed to coordinate care for identified patient populations. Barriers to implementation included difficulty identifying and engaging eligible beneficiaries and the lack of affordable housing. These findings offer insights to leaders and policymakers interested in testing new approaches for improving the health and well-being of medically and socially complex patients.


California Fines More Than a Dozen Drug Makers for Not Providing Drug Pricing Data
By Ed Silverman | STAT | April 28, 2020

In the past six months, California state authorities have fined more than a dozen drug makers a total of $17.5 million for failing to report price hikes as required by law, according to STAT. The fines underscore an ongoing struggle between the state and the pharmaceutical industry over disclosing price increases, an issue that has galvanized consumer advocates and lawmakers around the country as they seek to control prescription drug costs. The California law requiring drug makers to provide advance notice of price hikes and explain the reasons for any increases, implemented in January 2019, has served as a model for other states exploring ways to respond to rising drug prices.


Mental Healthcare in Colorado Has Gone Virtual Thanks to Coronavirus. For Some Patients, It's Long Overdue
By Jennifer Brown | Colorado Sun | March 30, 2020

While crisis walk-in mental health centers and mobile response teams across Colorado remain open during the coronavirus pandemic, most clinical therapy sessions have gone virtual, according to the Colorado Sun. While therapists say virtual sessions don’t provide the same level of human connection, they do have other benefits, including making it easier for clients to get to their appointments and allowing people to ease into therapy from home. Mental health professionals are operating under temporary guidance approved by federal and state agencies that will allow them to bill Medicaid, Medicare and other insurance providers the same amount for a telemental health appointment as they could for an in-person session. This is drastically different from previous rules in Colorado around telehealth, including one rule stating that therapists could only use telemental health if the client lived in a town with a population under 50,000, or that the client had to travel at least 30 miles to visit their therapist. 


Connecticut Governor Limits Hospital Billing to Uninsured
By Rachel Cohrs | Modern Healthcare | April 7, 2020

Connecticut's governor issued an executive order prohibiting hospitals from charging uninsured patients more than the Medicare price for their COVID-19 care, according to Modern Healthcare. The order also aligns payment for emergency and non-emergency out-of-network care by requiring insurers to pay out-of-network providers in-network prices for care during the COVID-19 public health emergency, and protects healthcare workers and facilities from lawsuits if they are “acting in good faith” to provide COVID-19 care despite shortages or capacity issues. 


Florida First State to Get Medicaid Flexibility for Coronavirus
By Health News Florida | March 17, 2020

The federal government has approved Florida’s Medicaid waiver, giving the state authority to use out-of-state providers and hospitals to treat Medicaid patients and ensure that they qualify for reimbursement, according to Health News Florida. The providers and hospitals must either be Medicare providers or part of another state’s Medicaid network of providers to be eligible for reimbursement from Florida’s Medicaid program.


Many Marylanders Taking Advantage of Special Enrollment Period
By Bruce DePuyt | Maryland Matters | April 8, 2020

When fears of COVID-19 surfaced, the Maryland Health Benefits Exchange opened a special enrollment period so that uninsured people have until June 15 to get coverage, according to Maryland Matters. In March alone, 10,222 people enrolled for coverage through the Maryland Health Connection. For consumers who enroll by April 15, their policies become effective on April 1, meaning it could apply to treatment they already received. The same retroactive provision applies for consumers who sign up between May 1 and May 15.

Maryland's Prescription Drug Affordability Board Gets to Work
By Catherine Kirk Robins | AARP | April 9, 2020

Despite an abbreviated legislative session, the Maryland General Assembly approved permanent funding for the Prescription Drug Affordability Board, reports AARP. The Board has the authority to require that pharmaceutical manufacturers justify large price increases. The Board’s scope will focus on implementing measures to make prescription drugs purchased by state and local government entities and programs more affordable, and to present a plan to the legislature to expand its authority  in the future.  

Coronavirus: Maryland Hospitals Given Green Light to Raise Rates on All Patients to Help Pay for COVID-19 Response
By Natalie Dreier | KIRO7 | April 2, 2020

Hospitals in Maryland have been given permission to temporarily raise rates patients are charged to help pay for emergency care related to COVID-19, reports KIRO7. Normally, the amounts hospitals can charge for surgeries and childbirth are regulated in Maryland, but due to the coronavirus, medical facilities are adding capacity without offsetting costs with other health services.


Massachusetts Will Spend $800 Million to Shore Up Hospitals and Other Healthcare Providers
By Chris Lisinski | WGBH | April 7, 2020

Massachusetts will direct another $800 million to the state’s healthcare industry, supplementing $840 million in previously announced assistance as the state works to bulk up its front line of defense against COVID-19, according to WGBH. Half of the new funding will be split between 28 safety-net and high-Medicaid-population hospitals. This plan will also increase rates paid to hospitals for COVID-19 care by 20 percent and 7.5 percent for all other hospital services. The Massachusetts Health and Hospital Association estimated that hospitals across the state are losing $1 billion per month due to the pandemic as revenue has “evaporated.”


Minnesota Hospitals Project COVID-19 Hit of $2.9 Billion
By Christopher Snowbeck | The Star Tribune | April 10, 2020

The Minnesota Hospital Association says healthcare systems and medical centers across the state are facing a financial hit of $2.9 billion over the next 90 days due to COVID-19, reports the Star Tribune. The biggest factor is that hospitals and health systems are seeing a decline of $2.8 billion in revenue due to postponed elective surgeries that help preserve scarce supplies needed for handling COVID-19 patients. Minnesota hospitals and health systems are collectively losing $31 million in revenue per day from reduced patient volumes, the association says.

Governor Signs Alec Smith Insulin Affordability Act
By Office of the Minnesota Governor  April 15, 2020

The Governor of Minnesota signed into law the Alec Smith Insulin Affordability Act to provide relief to residents struggling to afford their insulin, reports the Office of the Governor. The bill contains emergency and long-term components, which take effect on July 1, 2020. The emergency provisions allow eligible individuals in urgent need of insulin to go to their pharmacy once in a 12-month period and receive a one-time, 30-day supply of insulin for a $35 co-pay. The long-term program requires manufacturers to provide insulin to eligible individuals for up to one year, with the option to renew annually. Insulin will be available in 90-day increments for a co-pay of no more than $50.


Montana Hospitals Feel COVID-19's Financial Hit
By Patrick Reilly | The Missoulian | April 16, 2020

The Montana Hospital Association has issued a conservative estimate that the COVID-19 impact on its hospitals in the first three weeks would be around $100 million, reports The Missoulian. A 2019 study found that Montana’s hospitals are responsible for around $4.7 billion worth of annual Gross Domestic Product. The combination of canceled elective procedures and people avoiding doctors’ offices is having a real depressive effect on hospital revenue. Earlier in April, Montana’s Congressional delegation announced that Montana hospitals altogether would receive about $111.5 million from the program set up by the CARES Act. 

New Jersey

NJ Grants Legal Immunity to COVID-19 Healthcare Providers
By Lilo H. Stainton | NJ Spotlight | April 15, 2020

New Jersey’s hospitals and healthcare professionals responding to the coronavirus are now largely protected from legal liability if a patient is injured or dies while under their care during the current pandemic crisis, reports NJ Spotlight. The new law, retroactive to March 9, is designed to ensure that there are no impediments to providing medical treatment to COVID-19 patients, but many lawmakers raised questions about the lack pf public input on the bill, its broad scope of immunity and the impact it could have on communities of color that are suffering disproportionately in the pandemic.

New Mexico

Governor Signs Priority Public Health Bills into Law
By Office of the Governor | March 4, 2020

The Governor of New Mexico signed four significant public health bills designed to reduce the high cost of prescription drugs and develop more affordable healthcare insurance options, the office reported in a press release. Of note is House Bill 292, which caps co-pays and out-of-pocket expenses for insulin at $25 per prescription for a 30-day supply – making them the lowest in the country. Also, House Bill 100 empowers beWellnm, the New Mexico health insurance exchange, to operate as a fully state-based exchange meeting the needs of families seeking health insurance coverage in New Mexico and promoting access to more affordable, higher-quality insurance plans.

New York

The Development of Health and Housing Consortia in New York City
By Amy Freeman, et al. | Health Affairs | April 2020

Two health and housing consortia in New York City offer a model for better integrating the health and housing sectors, according to this article in Health Affairs. The Bronx Health and Housing Consortium is a collaborative network of healthcare, housing, social services and government organizations and agencies that seek to strengthen and integrate healthcare and housing systems at the policy, operational and individual patient/client levels. However, researchers note that structural changes are needed. Researchers believe this model could be replicable in not just large cities, but smaller and nonurban areas, as well.

North Carolina

Buying Health for North Carolinians: Addressing Nonmedical Drivers of Health at Scale
By Zachary Wortman, Elizabeth Cuervo Tilson and Mandy Krauthamer Cohen | Health Affairs | April 2020

Since 2017 the North Carolina Department of Health and Human Services has been incorporating whole-person care into all of its priorities, focusing on food, housing, transportation, employment and interpersonal safety/toxic stress. An article in Health Affairs describes four, interconnected initiatives that aim to (1) better align financial incentives for healthcare providers and Medicaid health plans to address both medical and nonmedical drivers of health; (2) introduce a standard screening process to identify people with unmet resource needs; (3) establish NCCARE350, an innovative technology platform that allows healthcare providers and human services organizations to connect people with social resources and track outcomes; and (4) launch large-scale Healthy Opportunities Pilots to evaluate the impact of nonmedical health interventions on the health outcomes and healthcare costs of high-need Medicaid beneficiaries.


Ohio Hospitals Projecting Large Financial Losses Because of Pandemic
By Lydia Coutre | Modern Healthcare | April 9, 2020

The Ohio Hospital Association estimates a $1.2 billion negative financial impact to Ohio hospitals every month, according to Modern Healthcare. In addition to the cost implications of shifting away from nonessential surgeries and procedures, hospitals are grappling with increasing prices in the supply chain for the equipment they desperately need to treat COVID-19 patients. The state has already launched the Variable Rate Demand Obligation (VRDO) Stabilization Program, which aims to provide added liquidity and ease the financial pressure hospitals face as they respond to the pandemic.


Coronavirus in Oklahoma: Rural Hospitals Face More Hurdles in COVID-19 Fight
By Adam Kemp | The Oklahoman | April 14, 2020

As coronavirus spreads into rural Oklahoma, hospitals serving those communities face difficulties that go beyond those of their metropolitan counterparts, reports The Oklahoman. Rural hospitals less likely to receive shipments of personal protective equipment (PPE) -- a concern not only for staff safety but potentially leading to debilitating workforce shortages if providers fall ill. Moreover, the COVID-19 outbreak comes at a time when rural hospitals are struggling financially due to declining rural populations and rising costs, among other factors.


Texas Will Let Food Stamp Recipients Have Groceries Delivered
By Robert T. Garrett | The Dallas Morning News | April 23, 2020

Food stamp recipients in Texas will be allowed to use their benefits to order groceries online and have them delivered to their door, according to The Dallas Morning News. Food stamps help about 1.4 million eligible low-income households in Texas with benefits worth nearly $5 billion a year. However, the state is still awaiting word from the U.S. Department of Agriculture’s Food and Nutrition Service on its recent request to let people in the Supplemental Nutrition Assistance Program use their Lone Star Cards to buy carryout or delivered food from restaurants.


Vermont Requires Insurers to Cover COVID-19 Diagnosis and Treatment with No Cost Sharing
By State of Vermont Office of Governor Phil Scott | April 15, 2020

Vermont is requiring commercial health insurers to waive cost-sharing requirements—such as co-payments, coinsurances or deductibles —for the diagnosis and treatment of COVID-19, according to an official press release. The emergency regulation applies to fully funded health insurance plans, such as plans sold on the exchange or to large-group employers. Consistent with existing Department of Financial Regulation rules, insurers will be required to cover out-of-network services for members if in-network providers are unavailable.


Virginia Announces New Actions to Expand Healthcare Workforce
By Alena Yarmosky | Office of the Governor | April 17, 2020

Virginia legislators are implementing new policies to bolster the state’s healthcare workforce in response to the pandemic, according to a press release from the Governor’s office. It is estimated that up to 30,000 additional workers are needed in Virginia’s hospitals, long-term care facilities, and public health departments, should a surge occur. The executive order allows hospitals, nursing facilities, and dialysis facilities to have out-of-state licensees provide in-state care and Virginia-licensed nurse practitioners with two or more years of clinical experience to practice without a collaborative agreement.


Two Wisconsin Emergency Orders Suspend Rules to Ensure Healthcare Staffing, Patient Care
By Joshua Rose | | April 6, 2020

Wisconsin has issued two emergency orders that suspend some administrative rules for the Wisconsin Department of Health Services to help maximize the state’s healthcare workforce while ensuring patients continue to get the care they need, according to The executive order adjusts training and license renewal deadlines, as well as paramedic-level ambulance staffing levels for emergency medical services. It suspends staff orientations at home health agencies and hospices, adjusts nurse aide training hours, relaxes criteria for resident care staff at community-based residential facilities and adult family homes and ensures nursing homes cannot discharge patients who are unable to pay. The law allows healthcare provider licenses that would have expired during the public health emergency to remain valid until 30 days after the emergency is over and gives providers who are licensed in other states, but assisting in Wisconsin, time to apply for a Wisconsin license.


'You've Been Served': Wisconsin Hospital Sued patients Even During Pandemic
By Bram Sable-Smith | Kaiser Health News and Wisconsin Public Radio | April 3, 2020

Froedtert Memorial Lutheran Hospital, Inc. has sued at least 46 people in small claims court since March 12, though a hospital spokesperson says they have suspended filing in small claims court as of March 18 in response to COVID-19, reports Kaiser Health News and Wisconsin Public Radio. Indeed, court records show at least 18 lawsuits filed on the hospital’s behalf since then, including 15 filed on March 31 alone, and that at least six additional health systems have also sued patients during the pandemic. ABC for Health, a nonprofit public-interest law firm in Madison, explains that facing a medical debt lawsuit is stressful under normal circumstances and is much more so given that many people have lost their jobs and health insurance during the pandemic.