A 2013 payment reform implemented by Oregon’s Medicaid program was associated with a 42.4 percent relative reduction in traditional primary care services—driven primarily by decreased use of imaging services, according to Health Affairs. The payment reform changed the Medicaid program’s reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. The authors stated that Oregon’s initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.
Despite state and federal requirements that health plans must cover a wide range of costs related to COVID-19 testing and care, New Jersey hospitals say they aren’t being properly paid, reports NJ Spotlight. Thirty acute care facilities in the state reported that more than 1,000 claims related to COVID-19 patients were denied by various health insurance companies between March and the end of June, according to the New Jersey Hospital Association. In half of the cases, the company questioned the medical necessity of the treatment. One hospital alone reported nearly 1,500 denials related to testing services, regardless of the requirements that these services be covered.
A $2.5 million grant for American Indian and Alaska Native students in the Montana State University College of Nursing will be used for Montana Advantage Nursing Scholarships, reports MSU News Service. These scholarships aim to increase American Indian and Alaska Native enrollment and graduation rates by reducing financial barriers. The ultimate goal is to achieve health equity for these populations by increasing the number and quality of American Indian and Alaska Native nurses and primary care providers who are educated to deliver culturally sensitive healthcare services to their communities in remote and rural settings, as well as urban areas. The grant, from the Health Resources and Services Administration of the U.S. Department of Health and Human Services, will be distributed over five years.
PhRMA, the drug industry lobbying association, sued the state of Minnesota over a newly enacted law meant to prevent people who cannot afford their insulin from rationing it, reports STAT News. The Alec Smith Emergency Insulin Act allows Minnesotans who would otherwise forgo their insulin to immediately pick up a 30-day supply of the drug from a pharmacy for $35, while drug makers would be forced to provide the insulin for free or face hefty fines. PhRMA is seeking a permanent injunction that would prevent the law from going into effect.
Nearly half of Wisconsin residents in a federal survey say that they have put off medical care because of the COVID-19 pandemic, reports the Wisconsin Examiner. In addition, more than one in five are concerned about someone in their household losing a job or having their hours cut, according to the U.S. Census Bureau’s weekly survey. The impacts of the COVID-19 crisis have impacted not just access to healthcare, but also housing and employment security.
A new Virginia law protects patients and their families from receiving surprise medical bills by setting up a good faith arbitration process for resolving billing disputes between insurers and providers, according to WHSV. The law prohibits balance billing for out-of-network emergency services and certain non-emergency services at in-network facilities.
Complaints made to the State of Texas about surprise medical bills are down more than 95 percent since a new law took effect this past January, according to News 4 San Antonio. However, authors note that only 20 percent of Texans are protected by the surprise medical bill law because it applies to insurance regulated by the state. Under the new law, medical providers and insurance companies can go to arbitration to settle price disputes.
The Michigan Department of Health and Human Services (MDHHS) is launching the We Treat Hep C Initiative to bring down the cost of hepatitis C medication for the state’s Medicaid program and the Michigan Department of Corrections, according to Upper Michigan Source. The agency will seek proposals from Direct-Acting Antivirals (DAA) manufacturers to provide a significant discount to these programs. In return for this discount, the product will be the preferred DAA for Medicaid and MDOC, with minimal prior authorization requirements.
Integrating health and social services is increasingly important, particularly as patients with complex needs cope with the COVID-19 pandemic. A case study by the Commonwealth Fund describes how a nonprofit in Snohomish County, Washington, partnered with a Medicare Advantage plan to provide care coordination and social services – like home-delivered meals and medically related transportation – as a cost-saving intervention for the plan’s high-need, high-cost members. The process offers insights about how to integrate health and social services in a financially sustainable way.
New Hampshire has enacted a new law that greatly expands how care providers in the state can use telehealth, reports mHealth Intelligence. The new law amends the state’s definition of telemedicine to include new modalities, like audio-only phones, and requires Medicaid and private payers to reimburse for telehealth services at the same level as in-person care. The law makes several telehealth expansions passed by emergency measures due to the COVID-19 crisis, such as reimbursement parity and the ability for providers and patients to collaborate on care via telephone, permanent.