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The state of Maryland and CMS signed an agreement to implement the Maryland Total Cost of Care Model, which marks the first time CMS will hold a state accountable for total cost of care incurred by resident Medicare fee-for-service beneficiaries, according to JAMA. This 8-year model began on Jan. 1, 2019, and will test whether accountability for Medicare spending will spur statewide healthcare delivery transformation, potentially reducing expenditures, preserving or enhancing quality for beneficiaries and improving individual and population level outcomes. This model builds on Maryland’s All-Payer Model, providing incentives for hospitals to increase high-value care for patients seeking care from their institutions and their community services by centering improved population health as the foundation for the model to achieve savings.
The overall cost of healthcare in Minnesota grew at a relatively low rate during 2016, but the broader trend points toward a doubling of expenses over the next decade, reports the Star Tribune. A report by the Minnesota Department of Health projected that annual health costs – totaling $47.1 billion in 2016 – will reach $94.2 billion by 2026. This means that Minnesota would spend $1 out of every $6 generated by the state's economy on healthcare. Spending growth will likely result from higher prices, greater use of services and advanced technology costs. Additionally, demographic shifts will boost Medicare enrollment and spending for people with multiple chronic ailments.
Lawmakers from both parties are rolling out a package of bills to overhaul the Texas Medicaid system, introducing protections for vulnerable patients who are denied treatments, increasing state oversight and signaling a crackdown on healthcare corporations that get richer by providing less care, according to Dallas News. One such bill would address the state’s broken medical appeals system. In light of limited state oversight that allowed managed care companies to refuse medically needed services and force families with sick or disabled children to pursue endless appeals, other bills would allow parents of children with disabilities to opt out a managed care program called STAR Kids and receive traditional Medicaid. The omnibus bill some lawmakers call the "Managed Care Accountability Bill,” would overhaul the state’s system for fining managed care companies when they fail to properly serve patients, empower the health commission’s Office of the Inspector General to assist in financial review of managed care companies and beef up the state’s tracking of company refusals to provide care.
A new survey conducted by the Healthcare Value Hub discovered that more than half (58%) of Coloradans were burdened by healthcare costs, according to the Durango Herald. Healthcare continues to be an important topic of conversation for Coloradans, especially those outside the Denver metro area, where nearly two-thirds of those surveyed indicated they were burdened by these high healthcare costs. The survey found that the majority of Coloradans (82%) agreed that the healthcare system needed to change to better meet the needs of the consumers. Coloradans should not have to delay or forgo healthcare due to cost: more than 40 percent delayed going to a doctor or having a procedure done, 38 percent avoided going altogether, 21 percent did not fill a prescription and 19 percent cut pills in half or skipped doses to save money.
A new law requires California hospitals to establish plans for discharging homeless patients and provide resources that might keep them from returning to the street, according to KPBS. For example, hospitals must provide meals and weather-appropriate clothing to homeless patients when needed and offer them transportation to their destination after discharge if it is within 30 miles or 30 minutes of the hospital. The law does not, however, require that homeless Californians be given temporary housing or provide new resources to deliver it. The legislation has spurred conversations among numerous stakeholders on how to better address homelessness in California communities.
The Governor of New Mexico announced that the state will seek federal approval to reverse cost-sharing and enrollment provisions instituted by the previous Governor that were designed to conserve state spending on Medicaid, reports AP News. Specifically, the state will reverse course on its plans to charge some Medicaid patients a monthly insurance premium of $10 and co-payments of $8 on certain brand-name drugs and visits to the emergency room for routine medical care. According to the Governor, these provisions threaten to limit access to emergency services and disrupt health coverage for hundreds of thousands of state residents who are poor and disabled.
North Dakota lawmakers voted down legislation that would have enabled dental therapists to practice in the state by a margin of 2 to 1. Report by The Bismarck Tribune, the bill would have allowed dentists to hire dental therapists, mid-level clinicians comparable to physician assistants and nurse practitioners, in certain settings including Indian Health Service clinics and nonprofit dental practices. Sponsors and advocates of the legislation believed that it would increase access to dental care for vulnerable populations such as Native Americans, children, the elderly, and low-income families, while opponents cited quality and safety concerns as the main reason for voting against the bill.
A large backlog in patients seeking government help left state regulators unable to provide timely support to thousands of Texans who requested mediation from the short-staffed Texas Department of Insurance, according to the Texas Tribune. The overwhelmed state mediation program highlights the widespread problem of surprise emergency medical bills after the Texas Legislature gave state regulators increased authority to force insurers and providers to the negotiating table. The demand for the mediation program has increased from just 43 requests in 2013 to 4,519 in 2018, accounting for $8.8 million in qualifying surprise bills. Though the agency is able to get insurance companies to agree to pay more, lowering the amount a consumer owes, the department does not keep track of how much the consumer pays at the end of the mediation process. Agency officials said they have already made strides to improve internal processes to prevent another backlog from choking the system.
Utah Gov. Gary Herbert signed legislation adopting a limited expansion of the state’s Medicaid program, defying voters who in November approved the full Obamacare program through the ballot, according to Politico. Under the new GOP-written plan, Utah will ask the Trump administration for permission to implement unprecedented restrictions on the health coverage program for the poor, while insuring about 60,000 fewer people than the Obamacare expansion would have and initially costing the state tens of millions of dollars more.
Colorado is joining a growing number of states that wants to cut certain prescription drug prices by importing licensed drugs from Canada, according to the Highlands Ranch Herald. This idea is central to Governor Polis' campaign to rein in healthcare costs for Coloradans, many of whom (especially those in rural and mountain regions) pay some of the nation's highest insurance premiums. The Colorado Senate Health & Human Services Committee advanced a bill that would direct the Department of Health Care Policy and Financing to design a program in which the state takes on the responsibility to act as a wholesale importer of prescription drugs from licensed Canadian suppliers and distribute them to Colorado pharmacies and hospitals. Opposition to this proposal includes the Colorado Competitive Council and Colorado Chamber of Commerce, citing a lack of safety for patients to use drugs without FDA scrutiny.