State News

The Centers for Medicare & Medicaid Services has approved a Florida section 1115 pilot program that provides behavioral health services and housing to adult Medicaid beneficiaries with serious mental illness, substance abuse disorders, or both, according to HealthLeaders. The program, called the Behavioral Health and Supportive Housing Assistance Pilot, will provide transitional housing, tenancy support services, mobile crisis management and self- and peer-support, along with home and community-based services to people who are homeless or at risk of homelessness. The hope is that the program will promote independence for beneficiaries and improve health outcomes.  

The Washington Health Alliance has released several new reports on negotiated reimbursements from commercial payers, reports State of Reform. One report shows that reimbursement for a vaginal delivery at one medical center varies from $7,196 to $19,402, depending on the commercial payer. Another report reveals that overall inpatient utilization from 2015-2016 was down enough ($51.2 million) to offset price growth ($21.7 million). A third report analyzing “how well health plans are meeting the needs of their members and working to improve quality and reduce the cost of healthcare" identified Kaiser's HMO product as the overall top rated insurance plan, with Regence the top rated PPO plan.

A new bill proposed in the Texas Senate would direct the state health commissioner to develop a method to ensure that rural hospitals get full Medicaid reimbursement, according to an editorial in the Orange Leader. Since 2013, 21 rural hospitals have closed in Texas. Legislators believe that a major reason for these closures is an underpayment for Medicaid reimbursements. Over three million people live in the state’s 170 rural community—a population that tends to be older, poorer and less healthy than urban communities. About 50 percent of infants in the state are delivered to patients covered by Medicaid and in rural regions that rate is about 70 percent—demonstrating a need for rural hospitals. Though a budget provision requiring reimbursement for the full allowable cost of a service for Medicaid patients exists, managed care organizations omitted the budget provision after they began administering the Medicaid program in 2012. Legislators emphasized the need for coordination between agencies to agree on what rural hospitals are owed to avoid future hospital closures.

Legislators in Oregon have called for the development of plan to achieve a “predictable and sustainable” annual growth rate for statewide healthcare spending, according to Milbank Memorial Fund. The plan would be developed by a public-private advisory group and implemented, at least initially, by the Oregon Health Authority within existing laws. Enforceable limits on cost growth will take effect in 2022. Other states, like Massachusetts, Rhode Island, and Delaware, have already implemented healthcare cost growth benchmarking.

There is momentum and support to continue to build telehealth commercial coverage. Massachusetts legislators filed five new telehealth bills for consideration, according to the National Law Review. Four of these proposed bills directly compete with each other, so it will be important to monitor their progress through committee and reconciliation. All of the bills state that insurers (including Medicaid MCOs, Massachusetts Group Insurance Commission, Individual plans, Hospital service plans, HMOs and PPOs) must not decline to provide coverage for health care services solely on the basis that the services were delivered through telemedicine. While it is not yet clear which bill will prevail, it is clear that Massachusetts is continuing to explore ways for policy to drive innovation in health technology, while balancing patient safety and the insurance industry. 

Community health workers have the potential to help improve health outcomes, reduce costs and reduce health disparities. Despite this, the role of community health workers in the healthcare system remains precarious and not widely understood. A report released by the Connecticut Health Foundation aims to shed light on the work community health workers are doing in Connecticut and their potential to bridge gaps between clinical care and patients’ lives. This report complements previous research published by the Connecticut Health Foundation, including a brief and report identifying specific ways community health worker services can produce a positive return on investment and a report detailing how 15 other states handle certification for community health workers.

California healthcare giant Sutter Health has failed in its attempt to persuade a San Francisco Superior Court judge to dismiss key claims in the Attorney General’s (AG’s) antitrust lawsuit alleging that Sutter has used its market power to control prices and exclude competition, reports the Sacramento Bee. Sutter argued that the AG’s lawsuit would favor insurance carriers and increase their negotiating power, and that the AG’s demands would make doing business especially onerous by forcing Sutter to use lengthy arbitrations to determine future contract terms. They also fear that they will have to negotiate contracts with insurers at staggered times, using separate teams that may not communicate with one another. This decision marks the most recent action in the lawsuit, which was filed in early 2018.

A new report from MedStar Health Research Institute and the Rutgers Center for State Health Policy describes early lessons from Mountain-Pacific Quality Health’s innovative “ReSource Teams” designed to expand access to care in three rural Montana communities. The ReSource teams consist of community health workers and volunteers who visit patients in their homes and consult remotely with registered nurses, pharmacists and behavioral health providers. ReSource Team members shared their perspectives on accessing and combining data sources to track patients’ hospital and social services needs and utilization; using ICD-10 Z-codes to monitor and respond to patients’ social determinants of health needs; and connecting patients to care in the context of limited and highly fragmented community resources.

A new report from the United Hospital Fund, supported by the New York State Health Foundation, examined patient and family decision making around post-acute care, which includes service provided by home health agencies, inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The analysis found a robust evidence base around improving post-acute decision support and provided a number of policy recommendations and solutions to increase supports for patients and their families when making decisions about where to receive post-acute care.