Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
Clip File
Clip file / Local news from the states
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
Tennessee legislators rebuke state officials
for failure to release external quality report
NASHVILLE,TNÑ Angry over news that the Department of Health did not promptly release an external review of the state's troubled mental health and substance abuse program, Tennessee legislators called for an independent monitor and an independent consumer advocate to be placed in a different department, such as the attorney general's office.
The state's external quality reviewer, First Health, Inc., identified serious problems with TennCare Partners, the state's Medicaid managed behavioral health care program, in two reports completed last fall. Legislators only obtained a copy recently.
The reports found that behavioral health patients were not given reasons for denials of service and were not informed of their rights to appeal. Among other findings: use of case managers is sporadic, there are no preventive mental health care services and one behavioral health firm only authorizes 24 hours of intensive treatment at a time, regardless of the patient's condition.
The Commercial Appeal, Memphis, TN, Feb. 1, 1998
Pennsylvania Medicaid managed care rates too low for disabled and chronically ill recipients, report says
HARRISBURG,PAÑA long-awaited report on the adequacy of Pennsylvania's Medicaid managed care rates has concluded that plans are being underpaid for disabled and chronically ill beneficiaries. Arthur Anderson LLP, which produced the report, said the Department of Public Welfare underestimated rates for these beneficiaries by 3%.
The accounting firm said rates are sufficient to cover most Medicaid recipients including mothers and children. In fact, the state probably overpaid plans with its inflation factor of 5%, the firm's actuaries said. The national rate of inflation was 1.7%. Profits and administration for HealthChoices plans amounted to 13-15%, higher than the 11% estimated by DPW.
HealthChoices plans all lost money last year, but state officials note that, in previous years, the plans reported substantial profits. Plan executives say the state has offered plans an increase of payments in the 7% range.
Inquirer, Philadelphia, PA, Feb. 8, 12, 1998
Chicago employers join to purchase health care
CHICAGO'In a first for the Chicago business community, eight large employers are banding together to purchase medical services from managed care plans.
The buying group will design a model HMO benefits package, with different options employers may choose. A single request-for -proposal will be issued and bids will be scored by the buying group. The Healthcare Purchasing Group will collectively negotiate prices on behalf of its members. HMOs will be asked to report regularly on employee satisfaction and health care quality and to meet performance requirements.
The Healthcare Purchasing Group's eight initial members are ABN AMRO, First Chicago NBD, Ford Motor, the State of Illinois, the Jewish Federation of Metropolitan Chicago, Northern Trust, the University of Chicago and Zenith Electronics. They employ 97,000 people in the Chicago area.
Although that's a relatively small number, the move has enormous symbolic significance, the newspaper reports.
Chicago Tribune, Jan. 15, 1998
Cook County Hospital's patient load drops 13%
leading county officials to rethink building plans
CHICAGOÑA 13% decline in patients spending the night at Cook County Hospital has county officials rethinking their plans to build a new hospital. The Bureau of Health Services, which oversees the county's hospitals and clinics, released its report on the decline just as county officials were preparing to open another round of bids on new construction.
Hospital officials said the reason for the decline include shorter hospital stays and greater use of the county's outpatient clinics. The average number of people spending the night at Cook County Hospital dropped from 475 in 1996 to 415 in 1997. The aged hospital has 695 beds.
The 464-bed hospital now planned for construction has an estimated price tag of $551 million including equipment. With the reported decline, some officials have proposed a smaller facility or an alternative plan that would tap the excess capacity of existing hospitals rather building a new public facility.
Chicago Tribune, Jan. 13, 1998
After hiatus, California legislature considers fresh batch of managed care legislation
SACRAMENTO, CA armed with recommendations from a 30-member HMO task force, Democratic lawmakers are pushing once again for stricter controls over HMOs.
Last year, nearly 80 managed care reform bills were either vetoed by Gov. Pete Wilson, who said he wanted to wait for the task force recommendations, or put on hold because of his veto threat.
Among the legislative proposals:
¥ require HMOs to cover drug treatments for a patient with an ongoing health problem, even if the HMO removes that drug from its list of covered treatments;
¥ require HMOs to cover glucose monitors and test strips for diabetes patients;
¥ require insurers to cover prostrate cancer exams for men;
¥ require health plans to justify authorizations or denials of care, and allow for independent reviews whenever a health plan denies service to a consumer;
¥ allow women who have undergone mastectomies to remain in the hospital for 48 hours after surgery; and
¥ transfer oversight of HMOs from the Department of Corporations (DOC) to a newly created agency that will focus on regulating the managed care industry. The DOC, which oversees the securities industry, has been criticized for not having enough expertise in health care. Republicans want the new regulator to be appointed by the governor; Democrats want a full board with diverse interests.
Other Democrat proposals include giving patients the right to choose their own doctor, requiring second opinions, and protecting the confidentiality of medical records.
Many Republicans appear willing to go further than the governor in support of new regulations, but say they want to stay away from mandates that could drive up premiums, such as a plan to require HMOs to pay for contraception for women.
Sacramento Bee, Sacramento, CA, Feb. 3, 1998
Missouri considers broadening attorney general review of nonprofit hospital sales and mergers
JEFFERSON CITY, MO As Attorney General Jay Nixon nears a decision on the pending $309 million sale of St. Louis University Hospital to Tenet Healthcare Corp., the second largest for-profit hospital chain, legislators are considering proposals to broaden the attorney general's authority in reviewing sales or mergers of nonprofit hospitals.
A bill by Sen. Betty Sims would formalize procedures under which the attorney general reviews such transactions. The reviews would focus on three broad questions: whether the price offered for the nonprofit entity is fair, whether the transaction involves no conflicts of interest and whether the proceeds will be used in keeping with the purposes spelled out in the nonprofit entity's charter.
The attorney general would have 60 days to approve or reject a sale. Sales also would be cleared by the Missouri Department of Health and there would be an appeal process for consumers and others who might oppose the sale.
Consumer health advocates in Missouri say they are worried that the poor and uninsured would not receive the same level of care if Tenet acquires the hospital. Under a bill sponsored by Sen. Franc Flotron, a for-profit buyer would not have to offer any more medical services than is specified in the nonprofit hospital's charter . Mr. Flotron said he wants to prevent the attorney general from trying to shake somebody down in return for approving a sale.
St. Louis Post-Dispatch, Feb. 2, 1998, Jan. 28, 1998
Medical directors accountable to state board of medical examiners, Arizona Supreme Court rules
PHOENIX edical directors of insurance companies are accountable to the Arizona Board of Medical Examiners, the Arizona Supreme Court has ruled.
The state Supreme Court upheld a decision against Blue Cross and Blue Shield of Arizona which challenged the right of the medical examiners board to discipline its medical director. The case revolved around the insurer's refusal in 1992 to pay for a Phoenix woman's gallbladder surgery.
The medical examiners board tried to discipline Dr. John Murphy, Blue Cross medical director, for his decision not to approve surgery of the diseased gallbladder. Blue Cross argued that the board lacked the authority to review its decisions.
Arizona Republic, Phoenix, AZ, Jan. 26, 1998
New Jersey health plan fined for canceled surgeries
TRENTON, NJ Backed by its new HMO regulations, the New Jersey Health Department fined First Option Health Plan at least $200,000 when patient surgeries were canceled as a result of contract disputes with anesthesiologists.
When anesthesiologists refused to sign contracts which called for an average 22% reduction in fees, operations scheduled at two hospitals were canceled, the state said.
First Option's actions resulted in the disruption of physician-patient relationships, disruption of services, continuity of care problems, as well as undue inconvenience and stress to its members with surgical needs who were already under significant pressure, Health Commissioner Len Fishman said in a letter to First Option officials. First Option was acquired in January by Foundation Health Systems of California.
The head of the New Jersey State Society of Anesthesiologists said the dispute caused at least a couple dozen operations to either be canceled, temporarily postponed, or moved to other hospitals in recent weeks. He said the reduction in fees for Medicare and Medicaid HMO patients was considerably higher than 22%.
The Record, Hackensack, NJ, Jan. 23, Jan. 24, 1998
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles
both enjoyable and insightful. For information on new subscriptions, product
trials, alternative billing arrangements or group and site discounts please call
800-688-2421. We look forward to having you as a long-term member of the Relias
Media community.
