Clip file / Local news from the states
Clip file / Local news from the states
Each month, this column features selected short items about state health care policy from publications from around the country.
Connecticut moves to strengthen patient privacy protections
HARTFORD, CT—Connecticut legislators want to "plug the holes" in the state’s medical records regulations that allow drug companies or medical supply companies to solicit patients regarding products directly related to their medical conditions.
"What happens to your medical records is enough to make you sick," said state Sen. Kevin B. Sullivan, the Senate’s top Democratic leader.
Mr. Sullivan said the plan is to provide strict prohibitions on the commercial sale or transfer of any medical records except when specifically authorized by a patient for medical purposes. Lack of congressional action on the issue has left the states to take up the slack, he said. The proposal is slated for the spring 1999 session.
A former head of the Connecticut State Medical Society, Michael Deren, MD, attributed the widespread use of medical information to the blanket medical information release that many health maintenance organizations and insurance companies now require. The release allows far too many people far too much access to those records, he said.
A spokesman for the Association of Connecticut HMOs challenged the need for additional privacy protection. Health insurers and providers also must meet "very strict guidelines [on maintaining privacy] in order to get and maintain accreditation" from national agencies, said association lobbyist Keith J. Stover.
Estimates on the profits made on the use of medical records or the cost of enforcing stricter privacy provisions were not available.
— New Haven Register, Dec. 30, 1998
Clinton backs plan to expand Medicaid for disabled
WASHINGTON, DC—Proposals to help get the disabled back to work by expanding their health insurance options through Medicare and Medicaid received a high-profile boost from President Clinton in his state of the Union address.
Specifics released earlier called for a $2 billion five-year jobs program that would be the most significant legislation affecting the disabled since enactment of the Americans With Disabilities Act in1990.
The centerpiece of the plan is a $1.2 billion "work incentives’’ initiative. It would provide grants to states that allow disabled people who return to work to maintain eligibility for Medicaid. The disabled whose earnings or assets are above federal income limits would be able to buy health insurance through Medicaid. And, for the first time, Medicare coverage would be extended to people with disabilities who return to work.
About 1.6 million working-age adults have a disability that leads to functional limitations, and 14 million working-age adults have less severe (but still serious) disabilities, including the use of a wheelchair, cane, or walker, or a developmental disability. Many of them can work if there is an incentive to do so, advocates for the disabled said. Officials estimated that the proposal could allow tens of thousands to return to work.
The proposal also includes a program that offers Medicaid to people who have physical or mental impairments that are expected to lead to severe disability.
This plan, which would be tested on a limited basis, would include people with muscular dystrophy, Parkinson’s disease, HIV, or diabetes who may be able to function and work with appropriate health care, but who, under current rules, get the care only after their conditions have become severe enough to qualify them for disability coverage, Medicaid and Medicare.
Congressional sponsors of the initiative are Sen. James M. Jeffords (R-VT) and Sen. Edward M. Kennedy (D-MA).
—Boston Globe, Jan. 13
States prefer public providers for behavioral health carve-outs
FAIRFAX, VA—All but four states are implementing some type of managed behavioral health care, according to a tracking analysis by The Lewin Group in Fairfax, VA.
The report, completed for the Substance Abuse and Mental Health Services Administration, documents how state strategies for delivering behavioral health differ by whether state officials are providing care through an integrated plan or through a behavioral health carve-out. When states provide behavioral health through an integrated plan—where such benefits are integrated into physical health benefits—the behavioral health provider most likely is in the private sector. When states carve out behavioral health care services, the providers are more likely to be in the public sector.
Of 53 state mental health and/or substance abuse carve-out plans analyzed in the study, 30 are managed by public sector agencies or public/private partnerships. By comparison, 76% of the integrated plans contract with private-sector organizations for behavioral health.
The dominance of public health providers in the state’s carve-out plans likely "reflects a greater participation of the mental health and substance abuse stakeholders in the process," Lewin senior manager Gail K. Robinson, PhD, tells State Health Watch.
The use of carve-outs appears to have grown in recent years, but Balanced Budget Act provisions mandating choice of provider in public programs may affect that trend, Ms. Robinson says.
"We need to watch very closely how the Balanced Budget Act will be interpreted and implemented," she says.
The report also found that most states placed behavioral managed care entities at risk, even if those organizations are in the public sector. If the providers do not also own the managed care entity, providers are paid fee for service and do not assume risk, the report found.
—Lewin release, Dec. 1, 1998
Contact Ms. Richardson at (703) 218-5602.
Providers sue Ohio officials over failure of Medicaid HMO
COLUMBUS—Physicians and hospitals claiming as much as $15 million in losses from the failure of a Medicaid HMO are suing Ohio officials for inadequate oversight of the plan.
The Ohio State Medical Association and the Association for Hospitals and Health Systems brought the suit in the Ohio Court of Claims over the failure of Personal Physician Care, once the largest Medicaid HMO in Cuyahoga County. It had more than 55,000 subscribers in 1997 and was shut down by the Ohio Department of Insurance in August 1998.
Some providers say that, in addition to the losses they have sustained, they have been asked to return some of what they were paid as part of the company’s liquidation.
The plan also operated in Akron and Youngstown. Among the hospitals financially hit by the closure are Rainbow Babies and Children’s Hospital in Cleveland and Children’s Hospital Medical Center of Akron.
Regulators should have known the health plan was in financial trouble and intervened earlier, the lawsuit alleges.
The state now requires all Medicaid beneficiaries in urban counties (except the disabled) to sign up for a health maintenance plan. The HMO program is voluntary in the rest of Ohio.
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.