State News

Indiana's nonprofit hospitals are charging prices well above the national average and producing profit margins far above other states, according to a Wall Street Journal editorial. Indiana University Health and other large nonprofit hospitals in particular are charging far above the national average, while small, independent and rural hospitals are charging below the national average. State legislators have called for Indiana hospitals and insurers to present a plan that will reduce hospital prices to the national average within three years, otherwise they will pursue legislation to reduce prices. 

Maine’s governor announced the launch of a pilot project to mail 125,000 free COVID-19 tests directly to the homes of Maine residents most in need, according to the Office of the Governor. The state is partnering with the Rockefeller Foundation to provide 25,000 Maine households five at-home rapid tests for free. Households in rural ZIP codes and ZIP codes that are the most socially vulnerable, based the Centers for Disease Control and Prevention’s social vulnerability index, are eligible for the free tests. 

Massachusetts' largest and most expensive hospital system is seeking to expand, spotlighting quesitons about whether such expansions by big health systems are driving up healthcare costs, reports Fortune. Mass General Brigham, which owns 11 hospitals in the state, has proposed a $2.3 billion expansion, which includes a significant expansions. The most controversial element, however, is the plan to build three ambulatory care centers, offering physician services, surgery and diagnostic imaging, in three suburbs west of Boston. Massachusetts' Health Policy Commission unanimously concluded that these expansions would drive up spending for commercially insured residents by as much as $90 million a year and boost health insurance premiums. The Commission also ordered the health system to develop an 18-month performance improvement plan to slow its cost growth.   

In North Carolina, nonprofit hospitals billed low-income patients who would otherwise be eligible for charity care at a higher rate than the national average, reports Wilmington Biz. A report by the North Carolina State Treasurer’s office shows that only 18 of the state’s 105 nonprofit hospitals reported actual dollar figures for bad debt—debt that the hospital cannot recover—incurred by patients eligible for charity care. Of those 18 hospitals, the average share of eligible charity care to bad debt is 29 percent, nearly three times the national average. In addition, hospitals attributed an estimated 12 percent to nearly 29 percent of their bad debt to patients otherwise eligible to receive charity care. Furthermore, the study’s authors cast serious doubts on the accuracy of hospitals’ reporting practices that show all patients eligible for charity care received it, as those hospitals are in counties with relatively high poverty rates.

For the first time, the Massachusetts Health Policy Commission has taken action on a hospital system in an attempt to rein in healthcare costs, reports Axios. The Commission is requiring Mass General Brigham (a dominant, tax-exempt academic hospital organization with $16 billion of annual revenue) to submit a plan to lower rising costs that stem from the system's expensive care. Indeed, the Commission claims that the system's high prices (the highest in the state) and market power has led to residents paying a lot more in health insurance premiums and taxes, and that the high spending will impat the state's ability to meet their benchmark of lower cost growth. The system has 45 days to submit a performance improvement plan explaining how it will address the underlying causes of its high costs. If they fail to do so, the Commission may levy a $500,000 fine.  

The Massachusetts Health Policy Commission unanimously voted to issue a performance improvement plan to Mass General Brigham, reports Modern Healthcare. Mass General Brigham is the largest health system in the state and has spent $293 million in excess of Massachusetts’ cost growth benchmark from 2014 to 2019. The main driver of this spending growth was prices and its payer mix, rather than utilization. This is the first time the Health Policy Commission has used this power, and the system has 45 days to provide a performance improvement plan, request a waiver or apply for an extension.    

A group of retired Illinois educators is suing the state over what they say is a diminishment of promised benefits, reports the Center Square. The state is reducing what taxpayers pay for retired teachers’ healthcare by around $100 million per year, starting in July 2022. The group believes that reduced state contribution would mean increased costs for retired teachers and claims that their actuary has said that the fund would be depleted in anywhere from one to four years. 

Patients who take re-exposure prophylaxis (PrEP), a medication that prevents HIV, should not be paying anything out of pocket for the drug or any of the associated costs, yet that is not the case for many, reports Axios. Peter Sacco described copays he received for clinic visits and lab work associated with monitoring his health for his PrEP prescription. Federal officials told insurers there should be no copays for baseline and monitoring services for PrEP, yet when Sacco appealed his $130 bill for such services, his insurer denied the appeals.

New legislation in New Jersey will require insurers to reimburse healthcare providers for telehealth and telemedicine services at the same rate as in-person services—originally enacted at the outset of the COVID-19 pandemic— with limited exceptions for the next two years, reports the Governor’s Office. The legislation also charges the state’s Department of Health with conducting an in-depth study of the use of telehealth and telemedicine and the effects on patient outcomes, quality and satisfaction and access to care in order to inform future decisions on payment structure for these services. The extension includes a requirement that audio-only behavioral healthcare services are reimbursed at the same rate as in-person services and prohibits insurance carriers from imposing geographic or technological restrictions on the provision of telehealth services, as long as they meet the same standard of care as if they were delivered in-person.