State News

Illinois Blue Cross Blue Shield members are having trouble finding in-network doctors due to a “ghost network,” reports WCIA. A “ghost network” refers to an insurance company’s inflated patient directory that over-promises and under-delivers on the number of providers who are actually available. While the company denies these claims, a thorough review of the company’s directory reveals that many doctors are not actually in-network, are not available, not taking new patients, and are located too far away, contrary to the directory. The complications arose after the insurance company escalated a contract dispute with Springfield Clinic and kicked all 650 of its providers off the Blue Cross Blue Shield network; patients who cannot find in-network care through the incorrect directory must shoulder high out-of-pocket costs to continue to see their providers. Those who cannot afford to do so may discontinue their care, with dire health consequences. 

The Ohio Department of Health is awarding 15 contracts for 136 new or expanded school-based health centers throughout the state, according to the Office of the Governor. The clinics will provide primary care and preventative care, including vision, dental and behavioral health in school settings. These clinics will eliminate many barriers to obtaining care, such as transportation, child time out of the classroom, parents missing time at work and a lack of provider or medical home. These clinics have emerged as effective models to improve student access to healthcare and have helped close the gap for children in underserved communities. 

Following the highly publicized death of a Black doctor named Susan Moore, who alleged racist treatment at a hospital before dying of COVID-19, Indiana’s five major hospital systems are collaborating to create a dashboard tracking racial disparities in patient care, according to the Indy Star. The dashboard currently includes data on diabetes care and will later expand to infant mortality and mental health, although it is unclear when the dashboard will be available to the public.

Pennsylvania’s state-based health insurance marketplace has added a new qualifying event that will allow low-income households to enroll in health insurance plans at any time, according to the . Rather than being restricted to regular open enrollment period in the Fall-Winter, residents with a household income at or below 150% of the federal poverty level will automatically get a qualifying event to start coverage or change their current plan. This is intended to make it easier for low-income residents to stay and get covered.

Nevada will join the Northwest Prescription Drug Consortium for prescription drug purchasing, according to the Las Vegas Review-Journal. Once the state joins, all state residents can get a free discount program card and can use whichever pharmacy benefit provides the best price, regardless of their existing coverage or insurance status. The consortium, called ArrayRx Solutions, is coordinated by Oregon and Washington, and enables participating states to combine their drug purchasing power to lower costs and negotiate and establish discounts for consumers.

Lifespan and Care New England Health System scrapped merger plans amid federal and state opposition, according to Modern Healthcare. Lifespan and Care New England decided not to appeal after the Federal Trade Commission and Rhode Island Attorney General sued to block the deal last week, claiming it would increase prices, reduce quality and stifle wages. The healthcare systems are the two largest providers in Rhode Island and together they would have controlled most of the general inpatient care, outpatient surgery and inpatient behavioral healthcare in the state.  

Michigan's governor signed a series of pharmacy benefit management (PBM) reforms into law, according to Fierce Healthcare. The legislation prohibits PBMs from preventing pharmacists from telling consumers it's less expensive to purchase drugs out-of-pocket, and will require PBMs to file transparency reports telling consumers about the backend costs and profits of their medications, among other provisions.  

None of the 12 hospitals analyzed in New York City and Long Island were in full compliance with federal price transparency regulations, reports the Gothamist. A recent report from Patient Right Advocate reveals that just 14 percent of the 1,000 hospitals surveyed across the U.S. were in full compliance with the regulations. While many New York City hospitals complied with certain aspects of the new federal rule mandating hospital price transparency, many have left out certain key information. Some hospitals, like Mount Sinai, left out its discounted cash prices, but included a complete list of rates it had negotiated with health plans, while others missed the mark by a lot more. Numerous hospitals in New York City have not posted the rates that they charge insurers, while some included negotiated rates for just some insurers, but left others out.

The New Mexico legislature will hold a hearing on uninsured patients' hospital charges following the passage of HM 36, according to NM Together for Healthcare. The legislation also asks the Human Services Department to report to the legislature on how hospitals are using public funds designated for the care of low-income, uninsured patients.