State News

New Mexico has launched a new partnership between the state Attorney General, Auditor, Ombudsman, and Department of Health and Adult Protective Services to increase accountability and the standard of care for individuals in nursing homes and long-term care facilities, according to a press release from the Office of the Governor. The partnering organizations will review data and investigate complaints about fraud and abuse, as well as charge civil penalties and prosecute as needed. These efforts are intended to strengthen financial transparency and protection of the elderly.

The Washington Health Alliance released its second Community Checkup report in 2020 on the quality of healthcare in Washington state. In addition to other features, the report includes a new Quality Composite Score that combines up to 29 Community Checkup measures to make it easier to compare the quality of healthcare being delivered across the state and by different provider groups. While the composite score provides a more streamlined and nuanced understanding of care quality on primary care measures endorsed by Alliance members, it does not provide an understanding of other important factors, such as cost, patient experience, and care disparities. As the work of the Alliance continues, the Quality Composite Score may evolve to incorporate and measure these important aspects of healthcare.

The Oregon Health Authority released the 2019 CCO Metrics Report, which shares the results of Oregon’s pay-for-performance quality incentive program for its coordinated care organizations (CCOs). This report shows CCO performance across three categories of measures: CCO incentive metrics, state quality metrics and CMS core metrics. For example, in 2019, nine of 15 CCOs improved on the use of emergency departments among members with mental illness. However, asthma as a cause of hospital stay increased almost 12 percent at the statewide level in 2019. 

The Maryland Health Department has convened an inter-agency task force aimed at reducing the COVID-19 positivity rate in Hispanic communities, reports WTOP and Maryland Matters. The Hispanic Outreach Task Force will look to provide support to Baltimore City to connect underserved Hispanic communities to social services, prevention tactics, isolation housing, educational materials and contact tracing. The task force will also experiment with an intervention program that would provide financial assistance, medical care, isolation, food and other services for families who have tested positive.

Beginning in 2021, pregnant Black and Pacific Islander women in San Francisco will get a $1,000 monthly supplement during and up to six months after their pregnancy in a first-of-its-kind initiative meant to help improve health outcomes for both mom and baby, according to ABC News. The initiative aims to reduce disparities in premature births and maternal deaths among Black and Pacific Islander mothers (compared to white mothers), resulting from a lack of access to quality healthcare, income inequality issues and systemic racism. The supplements will be paid for through private donations and some public funding and will come without any restrictions on how the women spend the money.

The Orangeburg County School District has developed a mobile application that can link its students and their families with telehealth services, reports the Times and Democrat. The district partnered with Palmetto Care Connections, a nonprofit telehealth network and two practices to create the SMART (Students’ Medical Access to Resources in Telehealth) Virtual Health Collaborative. Under the initiative, the app now appears on all district-issued devices and leads to a webpage of telehealth providers. Students and families can also begin accessing telehealth services through the district's website.

Proposed legislation in Pennsylvania would allow the state to set payment rates for high-cost prescription drugs equivalent to prices in Canada, where prescription drugs can cost as much as 80 percent less than in the U.S., reports NASHP. This model would reduce prices for 250 high-cost drugs identified by the state, hold drug manufacturers more accountable and result in significant savings for both patients and states. If a drug manufacturer refuses to comply or withdraws their drugs from the market, they will have to pay significant penalties to the state.

The Medical Society of New Jersey has launched a new insurance denial registry for physicians’ offices to help track denials of healthcare services to New Jersey consumers, reports New Jersey 101.5. Until now, there hasn’t been a systematic way of tracing which companies, which procedures and what types of drugs are routinely denied. Understanding the reasons for insurance denials will help physicians get patients the care they need. A spokesperson for the Medical Society of New Jersey explained that such denials disrupt patient care and office workflow, and they expect many physicians' offices to contribute data.

A legislative effort to curtail surprise medical billing in Michigan has gained attention from national healthcare organizations shifting their focus to states amid stalled federal efforts, according to MiBiz. The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. In emergency situations, the out-of-network provider would have to accept payment that’s the median amount within the region that a health insurer pays an in-network provider or accept 150 percent of what Medicare pays for a medical service, whichever is greater. If enacted, the legislation would require the Michigan Department of Finance and Insurance Services to conduct an annual survey on surprise billing that includes the number of out-of-network billing complaints and the adequacy of insurers’ care networks in Michigan.