State News

The transition from hospital fee-for-service to a population-based revenue system in Maryland is proceeding successfully, according to a Health Affairs Blog. The state’s Medicare savings performance in 2019 was the best since hospital global budgets were implemented in 2014. COVID-19 has provided an unforeseen stress test, which the state responded to with swift collaboration and communication with the Centers for Medicare and Medicaid Innovation, hospitals and other stakeholders, to ensure they could fulfill the promise of guaranteed level of revenue without dramatically increasing prices for payers, employers and consumers. COVID-19 has shown the weaknesses of the fee-for-service payment model, while Maryland’s Total Cost of Care model has allowed hospitals to fare relatively well during the pandemic.

Fees levied on insurers and patients for health services provided in hospital-owned facilities in Connecticut totaled $437.2 million last year, reaching their highest level since the state began tracking the charges in 2015, according to the Harford Business Journal. The increased revenue generated from the fees was partially driven by an 11.4 percent increase in the number of patient visits subject to a facility fee, with digestive-system and cardiovascular procedures generating more fee revenue than other service categories across the state. The average facility fee was $147 for visits billed to Medicaid, $213 for visits billed to Medicare and $426 for visits billed to commercial insurers. It is not clear what portion of the facility fees commercially insured patients ended up paying, compared to their insurer.

Starting in December 2020, low-income immigrants age 65 and older in Illinois will be eligible for Medicaid-like coverage, regardless of immigration status, reports the Chicago Tribune. Initially, between 400 and 2,000 people are expected to sign up for the program, which was part of the state budget passed earlier this year. An unpublished study by Rush University Medical Center shows the 75 to 85 age group without legal immigration status should increase elevenfold in the next 10 years. Currently, undocumented older adults are being served by a patchwork of organizations that are having to make exceptions to find solutions to help patients that would otherwise go without needed services. Advocates hope this program will provide preventive care benefits and provide a safety net that is currently inaccessible to this population. 

The Governor of Pennsylvania signed an executive order to set up new councils in an effort to control healthcare costs, improve access to medical care and address treatment disparities, reports the Pittsburg Post-Gazette. The Governor also plans to create five Regional Accountable Health Councils to develop ways to reduce disparities in the healthcare system and promote the purchase of healthcare services based on the highest value to the consumer. The Governor will also work with the state legislature to create a Health Value Commission, charged with keeping healthcare payers and providers accountable for spending growth and ensuring the long-term affordability and sustainability of the healthcare system by setting spending benchmarks.

The Ohio Department of Medicaid seeks to update its managed care setup with a focus on population health, meeting the needs of children with complex needs and reducing administrative hurdles for patients and healthcare providers, according to Health Policy Institute of Ohio. The state has invited privately operated managed care organizations to submit applications. These changes are the result of comments provided by beneficiaries, physicians, hospitals and other healthcare providers. Many highlighted concerns with the current system that forced families with children in need of intensive and costly services to relinquish custody for their children to be eligible for Medicaid. Under the plan, Ohio Rise, some youth would qualify for modified eligibility requirements, allowing them to receive assistance while remaining in their family’s custody

California will join 28 states that allow nurse practitioners to practice independently, in an effort to address workforce shortages creating barriers to care, according to The Sacramento Bee. The new law will allow nurse practitioners to open their own practices after a three-year period of operating under a doctor’s supervision, beginning in 2023. The state’s Board of Registered Nursing will establish a commission to oversee implementation and practice requirements, including nurse practitioners’ obligation to notify patients that they are not physicians.

Citing challenges to addiction treatment access in Colorado, a new state program has transformed six RVs into mobile clinics to reach isolated communities, reports Kaiser Health News. As brick-and-mortar addiction clinics have closed or stopped taking new patients due to COVID-19, these mobile clinics have become more crucial to rural residents seeking addiction care. Each RV has a nurse, a counselor and a peer specialist who has personal experience with addiction. And because broadband access is often limited in rural areas, these RVs provide a telehealth bridge to medical providers in cities, so that rural residents can be prescribed medicine to fight addiction and overdose. 

California’s governor signed legislation meant to bring down the cost of prescription drugs for taxpayers, employers and consumers, according to a press release from the governor’s office. The first-in-the-nation law tasks the California Health and Human Services Agency (CHHS) with developing manufacturing partnerships to produce or distribute generic prescription drugs, thereby increasing competition in markets that have driven up prices for consumers and helping address critical drug shortages. CHHS will focus on manufacturing drugs that could produce the biggest cost savings and will submit a report to the legislature analyzing how its efforts have impacted competition, access and costs for those drugs.

Virginia decisionmakers announced more than $8.4 million in community development block grants for 14 projects to help rural communities in Virginia, according to CBS 19 News. The funding can be used to help with COVID-19 response and recovery activities including, but not limited to: acquisition costs for telework or telemedicine services; business assistance for job training or re-tooling business services to reopen and adapt in a new environment; and construction or rehab of structures for shelters. For example, Wise County is using the funding to partner with Lunchbox276 to expand food programing options for approximately 500 children and families.