State News

A volunteer program in Maine that provides transportation to patients who would otherwise not be able to attend their healthcare appointments may serve as a good model for other states, according to a study in Preventing Chronic Disease. The Kennebec Valley Community Action Program consists of 93 volunteer drivers, who are reimbursed for mileage with Medicare and Medicaid dollars, in addition to a staff of drivers and office staff members to address the need of rural residents without access to transportation. The program’s volunteer training and recruitment process and coordination between volunteers and patients provide a model for rural communities to fill in gaps in transportation access.

Delaware, Maryland and Louisiana laws implementing out-of-pocket price caps for expensive specialty drugs reduced patient spending on these medications by $351 per month, according to a study published in The New England Journal of Medicine. Although the laws resulted in a 32 percent decrease in spending for patients in need of these drugs, they did not lead to any changes in health plan spending per patient. The study highlighted that health plan spending for specialty drugs has increased from approximately 26 percent of total drug spending to 49 percent in the past 10 years, even though these medications make up less than 2.5 percent of prescriptions overall

New York is cracking down on healthcare providers who may be charging patient fees for personal protective equipment and other charges related to increased costs from the coronavirus, reports the Times Union. The state’s Department of Financial Services issued new guidance for health insurers to protect patients from being improperly charged with these equipment fees, with the governor citing the financial burdens this practice places on patients. The guidance notes that a participating provider should not charge patients fees or other charges in addition to the patient’s financial responsibility for covered services nor should insurers cover the charges. The state financial department has received complaints of healthcare providers, particularly dental providers, charging these patient fees, which are passed to patients’ insurers and go beyond the patient’s applicable cost-sharing. Among other things, state officials are asking insurers to immediately notify participating providers not to charge PPE fees and patients should be held harmless for these charges.

While some Oklahoma hospitals have suspended or pulled back on filing lawsuits against their former patients in light of COVID-19, others are continuing with business as usual, according to Oklahoma Watch. At least 1,178 lawsuits were filed since the governor declared a statewide health emergency on April 2. In the bulk of those cases, hospitals have sought to collect anywhere from a few hundred dollars to more than $10,000. Although the vast majority of bills stem from hospital visits that occurred during or before 2019, patient advocates point out that the lawsuits are ill-timed as many families are struggling financially during the pandemic.

A new New Jersey law imposes a 2.5 percent tax on health insurance companies in order to help subsidize individual marketplace premiums, reports NJ.com. The Department of Banking and Insurance will levy the tax based on the amount of money insurance companies collect in premiums. The proceeds – estimated at about $200 million – will be deposited into the Health Insurance Affordability Fund and used to subsidize the cost of insurance for people who earn no more than four times the federal poverty level. An estimated $77 million of the tax money will bolster the state’s existing reinsurance program to cover high-cost claims and lower premium costs in the individual market.

Nearly half of Wisconsin residents in a federal survey say that they have put off medical care because of the COVID-19 pandemic, reports the Wisconsin Examiner. In addition, more than one in five are concerned about someone in their household losing a job or having their hours cut, according to the U.S. Census Bureau’s weekly survey. The impacts of the COVID-19 crisis have impacted not just access to healthcare, but also housing and employment security.

Two large, highly integrated health systems in California’s Central Coast are using their market leverage to obtain higher reimbursements from private insurers, raising the overall cost of care, reports New Times. Data from the California Office of Statewide Health Planning and Development revealed that the two systems made three times more revenue on privately insured patients than they did on Medicare patients in 2018. In 2017, prices charged by hospitals affiliated with the systems were five- to nine-times higher than what Medicare determined their costs to be—bigger markups than most hospitals in the state. High prices, combined with a lack of alternatives, make it difficult for local patients to afford needed care. 

Coloradans with individual health insurance plans can expect to save an average of 17.4% on their premiums in 2021, reports the Colorado Division of Insurance. In addition, two of the eight insurance companies that offer plans on the individual market will expand into new counties in the state. Colorado is one of fourteen states with a state-based reinsurance program, which works by paying a portion of high-cost claims so insurers can charge lower premiums for individual health plans. Recently passed legislation in Colorado has extended the reinsurance program for another five years.

A new Virginia law protects patients and their families from receiving surprise medical bills by setting up a good faith arbitration process for resolving billing disputes between insurers and providers, according to WHSV. The law prohibits balance billing for out-of-network emergency services and certain non-emergency services at in-network facilities.