State News

A 2013 payment reform implemented by Oregon’s Medicaid program was associated with a 42.4 percent relative reduction in traditional primary care services—driven primarily by decreased use of imaging services, according to Health Affairs. The payment reform changed the Medicaid program’s reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. The authors stated that Oregon’s initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.

Despite state and federal requirements that health plans must cover a wide range of costs related to COVID-19 testing and care, New Jersey hospitals say they aren’t being properly paid, reports NJ Spotlight. Thirty acute care facilities in the state reported that more than 1,000 claims related to COVID-19 patients were denied by various health insurance companies between March and the end of June, according to the New Jersey Hospital Association. In half of the cases, the company questioned the medical necessity of the treatment. One hospital alone reported nearly 1,500 denials related to testing services, regardless of the requirements that these services be covered.

A $2.5 million grant for American Indian and Alaska Native students in the Montana State University College of Nursing will be used for Montana Advantage Nursing Scholarships, reports MSU News Service. These scholarships aim to increase American Indian and Alaska Native enrollment and graduation rates by reducing financial barriers. The ultimate goal is to achieve health equity for these populations by increasing the number and quality of American Indian and Alaska Native nurses and primary care providers who are educated to deliver culturally sensitive healthcare services to their communities in remote and rural settings, as well as urban areas. The grant, from the Health Resources and Services Administration of the U.S. Department of Health and Human Services, will be distributed over five years.

PhRMA, the drug industry lobbying association, sued the state of Minnesota over a newly enacted law meant to prevent people who cannot afford their insulin from rationing it, reports STAT News. The Alec Smith Emergency Insulin Act allows Minnesotans who would otherwise forgo their insulin to immediately pick up a 30-day supply of the drug from a pharmacy for $35, while drug makers would be forced to provide the insulin for free or face hefty fines. PhRMA is seeking a permanent injunction that would prevent the law from going into effect.

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.