State News

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.

Complaints made to the State of Texas about surprise medical bills are down more than 95 percent since a new law took effect this past January, according to News 4 San Antonio. However, authors note that only 20 percent of Texans are protected by the surprise medical bill law because it applies to insurance regulated by the state. Under the new law, medical providers and insurance companies can go to arbitration to settle price disputes.

The Michigan Department of Health and Human Services (MDHHS) is launching the We Treat Hep C Initiative to bring down the cost of hepatitis C medication for the state’s Medicaid program and the Michigan Department of Corrections, according to Upper Michigan Source. The agency will seek proposals from Direct-Acting Antivirals (DAA) manufacturers to provide a significant discount to these programs. In return for this discount, the product will be the preferred DAA for Medicaid and MDOC, with minimal prior authorization requirements.
 

Integrating health and social services is increasingly important, particularly as patients with complex needs cope with the COVID-19 pandemic. A case study by the Commonwealth Fund describes how a nonprofit in Snohomish County, Washington, partnered with a Medicare Advantage plan to provide care coordination and social services – like home-delivered meals and medically related transportation – as a cost-saving intervention for the plan’s high-need, high-cost members. The process offers insights about how to integrate health and social services in a financially sustainable way.

The Governor of Pennsylvania announced that Pennsylvania’s Section 1332 Waiver application for a reinsurance program has been approved. Pennsylvania’s Reinsurance Program is authorized to operate under section 1332 of the Affordable Care Act (ACA) from 2021 through 2025. “By having a reinsurance fund that will directly pay some of the healthcare costs for high-cost individuals, we can lower premiums for other insured Pennsylvanians on the individual market and reduce the cost for subsidies to help low-income individuals,” the governor said.

New Hampshire has enacted a new law that greatly expands how care providers in the state can use telehealth, reports mHealth Intelligence. The new law amends the state’s definition of telemedicine to include new modalities, like audio-only phones, and requires Medicaid and private payers to reimburse for telehealth services at the same level as in-person care. The law makes several telehealth expansions passed by emergency measures due to the COVID-19 crisis, such as reimbursement parity and the ability for providers and patients to collaborate on care via telephone, permanent.

The Connecticut General Assembly passed legislation that will cap the monthly cost of insulin, supplies and emergency insulin for people with insurance, according to the CT Examiner. Beginning Jan. 1, 2022, the maximum monthly out-of-pocket cost for insulin will be $25, while non-insulin medication and devices/equipment will cost $25 and $100, respectively. Additionally, anyone with diabetes will be eligible for a 30-day emergency supply of insulin at any pharmacy in the state one time per year. The law is a major win for roughly 25 percent of patients with diabetes who report rationing insulin because of cost.