State News

Sutter Health and a group of physicians will pay the federal government $46 million to settle allegations that they violated the Stark law by billing Medicare for services provided by professionals with whom the entities had improper financial relationships, reports Modern Healthcare. This is the second federal settlement by Sutter this year – In April, Sutter and several of its affiliated medical foundations agreed to pay $30 million to resolve allegations that the foundations submitted inaccurate information about the health status of Medicare Advantage enrollees, resulting in plans and providers being overpaid.

The Hospital-Acquired Condition Reduction Program did not improve patient safety in Michigan beyond existing trends, according to an independent evaluation published in Health Affairs. While rates of all hospital-acquired conditions declined from 133 per 1,000 discharges in the pre-program period to 122 in the post-program period, greater improvements were observed for non-targeted measures.  

Maryland legislators announced that the Health Education and Advocacy Unit within the Consumer Protection Division of the Office of the Attorney General closed 1,974 cases in Fiscal Year 2019 and assisted consumers in saving or recovering almost $2.5 million. The Annual Report on the Health Insurance Carrier Appeals and Grievances Process estimates that when consumers seek assistance from the Health Education and Advocacy Unit, carrier denials are overturned or modified over 50 percent of the time. 

Connecticut’s state comptroller and Office of Health Strategy are developing a “healthcare affordability standard” to calculate how much money individuals and families in the state must earn in order to afford healthcare without compromising other basic needs, like food and housing, reports Hartford Business. According to officials, understanding the threshold at which healthcare becomes unaffordable is vital to creating sound policies. The tool is anticipated to launch in Spring of 2020. 

Florida likely suffered the second-highest total of deaths attributed to not expanding Medicaid —2,776 between 2014 and 2017— trailing only Texas, which has an estimated 2,920 deaths, according to a report from the Center on Budget and Policy Priorities. A bill to expand Medicaid with work requirements is making its way through the legislature, but advocates fear its chances are slim, an analysis from the Miami Herald states. Legislators in the state have already shortened the time period Medicaid can retroactively pay for hospital bills and criticized the costs of Medicaid for people with disabilities. 

The Delaware Division of Public Health announced updates to its My Healthy Community data portal, which delivers neighborhood-focused population health, environmental and social determinant of health data to state residents. Data indicators in areas like community safety, maternal and child health, healthy lifestyles and health services utilization help users understand and explore the factors that influence community health. Additionally, the data collected aids Delaware's efforts to bring transparency to healthcare spending and to set targets for improving the health of Delawareans.

As the need for mental health treatment in Missouri grows, patient advocates say the state’s refusal to enforce mental health parity may worsen barriers to access, according to KCUR. Missouri remains one of the last holdouts in the battle against the federal Mental Health Parity and Addiction Equity Act, which requires insurers to cover mental healthcare no differently than treatment for physical conditions. The federal government intended for states to enforce the law, passed in 2008, but Missouri officials insist they lack the authority. Every other state, except for Oklahoma, actively upholds the law.

As the need for mental health treatment in Missouri grows, patient advocates say the state’s refusal to enforce mental health parity may worsen barriers to access, according to KCUR. Missouri remains one of the last holdouts in the battle against the federal Mental Health Parity and Addiction Equity Act, which requires insurers to cover mental healthcare no differently than treatment for physical conditions. The federal government intended for states to enforce the law, passed in 2008, but Missouri officials insist they lack the authority. Every other state, except for Oklahoma, actively upholds the law.

Using methodology developed by HHS’ Office of the National Coordinator, a New York eHealth Collaborative (NYec) analysis revealed that the use of the Statewide Health Information Network for New York is reducing unnecessary healthcare spending in the state by $160-$195 million annually. The analysis estimates that were the network to be fully leveraged across all current participants, the state could save almost $1 billion annually by avoiding duplicative testing, avoidable hospitalizations and readmissions and preventable ED visits if current participants alone were to continue using the system’s full capabilities.