State News

An analysis conducted by the Henry J. Kaiser Family Foundation found that Kentucky has one of the lowest rates of surprise medical billing in the nation, reports Louisville Business First. The state has the eighth lowest rate for inpatient hospital stays and ninth lowest rate for emergency room visits with unexpected out-of-network charges in 2017, at 7 percent and 8 percent respectively. However, unlike other states, Kentucky lacks protections for residents who receive surprise medical bills as of 2019.

Hospitals in Wyoming charged private insurance plans more than three times what Medicare would pay for the same care in 2017, according to a national study that looked at 14 hospitals in the state and nearly 1,600 facilities statewide, according to the Casper Star Tribune. Of the 25 states studied, Wyoming had the second-highest disparity between Medicare and private insurance for outpatient services: Private plans were charged 302 percent more than Medicare, a difference of $8 million. Only Indiana had a higher disparity. SageWest Health Care in Fremont County had the highest relative price in the state: The hospital charged private insurance more than eight times what the facility was paid by Medicare. Representatives of the Wyoming Hospital Association responded to the report suggesting that Medicare “doesn’t pay the actual cost of delivering care,” and therefore should not be used as the “measuring stick.”

A study that examined the network adequacy in New York State provides an overview of hospital network size and quality in the commercial, Medicaid, and NY State of Health markets, according to the New York State Health Foundation. The report found that some New York State regions offer residents access to primarily low-quality hospital networks, that differences exist in network size both within and across plan-product lines and there is a weak correlation between network quality and size. This project demonstrated that it is possible to measure health plan hospital network quality using publicly available sources.

Texas has passed a law shielding patients from getting a huge bill when their insurance company and medical provider can’t agree on payment, according to Kaiser Health News. Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment, removing patients from the middle of payment negotiations. Last year, a Kaiser Family Foundation poll found that 67 percent of people worry about unexpected medical bills — a larger share than those who say they worry about prescription drug costs or basic necessities such as rent, food and gas. Commonwealth Fund’s most recent report on the issue found about half of states offer some legal protections from surprise bills, but only six states had laws that provide “comprehensive” consumer protections similar to those just passed in Texas.

Gaps in local health partners’ knowledge of available Medicaid services for homeless individuals and underuse of Medicaid reimbursements by qualified homeless individuals exhibit opportunities to reduce the healthcare costs associated with homelessness, according to KTVQ News. The Montana Healthcare Foundation report highlights that by targeting individuals in need of supportive housing intervention and aligning Medicaid funding for critical housing services, communities can realize cost savings and better health outcomes.

A new Maine law requires any private payer to cover any telehealth services that that would cover in person, based on six conditions outlined by the law. According to mHealth Intelligence, the bill also allows reimbursement for healthcare providers who use phone-based telehealth when scheduled telehealth services are technologically unavailable at the time of the scheduled telehealth service for an existing enrollee and the telephonic services are medically appropriate for the corresponding covered health care services. This new piece of legislation opens the door to more remote patient monitoring programs. 

State regulators approved two major hospital mergers and acquisitions under the condition that the organizations agreed to healthcare cost price caps tied to the Consumer Price Index, reports the Hartford Business Journal. This type of agreement is a first for Connecticut and one of the most stringent cost controls ever placed on hospital combinations in the state. Compared to states like Massachusetts and Rhode Island, Connecticut’s caps are relatively modest. Nevertheless, they are an important protection against rising healthcare costs, which have historically increased with consolidation

Alaska placed 30^th on The Commonwealth Fund’s 2019 health system scorecard, ranking states on access to care, cost of care and overall health outcomes, reports State of Reform. The state performed favorably in the areas of “healthcare disparities” and “avoidable hospital use and cost” – 14^th and 8^th in the nation, respectively. Alaska performed less favorably in “prevention and treatment” (38^th), “healthy lives measurements” (36^th) and “access and affordability” (39^th).

Minnesota lawmakers have extended to 2023 a moratorium that blocks the state’s nonprofit HMOs from being sold to for-profit companies, according to The Star Tribune. The measure was first adopted two years ago as a temporary measure to block conversion transactions, as lawmakers were concerned that nonprofit assets could wrongly be shifted to investor-owned carriers in a merger or acquisition.