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.
Through a unique partnership between Iowa Medicaid and public health agencies, Iowa’s I-Smile program addresses the disproportionate impact of dental disease on low-income individuals, reports the National Academy for State Health Policy (NASHP). I-Smile, and its related I-Smile @ School for children and I-Smile Silver for adults, help promote preventive oral health services and reduce barriers to dental care across the state. I-Smile primarily targets the 47 percent of Iowa children ages 0-12 who are enrolled in Medicaid to provide dental care and disease detection early in life and limit costly, preventable dental procedures. Additionally, given the link between mothers’ oral health and their infants’, I-Smile also serves pregnant women.
A COVID-19 patient from rural Kansas received an $80,000 medical bill after his insurance company declined to pay for the air ambulance needed for him to receive treatment, reports KCUR. While the insurer eventually covered the bill, the situation shed light on widespread confusion over patient protections in light of COVID-19. The current patchwork of federal laws, state laws and company policies mean patients may well be shielded from COVID-related medical bills, but they will likely have to figure out which protections apply to them and push to assert their rights.
Tennessee was one of 21 states to temporarily suspend scope-of-practice requirements in an effort to expand access to care during the coronavirus pandemic, according to the American Association of Nurse Practitioners. The order, which lapsed on May 18, cleared the way for nurse practitioners to write prescriptions without consulting a physician, waived a requirement for chart review and waived a requirement that a supervising physician visit remote sites every 30 days, among other things. Nursing groups have pushed the governor to extend the executive order.