Kaiser Daily Health Policy Report
Senate Finance Committee Republicans Outline Plans To Delay Medicare Physician Payment Cut
DHS Immigration Bureau To Start Reporting on Detainee Deaths in Detention Centers
House Panel Hearing Focuses on Health IT Privacy, Cost Concerns
Study Finds Wide Racial, Geographic Health Care Disparities Among Medicare Beneficiaries
South Los Angeles Residents Face Difficulties Receiving Medical Care for Variety of Reasons
Department of Defense, HHS Announce Program To Send Mental Health Care Professionals To Help Soldiers With PTSD
Nearly Three-Fourths of Medicare Drug Plan Beneficiaries Will Pay 16% More for Coverage This Year, According to Analysis
Kaiser Daily Health Policy Report Examines Recent Developments Related to Medicare
Walgreen Agrees To Pay $35M To Settle Allegations of Improper Medication Switches for Medicaid Beneficiaries
Colorado Gov. Ritter Signs 11 Health Care Bills To Increase Access, Expand Coverage
Connecticut Lawmaker Asks Gov. Rell To Delay Implementation of Charter Oak Health Plan
Kansas Health Institute News Service Examines Prospects for Expanding Health Coverage in State
The Latest Reports in Health Policy
Study Finds Health and Wellness Initiatives in Work Place Increasing, Despite Lack of Evidence That They Save Money
Capitol Hill Watch
Senate Approves $3.1T FY 2009 Budget Resolution Without Proposed Reductions in Medicare, Medicaid Spending
[Jun 05, 2008]
The Senate on Wednesday voted 48-45 to approve a $3.1 trillion fiscal year 2009 budget resolution (S Con Res 70), which includes large increases in funds for domestic programs and excludes reductions in funds for Medicare and Medicaid proposed by President Bush, the AP/Philadelphia Inquirer reports.
The resolution would increase funds for domestic federal agencies by almost 5%, or $24 billion (Taylor, AP/Philadelphia Inquirer, 6/5). The resolution includes $1.013 trillion in discretionary spending (Sanchez, CongressDaily, 6/4). The resolution would provide about $21 billion more in discretionary spending than Bush requested. According to the New York Times, Bush has threatened to veto appropriations bills that exceed his request, and Democrats might "try to avoid an election-year fight with the White House by holding back major appropriations bills until his successor takes office" (Pear, New York Times, 6/5).
According to the AP/Inquirer, the resolution "leaves to the next president the task of sorting out a host of fiscal problems" and "leaves wrenching Medicare and other federal benefit decisions to future policymakers." The resolution "paints a bleak picture for the next president, who will face tough decisions, such as on cutting benefit programs to prepare for the retirement of the baby-boom generation," the AP/Inquirer reports (AP/Philadelphia Inquirer, 6/5).
Senate Budget Committee Chair Kent Conrad (D-N.D.) said, "We have passed a fiscally responsible budget, and that is a major accomplishment." He added that the resolution would "expand health coverage for kids" (New York Times, 6/5). White House Office of Management and Budget Director Jim Nussle criticized the resolution as a "missed opportunity" to address long-term financial problems in entitlement programs such as Medicare and Medicaid. He added, "They deferred on the decision on entitlements, but they didn't on taxes" (Clarke [1], CQ Today, 6/4). Prospects
The House likely will approve the resolution on Thursday (Montgomery, Washington Post, 6/5). House Appropriations subcommittees likely will begin to mark up the 12 appropriations bills next week, "even though it appears unlikely that Congress will send those bill to Bush," according to CQ Today (Clarke [2], CQ Today, 6/4). Rep. James Walsh (R-N.Y.), ranking member of the House Appropriations Labor, HHS, Education and Related Agencies Subcommittee, said that the subcommittee will not mark up the Labor-HHS-Education appropriations bill for a few weeks (Clarke [1], CQ Today, 6/4).
The Senate will begin to mark up appropriations bills as early as June 16 (Clarke [2], CQ Today, 6/4). Supplemental War Appropriations Bill
In related news, opposition from the Blue Dog Coalition has delayed action on a $250 billion supplemental war appropriations bill (HR 2642) that includes a one-year moratorium on seven new Medicaid regulations proposed by the Bush administration, Roll Call reports (Dennis, Roll Call, 6/5). The regulations would save Medicaid an estimated $13 billion over five years (AP/USA Today, 6/4).
The coalition opposes the legislation because of a lack of offsets for some of the funds that the bill would provide. On Wednesday, members of the coalition asked House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) to include offsets for those funds. According to CQ Today, House leaders are "mulling" proposals to address the concerns of the coalition, whose members have threatened to vote against the bill (Clarke [3], CQ Today, 6/4).
Nussle on Wednesday reiterated that Bush would veto the legislation in the event that the bill includes domestic spending (Sanchez, CongressDaily, 6/5).
Senate Finance Committee Republicans Outline Plans To Delay Medicare Physician Payment Cut
[Jun 05, 2008]
Senate Finance Committee Republicans, led by ranking member Chuck Grassley (R-Iowa), on Wednesday released an outline of legislation that would halt a 10.6% reduction in Medicare physician fees scheduled to go into effect July 1, among other provisions, CQ Today reports. The bill will compete with legislation outlined by committee Chair Max Baucus (D-Mont.), which also focuses on halting the payment reduction.
The bills share some similarities, including creating electronic prescribing requirements, adding quality reporting programs and payment increases for physicians in underserved areas. In addition, both outlines do not contain provisions that Democrats and Republicans have disagreed on, including financial assistance for beneficiaries enrolled in the Medicare drug benefit. Both bills also would halt the payment reduction for 18 months.
However, Grassley's measure would provide physicians with a 1.1% increase next year, compared with a 0.5% increase proposed by Baucus. According to CQ Today, "While the difference seems small, it could mean hundreds of millions of dollars in reimbursements for physicians" (Armstrong [1], CQ Today, 6/4). Baucus said he plans to introduce his bill on Friday or Monday, while Grassley said he would introduce the competing bill shortly thereafter (Edney, CongressDaily, 6/4). 'Tactical Maneuver'?
Grassley's crafting of a similar bill "could represent a tactical maneuver ... to give moderate Republicans and those facing tough election battles a GOP-written version of the bill they can support," CQ Today reports (Armstrong [2], CQ Today, 6/4). Either bill would need 60 votes in the Senate to invoke cloture (Armstrong [1], CQ Today, 6/4). According to CongressDaily, attaining 60 votes could be difficult for Democrats. However, Baucus on Wednesday "returned ... to talk about compromise after he abandoned bipartisan negotiations two weeks ago," CongressDaily reports (CongressDaily, 6/4). "We'll come together," Baucus said, adding, "It makes much more sense for us to be together" (Armstrong [1], CQ Today, 6/4). Funding 'Split'
According to CongressDaily, "Democrats and Republicans mainly are split over how to fund the entire package." Democrats want to make cuts to Medicare Advantage plans, while Republicans are only willing to cut indirect medical education payments in MA (CongressDaily, 6/4). Conservative Republicans and the White House say that private sector competition will ultimately reduce costs, but Democrats disagree, according to CQ Today. Sen. Kent Conrad (D-N.D.) said, "There have got to be savings out of Medicare Advantage. That is a runaway train." The bills are estimated to cost between $12 billion and $18 billion (Armstrong [2], CQ Today, 6/4). However, neither outline contains details about funding. The Bush administration opposes any cuts to MA and has threatened to veto legislation that includes them. Conrad said, "Frankly, the big problem is the White House" (Armstrong [1], CQ Today, 6/4).
According to CQ Today, last December, Democrats, led by Baucus, were faced with a similar issue. At that time, they advocated for a two-year halt on payment reductions, "paid for with deep cuts" to MA. Instead, a "more modest package" that halted physician payment reductions for six months eventually emerged. According to CQ Today, Conrad, Baucus and other legislators have refused to discuss the possibility of a similar result. However, lobbyists and other congressional observers say the current debate could again result in a short-term solution, giving "lawmakers nine months' or a year's worth of time to reconvene and try again under a new administration" (Armstrong [2], CQ Today, 6/4). E-Prescribing Garners More Support
In related news, support for e-prescribing in Medicare is "gaining momentum in Congress" as both Baucus and Grassley included similar provisions in their outlines, the Wall Street Journal reports. According to the Journal, both plans "would take a carrot-and-stick approach" that would give physicians additional Medicare payments for adopting e-prescribing, then penalize physicians in subsequent years for failing to change over to the technology. E-prescribing efforts also have received backing by a broad lobbying coalition. An aide to Baucus said that the lawmaker "believes the Medicare program should be a leader in implementing widespread use of e-prescribing in doctors' offices all across the country." Grassley said that "e-prescribing makes a lot of sense wherever it's possible" (Wilde Mathews/Radnofsky, Wall Street Journal, 6/5).
DHS Immigration Bureau To Start Reporting on Detainee Deaths in Detention Centers
[Jun 05, 2008]
The Department of Homeland Security's Immigration and Customs Enforcement bureau will begin reporting more information to the Department of Justice regarding the deaths of inmates at federal detention centers, the Washington Post reports.
During a congressional hearing Wednesday on medical care for detained immigrants, ICE Assistant Secretary Julie Myers said that the change creates "more transparency" about detainee deaths. However, DOJ publishes statistics on fatalities but not on the names of those who died. According to the Post, congressional Democrats since last year have been requesting that ICE reveal the identities and circumstances of immigrant detainees who have died in custody.
The hearing was the first since the Post last month published a four-part series on the "broken system of care" in detention centers for foreigners awaiting deportation. The articles, based on "thousands of pages of internal documents," revealed that 83 detainees had died in detention centers since ICE was created five years ago, according to the Post.
In Wednesday's hearing, Myers and committee Republicans released figures that showed detainee deaths have fallen in recent years and that fewer immigrant detainees die than U.S. prisoners. ICE officials said deaths among immigrant detainees declined 49% between 2006 and 2007, according to the Post. However, Bellevue/New York University Program for Survivors of Torture physician Homer Venters testified that those figures are misleading because they do not factor in that detainees on average are younger and spend less time in custody. Venters testified that when taking the length of stay into account, the mortality rate has increased by 20%. Comments
House Judiciary Committee Immigration Subcommittee Chair Zoe Lofgren (D-Calif.) said ICE officials were "defending the indefensible." Lofgren added, "Whatever you think about the overall debate on immigration, you are not supposed to kill people who are in custody." Rep. Peter King (R-N.Y.) said, "Why should the American people be responsible for paying for Rolls-Royce medical care for illegal aliens?" (Goldstein, Washington Post, 6/5).
House Panel Hearing Focuses on Health IT Privacy, Cost Concerns
[Jun 05, 2008]
Lawmakers, patient-privacy and health care advocates, and information technology experts on Tuesday "debated ... how Congress can strike a balance between accelerating the adoption of a nationwide system of electronic medical records while protecting patient privacy," CongressDaily reports (Noyes, CongressDaily, 6/4). The House Energy and Commerce Subcommittee on Health hearing focused on a health IT bill drafted by Committee Chair John Dingell (D-Mich.) and ranking member Joe Barton (R-Texas). The bill would require the federal government to set software and hardware standards for health programs, such as Medicare, and assist providers in purchasing and establishing health IT systems (Wayne, CQ Today, 6/4).
Subcommittee Chair Frank Pallone (D-N.J.) said that a national health IT system would save the U.S. up to $170 billion annually, as well as improve health care quality, increase efficiency and reduce medical errors. Rep. Henry Waxman (D-Calif.) said that surveys have shown consumers lack confidence in health data privacy and security, and creating a nationwide health IT network could increase those concerns. Several privacy advocates called on lawmakers to adopt a clear definition of health privacy to be used in the legislation (CongressDaily, 6/4). According to privacy advocates, there is an industry based on buying and selling medical records that could be harmed by strong privacy protections. Deborah Peel, founder of Patient Privacy Rights, said, "Data mining and sale of health information is rampant." Industry groups have said strong privacy language could prevent them from easily communicating with patients and each other.
Meanwhile, physicians at the hearing discussed concerns about the cost of implementing health IT. Steven Stack, a physician representing the American Medical Association, at the hearing said that "it is truly essential" that Congress provide funds for physicians to purchase health IT equipment, especially those in small practices and rural areas. The draft bill would authorize grants and loans to providers, but it would not provide actual funds, CQ Today reports. Pallone, a co-sponsor of the House draft bill, said, "While some providers have already begun to make the investment in (health IT), far more have not because of serious financial and operational barriers" (CQ Today, 6/4). GOP Health IT Bill
Also on Tuesday, Republican Reps. Dave Camp (Mich.) and Sam Johnson (Texas) introduced legislation (HR 6179) similar to the draft bill that they said would provide a "workable solution that utilizes public-private partnerships and tax incentives to rapidly adopt health IT while protecting patient privacy," CongressDaily reports.
The bill would allow physicians who purchase health IT equipment to deduct a larger portion of the business expense more quickly. The measure also would a eliminate a 2013 sunset that HHS placed on the practice of hospitals providing physicians with electronic health record software, according to CongressDaily. In addition, the legislation would require HHS to establish technology and privacy standards for EHRs and mandate an HHS study to indentify strengths and weaknesses in current federal security and confidentiality standards (CongressDaily, 6/4).
Coverage & Access
Study Finds Wide Racial, Geographic Health Care Disparities Among Medicare Beneficiaries
[Jun 05, 2008]
Race and place of residence can have a significant effect on the quality of care a Medicare beneficiary receives, according to a report released Thursday by the Robert Wood Johnson Foundation, the New York Times reports. The study -- conducted by the Dartmouth University Institute for Health Policy and Clinical Practice's Atlas of Health Care project and led by Dartmouth professor Elliott Fisher -- examined Medicare claims over the past two decades for evidence of racial and geographic disparities in several indicators of health care quality. Blacks were found to be less likely than whites to receive recommended care within a given region, but greater disparities in care were found among different geographic regions, according to the study (Sack, New York Times, 6/5).
The study found: - Sixty-four percent of white women ages 65 to 69 received recommended breast cancer screenings in 2004 and 2005, compared with 57% of black women, while screening rates by state ranged from 74% in Maine to 56.9% in Mississippi (Wilde Mathews, Wall Street Journal, 6/5);
- In all but two states, blacks with diabetes were less likely than whites to receive annual hemoglobin testing, and in Colorado, 66% of blacks were screened, compared with 88% of blacks in Massachusetts (New York Times, 6/5); and
- Blacks nationwide had their legs amputated at about four times the rate of whites. Black residents of Louisiana, Mississippi and South Carolina had six amputations per 1,000 Medicare beneficiaries, while blacks in Colorado and Nevada had less than two per 1,000 beneficiaries (Appleby, USA Today, 6/5).
Variations in care could be partly attributed to regional differences in education and poverty levels, but researchers "increasingly believe" that variations in medical practice and spending also affect care, the Times reports ( New York Times, 6/5). Fisher said, "The level of understanding, and the level of knowledge, varies across communities," adding, "Concern or fear about the tests, health literacy, certainly varies across educational groups" ( Wall Street Journal, 6/5). Initiative
RWJF on Thursday also announced a $300 million program that will aim to reduce racial and regional disparities in health care delivery by targeting 14 communities and regions across the U.S. RWJF President and CEO Risa Lavizzo-Mourey said the funding will allow communities to bring together physicians, employers, patients and others to determine which chronic diseases should be the focus of efforts. The program aims to eventually provide models for national health reform.
RWJF will provide resources and technical expertise to help physicians learn about changes they can make to improve care and to help patients better manage their conditions, Lavizzo-Mourey said. "Despite having the most expensive health care system in the world, patients are subject to too many mistakes, too much miscommunication and too much inequity," Lavizzo-Mourey said (Freking, AP/Chicago Tribune, 6/4). She added, "The only way you can improve quality of care is where it's delivered" (Wall Street Journal, 6/5).
John Lumpkin, senior vice president of RWJF, said, "We want to build a template in each of these communities that will teach America how to improve health care quality in a dramatic way" (New York Times, 6/5). Officials said Aligning Force for Quality is the largest effort of its kind by a private foundation (Boulton, Milwaukee Journal Sentinel, 6/4). The regions that will receive the grants are Cincinnati; Cleveland; Detroit; Humboldt County, Calif.; Kansas City, Mo.; Maine; Memphis; Minnesota; Seattle; south central Pennsylvania; western Michigan; western New York state; Willamette Valley in Oregon; and Wisconsin (New York Times, 6/5).
More information about the initiative and the study is available online.
South Los Angeles Residents Face Difficulties Receiving Medical Care for Variety of Reasons
[Jun 05, 2008]
A shortage of primary care physicians and low Medi-Cal reimbursement rates have made South Los Angeles "one of the most difficult places in the nation to both receive and give medical care," the New York Times reports. Medi-Cal is California's Medicaid program. According to the Times, "[T]he woes of South Los Angeles mirror other poor urban health systems," such as those in Philadelphia; Washington, D.C.; and Cleveland, which "have closed or fallen into bankruptcy in recent years, leaving patients scrambling." However, "the situation in South Los Angeles is particularly grave" because Medi-Cal offers the lowest Medicaid reimbursement rate per capita nationwide, which has made recruiting new physicians difficult, according to recruiters.
Nationwide, a decrease in employer-sponsored insurance and Medicaid reductions have contributed to more than 2.2 million U.S. residents becoming uninsured between 2005 and 2006, the Times reports. Nearly one in three patients who visits a Los Angeles emergency department is uninsured, and the number of uninsured patients and those on Medi-Cal in South Los Angeles has increased by more than 38% since 2000. Adding to those problems, Gov. Arnold Schwarzenegger (R) also has proposed a 10% cut for Medi-Cal, which combined with Congress' proposed reductions to Medicaid programs nationwide could mean $240 million less for Los Angeles over the next year, the Times reports.
In addition, since 2000, 15 general acute care hospitals in Los Angeles have closed. The Los Angeles County Department of Health Services, which "is sagging under its own budget woes," has adopted complex patient transfer policies that have shifted a number of its low-income patients to private hospitals, which have similar financial problems. Nine area clinics that have attempted to absorb uninsured patients since Martin Luther King Jr.-Harbor Hospital closed in 2007, have seen a 157% increase in patient visits, according to Jim Mangia, who runs the consortium of clinics. Jim Lott, vice president of the Hospital Association of Southern California, said, "We have less than one hospital bed per 1,000 residents here compared to 4.3 per 1,000 in the U.S."
Carol Meyer, director of governmental relations for the county health department, said, "We have an all-out crisis here," adding, "In terms of lack of access to care, emergency room overcrowding and total underfunding of the health care system" (Steinhauer, New York Times, 6/5).
Department of Defense, HHS Announce Program To Send Mental Health Care Professionals To Help Soldiers With PTSD
[Jun 05, 2008]
Department of Defense and HHS officials on Wednesday announced a program under which the departments will send 200 psychiatrists, social workers and other mental health care professionals to military facilities to treat the increased number of soldiers who have post-traumatic stress disorder, the Washington Times reports.
Adm. Joxel Garcia, assistant secretary for health at HHS, said that the program will coordinate scientific research for the mental health care needs of soldiers and improve treatment and prevention efforts for PTSD. Garcia said, "We are very proud that this is an effort to essentially serve not only the veterans that are coming from war, but also their families."
S. Ward Casscells, assistant DOD secretary for health affairs, said, "The cavalry riding to the rescue is the public health service." He added that the departments might decrease the number of mental health care professionals sent under the program to 100, as the current number assumes "that there would be a surge of people asking for mental counseling and psychological counseling" because of efforts to "reduce the stigma of asking for help, to assure people that this won't adversely impact their career" (Hudson, Washington Times, 6/5).
Medicare
Nearly Three-Fourths of Medicare Drug Plan Beneficiaries Will Pay 16% More for Coverage This Year, According to Analysis
[Jun 05, 2008]
Monthly premiums for Medicare beneficiaries enrolled in the 10 largest prescription drug plans this year increased by an average of 16% to $26.39, according to an analysis released on Wednesday by Avalere Health, the Los Angeles Times reports.
Among the 10 prescription drug plans -- which account for about three-fourths of all Medicare beneficiaries enrolled in such plans -- six increased premiums this year, and four reduced them, the analysis found. The analysis found that average monthly premiums for AARP MedicareRX Preferred, the largest prescription drug plan with 2.7 million beneficiaries, this year increased by 15% to $32.08. In addition, the analysis found that average monthly premiums for the next two largest plans, Humana PDP Standard and Humana PDP Enhanced, this year increased by 69% and 6%, respectively.
Avalere President Dan Mendelson said, "A 16% increase is significant ... because premiums are rising rapidly at a time when Medicare beneficiaries are finding it harder to afford it," adding, "These are individuals on a fixed income who are facing rapidly rising prices elsewhere in the economy."
CMS officials said that Medicare beneficiaries can switch to prescription drug plans with lower monthly premiums during the annual open enrollment period from Nov. 15 to Dec. 31.
However, Tricia Neuman, a Kaiser Family Foundation vice president and director of the Medicare Policy Project at the foundation, said that the "tendency for many people is to stick with the plan they have from year to year." She added that, because Medicare premiums and cost sharing account for almost one-third of the average monthly Social Security check, the "additional dollars here and there add up and can take a toll" (Alonso-Zaldivar, Los Angeles Times, 6/5).
 The analysis is available online (.pdf).
Kaiser Daily Health Policy Report Examines Recent Developments Related to Medicare
[Jun 05, 2008]
- Competitive bidding program: House members on Monday in a letter asked leaders of the House Ways and Means Committee and the Health Subcommittee to pass legislation to delay for one year the first phase of a competitive bidding program for durable medical equipment under Medicare, The Hill reports. In the letter, 132 House members wrote, "We are very concerned that the suppliers will not be able to meet the needs of the Medicare beneficiaries" (Young, The Hill, 6/3). They added, "The vast majority of rejected bidders were informed that they have not submitted sufficient financial information, when in many cases, bidders have evidence they had. These rejected bidders have no appeal rights." In a statement, acting CMS Administrator Kerry Weems said, "Let's be clear about the meaning of this letter demanding at least a one-year delay in the competitive bidding program: It means at least another year in which Medicare beneficiaries and American taxpayers are overcharged, by an average of 26%, for durable Medicare equipment" and "at least another year in which our beneficiaries will not have the assurance of accredited and financially sound suppliers providing this vital equipment and these services" (Johnson, CQ HealthBeat, 6/4).
- Mental health services: Bills (S 1715, HR 1571) that would reduce copayments for mental health services under Medicare would improve access for beneficiaries and reduce their risk for suicide, suicide prevention advocates said on Tuesday at a briefing CQ HealthBeat reports. The legislation would reduce copays for outpatient mental health services from 50% to 20% of the cost over five years. According to Jerry Reed -- executive director of the Suicide Prevention Action Network USA, which hosted the briefing -- suicide among elderly individuals is a public health problem in the U.S. Yeates Conwell of the SPAN USA National Scientific Advisory Council added that suicide among elderly individuals "too often flies under the radar" (Blair Wyckoff, CQ HealthBeat, 6/3).
Medicaid
Walgreen Agrees To Pay $35M To Settle Allegations of Improper Medication Switches for Medicaid Beneficiaries
[Jun 05, 2008]
Walgreen has agreed to pay $35 million to settle allegations that the company improperly switched the form of generic medications prescribed to Medicaid beneficiaries to receive higher reimbursements from the program, the Hartford Courant reports (Levick, Hartford Courant, 6/5).
The allegations resulted from a lawsuit filed in 2003 in U.S. District Court for Northern Illinois by independent pharmacist Bernard Lisitza. Forty-two states; Washington, D.C.; Puerto Rico; and the federal government later joined the lawsuit. According to the lawsuit, Walgreen switched Medicaid beneficiaries from the tablet form to the more expensive capsule form of generic versions of the heartburn medication Zantac, the antidepressant Prozac and the Parkinson's disease treatment Eldepryl (Won Tesoriero, Wall Street Journal, 6/5).
Under the settlement, Walgreen will pay the states; Washington, D.C.; and Puerto Rico about $16.4 million under separate agreements and pay the federal government about $18.6 million (Parmely, Philadelphia Inquirer, 6/5). Walgreen also will increase compliance training for many employees as part of a five-year agreement with the federal government (Wall Street Journal, 6/5). Lisitza will receive about $5 million under the settlement. Walgreen denied any wrongdoing in the settlement (Philadelphia Inquirer, 6/5). Comments
Patrick Fitzgerald, U.S. attorney for the Northern District of Illinois, said, "Switching between tablets and capsules to deliver medications might seem harmless, but when that is done solely to increase profit and in violation of federal and state regulations that are designed to protect patients, pharmacists must know that they are subjecting themselves to the possibility of triple damages, civil penalties and legal fees" (Jones, Chicago Tribune, 6/5). Gregory Katsas, acting assistant attorney general for the Civil Division of the Justice Department, said, "The United States will not tolerate pharmacies or any other health care providers that attempt to manipulate the Medicaid program at the taxpayers' expense" (Knowles, Chicago Sun-Times, 6/5).
Walgreen officials said that the company "believes the reimbursements it received from Medicaid were consistent with applicable regulations" and agreed to the settlement to "avoid the expense and uncertainty of litigation and to resolve all of the governments' claims" (Wall Street Journal, 6/5).
State Watch
Colorado Gov. Ritter Signs 11 Health Care Bills To Increase Access, Expand Coverage
[Jun 05, 2008]
Colorado Gov. Bill Ritter (D) on Tuesday signed into law 11 health care bills, including measures to expand coverage requirements and increase children's access to care, the AP/Denver Post reports. One of the measures (SB 160) Ritter signed will expand eligibility for Child Health Plan Plus, the state's version of SCHIP, to include children in families with incomes up to 225% of the federal poverty level. The bill also will expand mental health benefits for children enrolled in the program. A companion bill (SB 161) also signed into law will remove administrative barriers to applying for Medicaid and Child's Health Plan Plus (AP/Denver Post, 6/3). According to the Denver Rocky Mountain News, the legislation will qualify an additional 50,000 uninsured children for the programs (Torkelson, Denver Rocky Mountain News, 6/3).
The other health care bills signed into law were:
- SB 57, which will require insurers to cover children's hearing aids;
- SB 135, which will create standardized health plan identification cards to make it easier for providers to get information from insurers;
- SB 138, which will establish minimum requirements for designations or rating systems for physicians developed by health care or insurance entities;
- SB 194, which will direct the Colorado Department of Public Health and Environment to develop a public health improvement plan for the state;
- SB 217, which will direct two state agencies to develop a "Centennial Care Choices" plan that could provide many state residents with basic health coverage;
- HB 1100, which will restore funds to the Colorado Responds to Children with Special Needs Program;
- HB 1385, which will establish a consumer guide to purchasing health insurance on the state Division of Insurance Web site and increase transparency of insurance brokers' commission fees; and
- HB 1410, which will require most insurance plans to cover colorectal cancer screening tests (AP/Denver Post, 6/3).
Ritter said the new laws "don't get us to the place where we cover every Coloradan," adding, "But we define this as a building-blocks approach, and it gets us a lot closer to that goal." Joan Hennebery, executive director of the Department of Health Care Policy and Financing, said she has already begun taking ideas from medical groups and advocacy organizations for issues to be addressed next year, and has begun looking at budget implications and preparing an agenda (Sealover, Colorado Springs Gazette, 6/3).
Connecticut Lawmaker Asks Gov. Rell To Delay Implementation of Charter Oak Health Plan
[Jun 05, 2008]
Connecticut House Majority Leader Christopher Donovan (D) on Tuesday asked Gov. Jodie Rell (R) to delay implementing a new health plan for uninsured adults because of concerns that it could disrupt care for children in low-income families, the Hartford Courant reports. The administration plans to merge the new Charter Oak health plan with HUSKY, which covers 320,000 low-income children and adults who are eligible for Medicaid. Charter Oak is expected to cover about 20,000 adults next year and about 50,000 by 2011.
The state is accepting bids for the combined program contract. HealthNet and WellCare, two of the four HUSKY providers, left the program in April, and Anthem Blue Cross and Blue Shield of Connecticut withdrew from the bidding for the combined program in March, citing "concerns about inadequate state funding." Two other insurers bidding on the program do not have provider networks established in the state. HUSKY beneficiaries will have six months, starting July 1, to transition to new HUSKY providers. Sheldon Toubman, a Connecticut legal aid attorney, said the merger could force thousands of HUSKY beneficiaries to find new physicians for the second time in less than one year.
Child advocates also worry that covering uninsured adults could be too costly and would weaken HUSKY. "Give kudos to the governor for at least trying something different," Liz Brown, legislative liaison for the Connecticut Commission on Children, said. She added, "But our concern is this would divert resources from a population that was much more needy."
Rell has no plans to delay the program, according to spokesperson Chris Cooper. Cooper said, "We know the need is out there for credible and affordable health coverage," and Charter Oak "fits the bill." Donovan said some state lawmakers would like to hold a special session next week to discuss delaying Charter Oak (Pazniokas, Hartford Courant, 6/4).
Kansas Health Institute News Service Examines Prospects for Expanding Health Coverage in State
[Jun 05, 2008]
The Kansas Health Institute News Service on Monday in a series of articles examined prospects for expanding health coverage in Kansas this year. Last month, lawmakers agreed to expand HealthWave, the state's version of SCHIP, to children in families with incomes up to 225% of the federal poverty level in fiscal year 2009 and to 250% of the poverty level in FY 2010. However, whether the state expands the program largely depends on whether Congress and the next president approve additional federal funds for SCHIP (Ranney [1], KHI News Service, 6/2).
According to KHI News Service, lawmakers told the Kansas Health Policy Authority at the end of the last legislative session that "it could help low- and modest-income families" purchase health insurance for their children. However, lawmakers did not appropriate any funds for the initiative. Rep. Bob Bethell (R), chair of the state House Special Services Budget Committee, maintains that the agency did not request any funding for the expansion. However, health authority officials said they told legislators that the initiative would cost $234,000 in FY 2009. Andy Allison, the deputy director of the health authority, said the state would not be able to expand the program without additional federal matching funds. KHI News Service reports that the "board's options include shelving the expansion, shuffling priorities within the agency's budget or asking for a mid-fiscal year appropriation" (Ranney [2], KHI News Service, 6/2).
KHI News Service also examined efforts by other states to expand SCHIP (Ranney [1], KHI News Service, 6/2).
KHI News Service reports that a $55 million loss in state revenue for this fiscal year likely "means little or no new spending" for health care expansions in the next legislative session. Several lawmakers said major developments could affect Medicaid, with the state looking to reduce or slow costs.
House Speaker Melvin Neufeld (R) said, "Given where the revenue estimates are, it appears next session it is going to be very difficult to do much," adding, "That doesn't mean changing the health system is dead. What that means is that progress will be slowed by the lack of capital." Other lawmakers said cost containment will be key to any health care proposals (Sheilds, KHI News Service, 6/2).
The Latest Reports in Health Policy
Study Finds Health and Wellness Initiatives in Work Place Increasing, Despite Lack of Evidence That They Save Money
[Jun 05, 2008]
"Health and Wellness Initiatives: The Shift From Managing Illness to Promoting Health," Center for Studying Health System Change: The issue brief found that health plan initiatives designed to promote health and wellness among workers have become commonplace, even though there is a lack of evidence that the programs save businesses money. The study was funded by the Robert Wood Johnson Foundation and based on HSC's 2007 site visits to 12 nationally representative metropolitan communities. According to the study, the increase in health and wellness initiatives is a result of large employers looking for long-term strategies to address rising costs and to support their plan to give employees more responsibility for health care decisions and costs (HSC release, 6/4).
Looking for a Daily Report on a specific date? Click here for instructions on how to find it.
...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... .....
|
