Kaiser Daily Health Policy Report
Indiana Officials Seek Waiver To Cover Costs of Hospice Care Through Medicaid
Nevada Receives Federal Approval To Cover In-Home Services for Diabled Adults Through Medicaid
'Diane Rehm Show' Discusses State Budget Problems, Including High Medicaid Costs
Blue Shield of California Chief Calls for Universal Health Care in State
Three Years After IOM Medical Error Report, Little Progress Made, Washington Post Says
Washington, D.C., Officials Questioned Over Future of Greater Southeast, Health Care Access
Medicare Overpaid Specialty Hospitals by $800M in 2000, Report Says
Ruling Allows Minnesota To Proceed with Patient Database
Health Insurance Costs Nearing State-Mandated Limit in Maryland
Medicaid
Supreme Court Declines To Hear Suit by Medicaid Beneficiaries Seeking Part of Tobacco Settlement
[Dec 03, 2002]
The Supreme Court on Dec. 2 decided not to hear arguments from former smokers seeking a share of the $246 billion settlement reached between tobacco companies and states in 1998, Bloomberg/Los Angeles Times reports. The court, without comment, refused to hear three lawsuits filed by Medicaid beneficiaries in West Virginia, North Carolina and South Carolina that sought a share of the settlement to cover their smoking-related medical costs (Stohr, Bloomberg/Los Angeles Times, 12/3). The lawsuits argued that the settlement was reached to repay states for smoking-related Medicaid costs, and as a result, individual Medicaid beneficiaries should receive a share of the funds. Lower courts in the three states have ruled that individual Medicaid beneficiaries do not qualify for a share of the tobacco settlement, and the 4th U.S. Circuit Court of Appeals earlier this year upheld the decisions (Kaiser Daily Health Policy Report, 11/20). Medicaid beneficiaries have filed a number of similar lawsuits nationwide; no courts have ruled in favor of the beneficiaries (Bloomberg/Los Angeles Times, 12/3). The 9th U.S. Circuit Court of Appeals last month ruled in a lawsuit filed by Medicaid beneficiaries in Hawaii that states have the right to use tobacco settlement funds for "any expenditures deemed appropriate" (Kaiser Daily Health Policy Report, 11/20). The Supreme Court this year has refused four times to hear lawsuits filed on behalf of Medicaid beneficiaries (Bloomberg/Los Angeles Times, 12/3).
Indiana Officials Seek Waiver To Cover Costs of Hospice Care Through Medicaid
[Dec 03, 2002]
Indiana officials on Dec. 3 plan to contact CMS officials to check on the status of a waiver application that, if approved, would allow the state to use Medicaid funds to cover the cost of hospice care, the Indianapolis Star reports. The state Office of Medicaid Policy & Planning, at the request of the state General Assembly, applied for the waiver last year. While just five residential hospices and only 69 beds for hospice patients exist within Indiana, advocates for such facilities hope that such a waiver would "allo[w] equal access" to residential hospices for Medicaid beneficiaries in the state, according to Adrianne May, executive director of Hospice of the Calumet Area. Under current state policies, Medicaid does not cover the cost of room and board at residential hospices -- typically about $100 per day -- once patients' symptoms are "under control," even if they are not capable of leaving the facility. Medicaid does cover similar room and board fees at nursing homes. While nursing homes often do provide end-of-life care, Harriet O'Connor, president and CEO of the Indiana Hospice and Palliative Care Organization, said facilities such as nursing homes are often "inappropriate" for dying patients because they must follow rules that "make no sense" for such patients, such as how often patients must get out of bed. Further, residential hospices typically have lower staff-to-patient ratios, staff members who specialize in palliative care and policies to allow family to stay with patients, according to Andy Candor, president of the Fort Wayne, Ind.-based Visiting Nurse Service and Hospice. "I look at the waiver as being budget-neutral. People aren't going to be coming into hospice because of this, but people will end up in the hospital or go to a nursing home and Medicaid will end up paying anyway," O'Connor said (Webber, Indianapolis Star, 12/2).
Nevada Receives Federal Approval To Cover In-Home Services for Diabled Adults Through Medicaid
[Dec 03, 2002]
HHS Secretary Tommy Thompson on Nov. 27 approved Nevada's amended home and community-based services Medicaid waiver, which will expand the in-home services the state provides to disabled adults. Through the expansion, Nevada will increase the number of people receiving home care services under the waiver from 304 to 1,716. The plan also will eliminate the age restriction for such in-home services, which previously limited aid to people ages 64 and older. Under the program, disabled adults will receive services such as home support, personal care, respite care, transportation and home-delivered meals. In addition, Nevada is revising its waiver to include participant self-direction in choosing, training and supervising personal care providers. "This latest waiver will give many more Nevada residents the kind of benefits that they need to stay out of nursing homes and remain a part of their communities," Thompson said (HHS release, 11/27).
'Diane Rehm Show' Discusses State Budget Problems, Including High Medicaid Costs
[Dec 03, 2002]
WAMU's "Diane Rehm Show," an NPR syndicated program, on Dec. 2 hosted a discussion on the factors behind state budget crises across the country, including rising Medicaid spending, and emerging coping strategies among governors and governors-elect. Guests on the program included Arkansas Gov. Mike Huckabee (R), Nicholas Johnson of the Center on Budget and Policy Priorities, John Thomason of the National Governors Association and Virginia Gov. Mark Warner (D) (Rehm, "Diane Rehm Show," WAMU, 12/2). According to an NGA report released last week, almost every state in the nation is "in fiscal crisis," a problem that could prompt many to reduce Medicaid spending. According to the report, "Fiscal Survey of the States," in the most recent fiscal year, states' coffers decreased to $14.5 billion from a peak of $48.8 billion in 2000. Medicaid and other health care costs account for 30% of states' spending, and those expenses rose 13% last year, the largest increase in a decade (Kaiser Daily Health Policy Report, 11/26). Describing the factors driving budget crises in most states, Huckabee said, "Number one it's the overall health care picture, but particularly Medicaid." Warner agreed that Medicaid is "just eating up state budgets, and the federal government plays an ever decreasing instead of increasing role in funding Medicaid." Thomason said that he expects to see "tough choices" on Medicaid eligibility levels, benefits and copayments ("Diane Rehm Show," WAMU, 12/2).
Coverage & Access
Blue Shield of California Chief Calls for Universal Health Care in State
[Dec 03, 2002]
Blue Shield of California CEO Bruce Bodaken has proposed that California adopt a universal care system that would provide "an essential benefits package" through private or public health insurers for every state resident, the New York Times reports. Under Bodaken's plan, which he intends to elaborate upon in a Dec. 3 speech at the Commonwealth Club in San Francisco, most employers in the state would be required to provide workers a package of health benefits, including coverage for preventive care, physician services, hospital care and prescription drug coverage. Small businesses would not be required to offer such benefits under Bodaken's proposal. He also has said that any resident eligible for Medi-Cal or Healthy Families, California's Medicaid and CHIP programs, respectively, would be enrolled. Residents who remain uninsured would be required to purchase private insurance; residents with higher incomes would have to pay full price for the policy, while people with lower incomes would receive subsidies from the state to help purchase coverage. According to Bodaken, the plan would "generate savings" by expanding access to preventive care, promoting earlier treatment, reducing use of emergency rooms and providing a "more secure financing" system for hospitals, doctors and insurers (Freudenheim, New York Times, 12/3). Bodaken first introduced the proposal in a San Francisco Chronicle opinion piece. He stated, "Universal coverage can be attained only when coupled with universal responsibility. We all must contribute our dollars and our ingenuity to build a health care system that protects everyone" (Bodaken, San Francisco Chronicle, 12/2). Support?
Todd Richter, a health care analyst for Banc of America Securities, said that a universal care system "would dramatically increase the size of the market and spread risk better," outcomes favored by the insurance industry. Lawrence March, an analyst at Lehman Brothers, added, "One reason a health insurance executive would propose universal coverage is to be seen as the good guy, not the bad guy, as the patient advocate." However, Richter said that Bodaken's plan would likely not receive much support from employers, many of whom do not wish to incur the cost of providing worker health benefits. Richter added that provision requiring individuals to purchase coverage would be "difficult to enforce" (New York Times, 12/3).
Three Years After IOM Medical Error Report, Little Progress Made, Washington Post Says
[Dec 03, 2002]
The Washington Post on Dec. 3 looks at the lack of "significant progress" in the effort to reduce medical errors since the release of an Institute of Medicine report in 1999 that found that preventable medical errors lead to the deaths of as many as 98,000 hospitalized U.S. patients every year and injure 1 million more. The report prompted Congress to hold hearings on the issue and allocate $50 million for medical error prevention research. In addition, former President Bill Clinton recommended mandatory reporting of serious errors, and lawmakers introduced four bills that would have created medical error reporting systems. Further, a consortium of Fortune 500 companies established the Leapfrog Group, which is urging hospitals to implement new methods to reduce mistakes. Despite those efforts, the Post reports that there has been "a lot of talk, but no significant progress" in reducing medical errors because of "fierce resistance by doctors and hospitals" to mandatory error reporting, "a lack of oversight by the federal government and the absence of an effective consumer lobby." Dr. Lucian Leape, a Harvard physician who helped write the IOM report, said, "Before the IOM report, nobody was doing diddly squat. Now there are a lot of good people involved and a tremendous amount of activity. Of course, activity is not the same as progress." The Post examines five areas -- medication errors, wrong-site surgery, hospital-acquired infections, fatigue and supervision and the nursing shortage -- that "directly affect hospital patients" to see the progress that has been made since the release of the IOM report (Boodman, Washington Post, 12/3).
Washington, D.C., Officials Questioned Over Future of Greater Southeast, Health Care Access
[Dec 03, 2002]
Washington, D.C., residents at a Dec. 2 town hall meeting raised concerns about access to care after Mayor Anthony Williams (D) said that the city supports but cannot guarantee the continued existence of Greater Southeast Hospital, the Washington Post reports (Moreno, Washington Post, 12/3). Greater Southeast filed for bankruptcy last month after its parent company, Doctors Community Healthcare, also filed for bankruptcy on Nov. 20, following the collapse of health care lender National Century Financial Enterprises on Nov. 18. National Century filed for Chapter 11 bankruptcy protection because it owed approximately $3.6 billion to bondholders, large money-management firms that buy bonds and other creditors. Doctors Community is the general contractor for the D.C. Healthcare Alliance, a private corporation that runs D.C.'s indigent health care system. Greater Southeast is the primary facility for patients enrolled in the alliance who require hospitalization or trauma care (Kaiser Daily Health Policy Report, 11/27). Residents expressed "discontent" with the D.C. Healthcare Alliance and asked the panel, including the mayor and D.C. City Council members, where they would receive health services if Greater Southeast closed. The facility is the only acute-care general hospital east of the Anacostia River in Washington, D.C. James Buford, the city's health department director, said, "The ultimate goal is to keep the hospital operating and providing care to citizens east of the river," adding that "the long-term fate of [Greater Southeast] is yet to be determined" (Moreno, Washington Post, 12/3). Greater Southeast Might Lose Alliance Contract
Williams is considering replacing Greater Southeast as the prime contractor for the D.C. Healthcare Alliance with D.C. Chartered Health Plan, a for-profit HMO for city Medicaid beneficiaries that handles claims for the indigent care system, according to Buford, the Washington Times reports. According to the Times, many city officials and medical providers have expressed support for removing Greater Southeast as the prime contractor for the alliance if the hospital "fails to perform" or to "streamline" health care delivery for the indigent. Further, D.C. Chartered has been lobbying city officials to replace Greater Southeast as the prime contractor. However, some D.C. City Council members said they are "wary" of "such a 'drastic' step." Council member Adrian Fenty (D) said that changing the contract is legal, but that "doesn't mean there is the political support to do it." He added that the city needs to keep its "options open" (Bhatti/Keary, Washington Times, 12/3).
Medicare
Medicare Overpaid Specialty Hospitals by $800M in 2000, Report Says
[Dec 03, 2002]
Medicare overpaid specialty hospitals by $800 million in 2000 because of a lack of government oversight, according to a report from the HHS Office of Inspector General, Bloomberg/Los Angeles Times reports. Medicare used a different formula to determine reimbursements for hospitals that provide specialized services such as psychiatric, rehabilitative and long-term care than for acute-care hospitals, and the reimbursements for specialty facilities "weren't scrutinized closely" by federal officials, Bloomberg/Times reports. About 9.2% of the $8.7 billion in reimbursements to specialty hospitals paid by Medicare in 2000 covered services that beneficiaries did not require, the report said. CMS has informed Medicare contractors that they may review reimbursements made to specialty hospitals, the report said (Bloomberg/Los Angeles Times, 12/3).
State Watch
Ruling Allows Minnesota To Proceed with Patient Database
[Dec 03, 2002]
An administrative law judge on Dec. 2 ruled that the Minnesota Department of Health can begin to collect medical information on most state residents as part of a "massive" patient data bank, the St. Paul Pioneer Press reports. The health department plans to collect patient data from hospitals, HMOs and other health insurers to "better track" the quality of care provided in the state's health care system and to develop plans to improve the system (Majeski, St. Paul Pioneer Press, 12/3). The health department plans to encrypt the data, which will include patient names, birth dates, street addresses, diagnoses, prescriptions, race and gender, before researchers can view the information. Administrative law Judge Allan Klein said in his decision yesterday that despite concerns over medical privacy, the health department demonstrated that the data bank is "reasonable under state law" and that officials have taken "adequate safeguards prevent misuse of the information," the Minneapolis Star Tribune reports. Klein, however, said that the health department was "impermissibly vague" about the information that officials plan to encrypt. Dave Orren, a spokesperson for the health department, called the decision a "relief." He said, "I really do think that the perception of some people that the data is going to be collected by us and basically posted on a billboard is just wrong" (Lerner, Minneapolis Star Tribune, 12/3). Twila Brase, president of the Citizen's Council on Health Care, which opposes the data bank, said, "We're disappointed but we're not surprised. We were hoping (the judge's ruling) would be a little less positive toward the department's position." She added, "We did state, and we still assert, that there are oversteppings of the law, but the judge did not find in our favor on those points. There's nothing to prevent them from, sometime in the future, collecting genetic information. I don't think the battle is over" (St. Paul Pioneer Press, 12/3).
Health Care Marketplace
Health Insurance Costs Nearing State-Mandated Limit in Maryland
[Dec 03, 2002]
The cost of health insurance benefits required by Maryland is nearing a state-mandated cap set to ensure affordability, according to a report by the Maryland Health Care Commission, the Baltimore Sun reports. Under a 1999 law, the annual cost of a policy that covered only state-required benefits is limited to 2.20% of the state's average annual wage. Maryland requires health insurance plans sold in the state to cover 25 services, including diabetes medicines, mental health treatment and hospital services for a two-day maternity stay. Large, self-insured companies are exempt from the mandates. The report found the cost of a policy sold in Maryland that covers only the 25 services is $841 per year, or 2.19% of the average annual wage. Given that health costs are increasing, the report said the ceiling is likely to be broken next year, even if the state Legislature does not mandate new benefits. While the report did not recommend cutting benefits or raising the cost ceiling, commission Executive Director Barbara McLean said that if the costs exceed the ceiling, the commission would freeze the mandates until it conducts a more detailed study (Salganik, Baltimore Sun, 11/27).
Looking for a Daily Report on a specific date? Click here for instructions on how to find it.
...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... ...... ...... ...... ...... ...... ...... ......
...... .....
|
