Conn. addresses insurance rates, Mass. physician groups evaluate controversial payment plan

State House News Service/The Boston Globe: "House and Senate leaders are eyeing passage of a second midyear spending bill before the start of the next legislative session to address more caseload-driven accounts that are running short on funds five months after Gov. Deval Patrick signed the fiscal 2011 budget. The deficiencies, which follow inaccurate enrollment estimates for MassHealth and other social service programs, threaten to eat into some the revenue surpluses the state has amassed over the first half of fiscal 2011, when tax receipts have exceeded projections" (Murphy, 12/7).

The Boston Herald: Massachusetts' "largest physician group gave a partial endorsement to a controversial new plan to lower mounting health care costs by putting everyone who has health insurance on an year-to-year medical spending budget, with the prospect of lower rates for spending less. … The new health care payment policy would stop escalating medical costs, supporters said, by putting people on an annual individual medical-care budget of an as-yet undetermined amount, under the management of a health-care team known as an 'accountable care group'" (McConville, 12/6).

CQ HealthBeat: "Connecticut's acting insurance commissioner Barbara Spear on Dec. 3 rejected a 20 percent rate increase requested by the state's largest health insurance, Anthem Blue Cross and Blue Shield. Spear called Anthem's request 'excessive,' in accepting the recommendation of her department's hearing officer" (Bunis, 12/6).

The Columbia Missourian/The Associated Press: "Cash-strapped sheriff's departments in Missouri are looking for ways to cut expenses, and one of those is to force inmates to pay their own medical expenses. State law allows counties to recoup the costs of physician visits, dental care or medication from inmates, either through insurance or by levying against an inmate's assets" (12/5).

The Spokesman-Review/The Associated Press: "Washington state's new computer system for processing Medicaid payments is failing to process hundreds of thousands of claims. Some doctors and clinics have stopped taking new Medicaid patients until they get paid for ones they've already treated, The Seattle Times reported. The Web-based program ProviderOne by vendor Client Network Services Inc. launched in May. The system processes claims submitted by health care providers on behalf of the state's poorest patients. Because of glitches, the computer system has suspended thousands of claims, which then must be processed by hand. A state report in mid-November said there was a total backlog of about 271,000 suspended claims" (12/6).

The Columbus Dispatch: "While Cleveland hospitals are scaling back on which uninsured patients they'll treat free, Columbus hospital systems have no plans to follow that cost-cutting lead. The Cleveland Clinic announced last week that, starting Jan. 1, it will routinely stop accepting uninsured patients who can't pay for their care and come from 150 miles or farther from Cleveland" (Hoholik, 12/7).

Dallas Morning News: "Health, life and disability insurers will no longer have blanket authority to decide what their policies do and don't cover in Texas, under rules approved Monday by Insurance Commissioner Mike Geeslin. The decision, which was sought by the state consumer advocate for insurance, ends long-standing provisions in most health and disability plans - called discretionary clauses - that give insurers the right to interpret their policies and decide what benefits must be paid. In formally adopting the new rules, Geeslin wrote that the discretionary powers of companies 'are unjust, encourage misrepresentation and are deceptive because they mislead consumers regarding the terms of coverage' in their policies" (Stutz, 12/7).

NPR: "Because of a state law passed nearly 50 years ago, North Dakota is the only state that requires its pharmacies be 51 percent owned by a pharmacist. The state does have a few exceptions. Hospitals are allowed to operate their own pharmacies, and chain store pharmacies older than the law were grandfathered in. Otherwise, most of the state's nearly 250 pharmacies comply. Opponents say the law puts consumers at a disadvantage. If larger stores like Target, Wal-Mart and Walgreens could set up pharmacies in North Dakota, it would mean lower drug prices, says Patrick Davis, a consultant for North Dakotans for Affordable Healthcare, a coalition of North Dakota citizens, hospitals and health care groups" (Wyckoff, 12/6).

The Associated Press: Thirty-three people have been charged in Buffalo, N.Y., "in a large-scale investigation that has opened a window into an emerging class of suppliers in the illicit drug trade: medical patients, including many who rely on the publicly funded Medicaid program to pay for their appointments and prescriptions" who sell their prescription drugs. "Often at no charge, the patients see a doctor, or several doctors, and come away with prescriptions for narcotic OxyContin and other pills they then sell to a dealer for as much as $1,000. If they are on Medicaid, the program is billed about $1,060 for a typical 60-pill, 80-mg prescription, along with the $23-to-$39 cost of the doctor's visit" (12/6).

---

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.