Roundup: Ga. rejects rule to curb dental hygienists' work; Ohio high-risk pool faces higher than expected costs

Sep 13 2011

News outlets report on a variety of state health policy issues.

Georgia Health News: Updates On Dentistry Proposal, Dialysis Deal
The Georgia Board of Dentistry on Friday rejected a proposed rule that public health officials feared would have restricted dental hygienists' work with low-income patients. Several health groups had said the provision, if approved, would require a dentist to examine a patient before a hygienist can apply sealants, clean teeth and perform other preventive dental services in a public health setting (Miller, 9/9).

Cleveland Plain Dealer: Ohio's High-Risk Health Insurance Coverage Faces Challenges
As Ohio marks its one-year anniversary this month of running a health insurance risk pool for those with pre-existing conditions, the much-lauded program is showing signs of growing pains: higher-than-expected costs and a behind-the-scenes rate battle. By all accounts, Ohio's risk pool, with its nearly 1,800 enrollees, is one of the biggest and most successful in the nation. But as federal regulators are lowering rates and struggling to understand why a lower-than-expected number of people are joining (read the GAO report here) the state-by-state pools, Ohio is raising prices and limiting enrollment (Tribble, 9/10). 

The Connecticut Mirror: Charter Oak Health Plan Enrollment Falls As Premiums Rise
More than 1,150 people dropped out of the Charter Oak Health Plan when premiums rose this month, largely because of legislation curtailing state subsidies for the program, and participation could fall even further in the coming months. After lawmakers raised concerns about the declining enrollment Friday, a top official at the state Department of Social Services said the department will consider ways to ease the premium costs (Levin Becker, 9/9).  

California Healthline: Legislature Passes Healthy Families Money, Mulls DMHC Move
Among the raft of bills that floated through the Legislature in the final days of session were two big health-related ones (Gorn, 9/9).

The Wall Street Journal: Puerto Rico Disability Claims Probed
The Social Security Administration's inspector general is investigating a case of potentially widespread disability fraud in Puerto Rico, two people familiar with the matter said, part of the agency's stepped-up efforts to tackle abuses in the financially struggling program (Paletta, 9/12).

Sacramento Bee: Sacramento-Area Experts Work To Prevent Falls By Seniors
According to the Centers for Disease Control and Prevention, falling is the leading cause of fatal injuries for older Americans, as well as the most common reason for their hospital visits for nonfatal traumas, such as head injury and fractures of the hip and spine. Fully one-third of people age 65 and older suffer a fall each year, the CDC says. Falling also increases the likelihood that older adults will lose their independence and require nursing home care. Yet studies suggest that half of all falls in the home can be prevented (Creamer, 9/11). 

The Miami Herald: Undocumented Immigrant And Federal Fugitive Costs Taxpayers $350,000 At Miami-Dade Hospitals
A longtime federal fugitive who was an undocumented immigrant cost taxpayers more than $350,000 in healthcare at Miami-Dade hospitals before he died last year, a county investigative report has revealed. The Miami-Dade Office of the Inspector General said the patient was a Colombian who fled the United States in 1983 after a cocaine smuggling conviction but returned under a false name. In 26 visits to the Jackson Health System from 2003 through 2010, his care cost $201,716 -; $155,334 in charity care paid by Miami-Dade taxpayers and $46,382 paid by Medicaid, the state-federal program for the poor (Dorschner, 9/10).

New Hampshire Public Radio: Federal Government Steps In To NH Family Planning
State health commissioner Nick Toumpas says the Obama administration has asked for bids from health care providers to offer federally funded family planning services in areas left uncovered since July first. That was when the Planned Parenthood contract expired, following an Executive Council vote to defund the agency (Grant, 9/9). 

Modern Healthcare: U.S. Joins Whistle-Blower Suit Against Florida Hospital
The U.S. Justice Department is seeking to intervene in a False Claims Act lawsuit that accuses a public hospital in central Florida and its independent payroll firm of violating the Stark law in its relations with nine specialty physicians. The tax-supported Halifax Health Medical Center and the related Halifax Staffing, both in Daytona Beach, Fla., were hit with a federal whistle-blower lawsuit in 2009 from its director of physician services, Dr. Elin Baklid-Kunz (Carlson, 9/11).

Dallas Morning News: Supervision Again The Subject Of Inquiry At Parkland
Last month, officials at UT Southwestern Medical Center agreed to a $1.4 million settlement to end a federal-state investigation into improper supervision of resident doctors in training at Parkland Memorial Hospital. UTSW and Parkland disagreed with the governments' contention that lax supervision led to false Medicare and Medicaid billing (Dunkline and Goetinck Ambrose, 9/11). 

San Francisco Chronicle: Legislature Ends Session With Marathon Meeting
The Legislature ended the yearly session early Saturday morning, after an all-day and night meeting, sending to Gov. Jerry Brownbills to require that health plans cover a certain type of therapy for children with autism and to move ballot measures to general elections. Both bills are controversial and Brown has not indicated whether he intends to sign or veto them. The bill relating to autism, SB946, requires health plans to cover applied behavioral analysis therapy for children with autism, beginning July 2012 and continuing for two years until the health benefit exchanges in federal health care take effect (Buchanan, 9/11).

The Atlanta Journal-Constitution: Even Those Insured May Face Big Bills
State Rep. Rusty Kidd was being carried down stairs in his wheelchair last November when one of the steps suddenly broke. Kidd flipped in the fall. The doctors at his local hospital in Milledgeville diagnosed a broken neck and sent him to Atlanta by air ambulance. Kidd recovered. But he got another jolt when he opened a bill for the helicopter ride -; about $27,000. Kidd's insurer paid what it thought was reasonable: about $8,000. The company wanted Kidd to pay the rest. … People such as Kidd, who have what is considered full medical coverage, can end up with crushing medical bills on top of what they pay in deductibles and co-pays through a practice called "balance billing." It happens when patients get care from a hospital, doctor or ambulance company that is not part of the network of providers under contract with the patient's insurer (Teegardin, 9/11).