State roundup: Another Medi-Cal lawsuit; medical homes in Tenn.; Pa. moving forward on exchanges

Nov 24 2011

California Healthline: California Hospitals Ask Courts To Halt Cuts
Some California hospitals would take a significant and long-lasting hit from Medi-Cal reimbursement cuts recently approved by CMS, according to the California Hospital Association, which this week filed a petition in federal court to put a temporary halt to those reductions. CHA's lawsuit and injunction request are separate from the court action taken earlier this week by the California Medical Association and other provider organizations (Gorn, 11/23).

Modern Healthcare: Injunction Sought Against Calif. Medicaid Rate Cuts
The latest complaint claims rate cuts submitted by the California Department of Health Care Services and approved by HHS failed to consider provider costs or whether payments were consistent with efficiency, economy and quality of care, as required. ... The lawsuit claims the reduced rates violate the constitution by paying inadequate rates for a mandated service (Evans, 11/22).

San Francisco Chronicle: Mayor Ed Lee Quickly Signs Health Care Amendments Into Law
Mayor Ed Lee wasted no time in signing legislation approved by the Board of Supervisors today intended to close a loophole in San Francisco's groundbreaking law that mandates employers provide some health care coverage to their uninsured workers. ... [The amendment] allows individual workers to accrue up to two years of unused funding in their health reimbursement accounts (Gordon, 11/22).

The Fiscal Times: Health Care Savings Bonanza: Docs Make House Calls
So a year ago, without government help, [Amerigroup Inc., the health insurer for Medicaid patients in Nashville] instituted a so-called medical home program, paying extra money to local physicians who care for Medicaid patients. They were asked to hire outreach workers to call patients to make sure they keep appointments, take their medication or simply to check up on how they were doing.  ... officials are so confident of its success that they've just opened a similar program in Georgia (Goozner, 11/22).

The Philadelphia Inquirer: Pa. Proceeds With Creating State-Run Health Insurance Exchange
After months of study, the Corbett administration said Tuesday that it was moving forward with a key - and widely supported - option offered by the federal health-care overhaul: a state-run insurance exchange. ... [Exchanges] are expected to transform the arduous process of buying health insurance for millions of people who get coverage individually or are covered by small businesses (Sapatkin and McCullough, 11/23).

Health Policy Solutions (a Colorado news service): Colorado Task Force Grappling With Simplifying Medical Billing Codes
The task force's charge is to provide a framework for uniform and transparent claim adjudication for each medical procedure. It will not affect the amount of money insurers pay for those procedures or the contracts between health insurers and providers. ... [At stake] is the potential to save hundreds of millions of dollars and potentially funnel them into increased care (Wolf, 11/22).

Sacramento Bee: Sutter Health Sued Over Theft Of Computer Containing Patient Data
Sutter Health is being sued for negligence and other allegations in the mid-October theft of a computer from Sutter Medical Foundation headquarters that held information on more than 4 million of its patients(Smith, 11/23).

The New York Times: Abortion Case Loses Ground, But Issue Stays Hot In Kansas
The prosecution of a Planned Parenthood affiliate here, the first such criminal case in the nation, has been treated locally as something of a proxy in the battle over abortion rights. Derided by supporters of the organization as politically motivated, the prosecution was celebrated by opponents as the capstone of increasingly aggressive actions here and elsewhere against Planned Parenthood, which provides abortions and other services at clinics around the country (Sulzberger, 11/22).

Health News Florida: QHP Members Go Back To Medicare
In an unusual move, federal health officials are returning 10,000 Florida enrollees in a defunct HMO to the traditional Medicare program on Dec. 1 instead of shifting them to a different HMO. The Centers for Medicare & Medicaid Services announced late Tuesday that members of Quality Health Plans, or QHP, will be able to see their usual doctors; however those doctors will bill the Medicare program for the treatments. ... No explanation was immediately available from CMS for the decision (Gentry, 11/22).

The Miami Herald: Small Wonders: More Preemie Babies Face Test Of Survival
While modern medicine has substantially increased the survival rates of preemies over the past two decades, the percentage of births that result in premature labor also has increased during that time. In Florida, the latest data put the rate at 13.5 percent. That rate led to the March of Dimes giving Florida a "D" in its 2011 Premature Birth Report Card. ... For those who survive the birth, there can be a lifetime of medical problems, which include cerebral palsy, lung issues, learning disabilities and vision and hearing loss (Clark, 11/22).

The Dallas Morning News: Regulators Find More Problems At Parkland Memorial Hospital
Federal regulators cited Parkland Memorial Hospital's troubled emergency-care operation Tuesday for more patient-safety breakdowns. In the latest documented incident, on Oct. 8, psychiatric ER staff failed to search a suicidal woman when she entered the unit (Moffiet and Egerton, 11/22).

The Associated Press/Times-Picayune: Louisiana Doctors Continue To Work While Under Investigation
Four Louisiana physicians wrote hundreds of bogus prescriptions that powered multimillion-dollar health-care frauds in the Baton Rouge area, according to evidence amassed by the nearly two-year-old local Medicare Fraud Strike Force. Yet, all four physicians remain licensed to practice medicine ... Officials of the Louisiana State Board of Medical Examiners declined to comment on the targeted physicians -- three of whom or were placed on probation or their licenses were suspended for questionable prescription practices before being charged in the Medicare fraud cases (11/22).

The Miami Herald: More Victims Step Forward In 'Toxic Tush' Case
More people are coming forward to claim they suffered life-threatening injuries from a buttocks-enhancement procedure performed by a woman who injected them with a stew of toxic substances. Police last week arrested Oneal Ron Morris, 30, on charges of practicing healthcare without a license, causing serious bodily injury (Brown, 11/22). 

The Baltimore Sun: Health Officials Alarmed Over Silicone Injections For Fuller Buttocks
Some women who want rounder, fuller buttocks are turning to a dangerous cosmetic procedure: illegal injections of silicone offered by people who lack medical training and may buy their supplies in home improvement stores. ... The U.S. Food and Drug Administration and other agencies have been investigating the incident in Baltimore and others across the country (Cohn, 11/22).