Highlights: Report finds Mass. Medicaid managed care doesn't reduce fees; Calif. delays nonprofit status requirement for adult day centers

Aug 3 2012

A selection of health policy stories from Massachusetts, California, Colorado, Maryland, Vermont, Georgia, Minnesota and Oregon.

Boston Globe: Medicaid Managed Care Program Doesn't Reduce Fees, Report Says
Insurers that contract with the state to manage the care of low-income Medicaid patients are expected to save money, in part by negotiating lower prices with health providers. But a new report by the state inspector general found that the plans pay higher fees to many hospitals and doctors than the traditional Medicaid program pays for the same services. In the 2011 fiscal year, the higher payments cost taxpayers $328 million, the ­report said (Conaboy, 8/3).

California Healthline: State Delays Not-For-Profit Requirement For Adult Day Centers
The Department of Health Care Services extended the not-for-profit deadline for potential providers of the Community Based Adult Services program. Organizations providing adult day health care services now have until Jan. 1, 2013 to become not-for-profit, a new stipulation by the state to be eligible to receive Medi-Cal funding. The previous deadline was July 1, 2012. The six-month delay in establishing not-for-profit status was done, in part, because the state will need a substantial number of former Adult Day Health Care providers to become CBAS providers. The department has granted eligibility to approximately 80% of former ADHC beneficiaries -- roughly 28,000 frail and elderly Californians (Gorn, 8/3).

USA Today: Colorado Theater Shooting Victims Face Bills With Wounds
Like many victims, Moser, whose daughter was killed in the shooting and who suffered a miscarriage from her injuries, will face mental and physical trauma that will lead to a lifetime of medical costs. Her family and others will have to sort through dozens of victim funds and find their way through a maze of medical bills (Alcindor and Welch, 8/2).

Kaiser Health News: Baltimore Center Brings Hope To Homeless Struggling With Mental Illness
Catering to mentally ill homeless individuals and staffed by workers who have struggled with the same problems, the HOPE Wellness and Recovery Center is providing a critical safety net in Baltimore (Birchenough, Gulin and Jackson, 8/2).

Kaiser Health News: Capsules: Vermont Wields New Power Over Hospital Budgets
Vermont's Green Mountain Care Board, established by state law in May 2011 and given new powers last spring, is taking over responsibility for virtually every aspect of health care in the state. This month's project for the new regulatory board: How much hospital budgets should go up on an annual basis (Kinzel, 8/2).

The Atlanta Journal-Constitution: More Budget Cuts Ahead For State Universities
Gov. Nathan Deal is making it clear that the era of state budget cutting isn't over, asking state agencies to find another $553 million in reductions through June 2014. About half of that would come from higher education and from public health -- $108 million from the University System of Georgia and $170 million from the Department Community Health, which handles Medicaid and PeachCare -- while most k-12 school funding is exempt. Agencies are still weighing their responses to the order, issued last week, but some will consider layoffs (Salzer, 8/2).

(St. Paul) Pioneer Press: Mayo Clinic Pays $1.26 M To Settle Federal Lawsuit
The Mayo Clinic and three related entities have agreed to a $1.26 million settlement of a federal whistleblower lawsuit, according to the U.S. Attorney's Office in Minnesota. Originally filed in 2007, the lawsuit claimed that the Rochester, Minn.-based clinic submitted false claims for payment to the government for pathology services that Mayo did not provide, according to a news release Thursday, August 2 from the U.S. Attorney's Office. … Karl Oestreich, a spokesman for the clinic, said Mayo corrected the error before it knew of the Justice Department's lawsuit and voluntarily refunded $262,975 to the government. Mayo Clinic then agreed to settle with the Justice Department for an additional $1 million "because we believe the prolonged legal process would have been more costly than the settlement itself," Oestreich said in a statement (Snowbeck, 8/2).

The Oregonian: Doctors, Lawyers Join At Oregon Medical Liability Reform Meeting
The Aug. 2 meeting was the first of three by a state advisory group Gov. John Kitzhaber has asked to present a recommendation to the 2013 Legislature. Kitzhaber outlined a potential compromise last month requiring earlier notification of injuries and the potential for a confidential apology as well as pretrial mediation before a lawsuit may proceed. The proposal calls for better sharing of medical error information as well. Key leaders of Oregon Medical Association as well as Richard Lane, a frequent representative of the Oregon Trial Lawyers Association, presented the Kitzhaber-backed proposal jointly at the meeting, held in Portland. OMA generally supports the effort; a trial lawyer spokeswoman said her organization is withholding judgment until details are worked out (Budnick, 8/2).