State highlights: Calif. fines three insurers for denying therapy; Colo.'s Denver Health to shed jobs; Ambulance Co. agrees to pay feds $3M over fraud allegations

Nov 20 2013

A selection of health policy stories from California, Colorado, Kansas and Florida.

Los Angeles Times: State Says 3 Health Insurers Denied Medically Necessary Therapy
California officials said three of the state's largest health insurers illegally denied speech and occupational therapy to patients, and regulators fined one of the companies, Health Net Inc., $300,000 for repeated violations. The state Department of Managed Health Care said Monday that it ordered Health Net, Anthem Blue Cross and Blue Shield of California to stop denying medically necessary therapy in cases of developmental disabilities, autism and other medical conditions (Terhune, 11/18).

Health Policy Solutions (a Colo. news Service): Struggling In The Red, Denver Health Cuts 170 Jobs
A loss of $7 million so far this year and fewer hospital patients have prompted Denver Health to cut 170 jobs. Often cited as a national leader in providing top-notch, low-cost health care for the poor, Denver Health also now faces a new penalty under the Affordable Care Act. Denver Health managers are calculating exactly how big that hit will be -- perhaps around $500,000 -- but federal Medicare managers are penalizing 1,500 hospitals across the country for not meeting various new quality measures, including low marks from patients (Kerwin McCrimmon, 11/18).

Los Angeles Times: O.C. Ambulance Company Pays $3 Million To Settle Fraud Suit
An Orange County ambulance company has paid $3.05 million to settle a lawsuit alleging that it billed Medicare and other federal health care programs to transport patients who didn't need an ambulance, federal prosecutors said. The suit was filed on behalf of the United States by two former employees of Lynch Ambulance, which is based in Anaheim, under whistle-blower provisions of the federal False Claims Act, according to a written statement by the U.S. attorney's Central District of California office (Esquivel, 11/18).

Kansas Health Institute: KanCare Open Enrollment Approaches
Open enrollment for thousands of the state's KanCare enrollees will start Dec. 1 and run through March 2, 2014, state Medicaid officials announced today. Enrollment packets are being put in the mail and members can expect to receive them by the end of the month, officials at the Kansas Department of Health and Environment said in a prepared statement (11/18).

Miami Herald: HIV-Disclosure Law Sparks Unique Legal Battle In  Florida
In Florida, and almost three dozen other states, it is a crime to have intercourse without disclosing a sexually transmitted disease. So prosecutors thought they had a solid case when they charged a Manatee County woman who failed to tell her female partner that she was HIV-positive (Ovalle, 11/18).

I-News/Health Policy Solutions (a Colo. news service): Mental Health Funding Cuts Fueled Homelessness In Colorado
The president of the Colorado Coalition for the Homeless, John Parvensky, says there are many more like Maseros who want help but can't get it. His organization stopped carrying a waiting list for mental health services when it reached 2,000 people. Parvensky believes there is a straight line between the decrease in funding for mental health – and especially the decline in inpatient capacity – and the increase in homelessness in Colorado (Jones, 11/18).

California Healthline: Innovation, Policy Outlook For Autism
A Senate select committee last week held a hearing in Santa Ana to examine a successful public-private autism research and treatment partnership in Orange County, and to see what legislation might be needed for autism care in the next year. Lou Correa (D-Santa Ana) is a member of the Senate Select Committee on Autism and Related Disorders and chaired the Santa Ana hearing. … One part of the solution is the autism work that's been done within the public Children and Families Commission of Orange County and the private not-for-profit Thompson Center for Autism, Correa said (Gorn, 11/18). 

California Healthline: More Changes Coming For California's Disparate County Health Systems
California's 58 counties, each operating its own health system under an established set of rules over the past several decades, are undergoing fundamental shifts in how they provide health care for low-income residents. The rules are changing. The two biggest vehicles of change are the Affordable Care Act and its Medicaid expansion. In addition, the relationship between state and county governments in California is being realigned, shifting responsibility and funding for physical and mental health care (Lauer, 11/18).

California Health Report: Public Mental Health Centers Face New Competition Under ACA
The small changes also have big implications for the Los Angeles County Department of Mental Health. Under the Affordable Care Act, health plans are now required to provide mental health services. That means the newly insured, even the low income, will have the option to seek care anywhere they want, even outside the county health system (Abram, 11/18).