State highlights: N.D. kids' program eligibility; Conn. nursing home transparency; La. hospital privatization

May 7 2014

A selection of health policy stories from North Dakota, Connecticut, Louisiana, Colorado, New York, Kansas and Missouri.

The Associated Press: Income Eligibility For ND Health Services Broadens
The income eligibility guidelines have changed for a state-funded specialty health care program that helps some North Dakota children. The North Dakota Department of Health on Monday announced the changes for the Children's Special Health Services Specialty Care Treatment Program. The department says that starting this month a family of four can earn up to $44,123 annually -- or $3,677 monthly for the household -- and still meet income eligibility requirements (5/5).

The CT Mirror: SEIU 1199 Wins Fight For CT Nursing Home Transparency Law
SEIU 1199 New England, a union closely allied with Gov. Dannel P. Malloy, won final passage early Tuesday of new financial reporting rules for nursing homes, a reaction to the union's long, continuing fight with HealthBridge Management, a company that has claimed financial distress to escape contract obligations. The Senate voted 24 to 11 to create a Nursing Home Financial Advisory Committee to regularly examine the financial solvency and quality of care of nursing homes. Senate Minority Leader John P. McKinney, R-Fairfield, and two other GOP senators, Kevin Witkos of Canton and John Kissel of Enfield, joined all 21 Democrats present in support (Pazniokas, 5/6).

The Associated Press: Jindal Won't Scrap Hospital Privatization Model
Louisiana Gov. Bobby Jindal's administration won't reverse course on privatizing state-owned hospitals that care for the poor and uninsured and will continue negotiating with federal officials on ways to pay for the deals, Jindal's chief budget adviser said Monday. The CMS, rejected financing plans submitted by the Jindal administration for most of the privatization contracts late last week, and lawmakers were trying to determine the state's next steps (5/5).

Kaiser Health News: Capsules: Colorado Redraws Map To Cut Sky-High Ski Town Rates
Relief is in sight -- and it won't involve a lawsuit -- for the four counties in Colorado that have the highest Obamacare health insurance premiums in the country. Local officials in the ski resort region in the mountains west of Denver had threatened to sue over the high rates. But on Friday Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw those boundaries, making the resort counties part of a much larger 22-county pool (Whitney, 5/5).

The Associated Press: Pharmacy Owner Serves Jail Time For Medicaid Fraud
A pharmacy owner has been sentenced for his part in a scheme that drained $16 million from the state Medicaid program. Attorney General Eric Schneiderman said Monday that 41-year-old Raheel Pervez of Dix Hills will serve one to three years for his part in a scheme that billed Medicaid for unfilled prescriptions (5/6).

Kansas Health Institute News Service: Former Legislator Named KanCare Inspector General
A former state legislator, Phil Hermanson, has been named inspector general for Kansas' Medicaid programs. As inspector general he will oversee audits of the state's KanCare contractors -- Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene -- and be on the lookout for potential fraud and abuse, and promote efficiency, agency officials said. The inspector general position had been vacant since Gale's exit in early January (Ranney, 5/5).

The St. Louis Post-Dispatch: Lucrative Biopsies Spur Fight By Pathologists 
For most people, a biopsy is a fast and simple procedure -- a sliver or patch of skin or a few drops of fluid are extracted in a doctor's office and sent to a laboratory for examination. It's also potentially lifesaving. Biopsies such as Pap smears and the analysis of polyps, tumors and skin anomalies are crucial in detecting certain cancers. But how much a biopsy costs and who pays for it can be complex. Biopsy markups are a hidden profit center in the health care industry, especially in states such as Missouri, where physicians are allowed to charge extra for lab services. Many states bar the practice, as do the Medicare and Medicaid programs. Unknown to most consumers, there's a running feud over who controls the billing for biopsies -- one stretching back for several years and involving a tug-of-war between physicians, hospitals and laboratories. As consumers pay an increasing share of their medical costs, markups are drawing new attention (Doyle, 5/4).