Health and Fitness

State Watch: Walgreen Medicaid Prescription Threat, Conn. Insurance Claims

A roundup of state health news: The (Spokane, Wash.) Spokesman-Review : "Walgreen Co. said it will stop filling Medicaid prescriptions at about half of its pharmacies in Washington next month because of continued reimbursement reductions" (Stucke, 1/14). The Wall Street Journal : It's not the first time Walgreen has made this type of threat. "A similar standoff occurred last year in Delaware" (Becker, 1/14). Hartford Courant : "The state Office of the Healthcare Advocate fought to get $6.7 million last year from health insurers in claims and health care services that were initially declined by insurance companies, " costs otherwise born by Connecticut consumers. The recession spurred a 23 percent increase in new cases of unpaid claims, compared with the prior year (Sturdevant, 1/14). The Providence Journal : "The state House of Representative's leading budget authority publicly questioned on Wednesday the value of the [Gov. Donald] Carcieri administration's landmark agreement with federal Medicaid officials, criticizing the deal to overhaul Rhode Island's long-term care system for repeatedly failing to meet savings projections.

With Federal Health Bill Stalled, California Senate To Vote On Comprehensive, Medicare For All Healthcare Reform

With prospects for national healthcare reform dimming following Tuesday's election in Massachusetts, a major bill that would establish universal healthcare, through a Medicare-for-all style reform, has been cleared today for a new vote in the California legislature. SB 810, The California Universal Healthcare Act, authored by Sen. Mark Leno and sponsored by the California Nurses Association/National Nurses United, with broad support among many healthcare, community, and labor groups, will be voted on in the State Senate by the end of next week. The bill would establish a single-payer system in California, modeled on the healthcare systems that exist in virtually all other industrialized nations, which cost far less than the U.S. system and surpass the U.S. in most measures of patient care outcomes. "Broad federal legislation looks less likely every day now, but the need for comprehensive reform has never been greater, " said CNA/NNU co-president Deborah Burger, RN. "California has an opportunity to chart a new course for the nation.

Medicare Fraud Round-Up: N.D. Beneficiaries Getting Illegal Phone Calls, Doctor Indicted In Ohio

The Bismarck Tribune reports on a new scheme "asking seniors to pay up for not having Part D coverage. The scammers have been calling beneficiaries saying they owe a penalty for not having the Part D prescription drug coverage and that they need to pay the fine right away, said a release from the office of the Insurance Commissioner" (1/20). The Fargo, N.D., Inforum also reports that state insurance officials were warning beneficiaries that " Medicare cannot call and ask for your financial or personal information over the phone. Always keep your personal information - including your Medicare number safe, just as you would a credit card or a bank account number. A Medicare drug plan may accept payments by phone, but they cannot call beneficiaries to request a payment be made. The beneficiary must be notified of the past due premiums via mail" (1/20). Columbus Business First reports on the arrest Wednesday of a Columbus doctor, Dr. Charles C. Njoku, and his office manager, Veronica Scott-Guiler, in a Medicaid and Medicare fraud case.

As Dems Look To Regroup, Pelosi Says House Will Not Pass Senate Reform Bill Without Changes

House Speaker Nancy Pelosi (D-Calif.) on Thursday said Democrats in the House do not have enough votes to pass the Senate's health care reform bill ( HR 3590 ) in its current form, effectively removing that option from the table as party leadership weighs how to proceed with the legislation, Politico reports. "In its present form, without any changes, I don't think it's possible to pass the Senate bill in the House, " Pelosi said, adding, "I don't see the votes for it at this time." According to Politico, House approval of the Senate bill would be the fastest strategy to advance a final bill to President Obama (O'Connor/Budoff Brown, Politico, 1/21). According to the Washington Post, Pelosi has "struggled" to convince Democrats to support the Senate bill since Tuesday's special election of Sen.-elect Scott Brown (R-Mass.). She said that there are "certain things" included in the Senate bill that some House Democrats "simply cannot support, " such as a provision by Sen. Ben Nelson (D-Neb.

Lobbyists Continue Efforts To Influence Health Overhaul

Here's a look at some last-minute lobbying campaigns and what impact they may have had. The Washington Post : "Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South." The language is "a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic" (MacGillis, 1/6). Los Angeles Times : A mainstay Republican-leaning lobbying group, the National Restaurant Association, worked last year to build stronger connections with Democrats working on the health care debate. It may be one sign that the "once-solid front of business groups backing the GOP began to crack." A changing political landscape led the association to reconsider its strategy, one board member said: "Are we going to lob bombs from afar and understand that return fire will kill us?

Analysis: Medicare Part D Has Lessons For Health Reform

The Wall Street Journal : "Four years ago, the U.S. government offered subsidized prescription-drug insurance to 43 million elderly and disabled, the biggest expansion of government-backed health care in decades. Today, the program is working better than many expected." One lesson could be for proposed health insurance exchanges. "Jonathan Gruber and Jason Abaluck of the Massachusetts Institute of Technology, with data on 2.7 million Part D enrollees, find that 70% could have chosen a lower-cost plan, and the typical enrollee could have saved about 25%. Consumers focused too much on premiums, not enough on out-of-pocket spending. It's a reminder that elaborate cost-sharing formulas don't guide consumers well if they're too complicated for consumers to understand." Another lesson: allowing the private insurers to negotiate drug prices, rather than the government, led to an average price cut of 12%. "That strengthens the case for harnessing private insurers to restrain health costs, but doesn't mean drug prices couldn't be lower still.

Inspector General Report On Wheelchair Claims Confirms Flaws In Medicare Requirements - American Association For Homecare

A federal report released last week on Medicare claims for power wheelchairs confirms that the regulatory documentation requirements are confusing, onerous, and must be improved, says the American Association for Homecare, the nation's largest association representing providers of durable medical equipment and services, including wheelchairs. The December 2009 report released by the Health and Human Services Office of Inspector General (OIG) found that "three out of five claims for standard and complex rehabilitation power wheelchairs did not meet Medicare documentation requirements during the first half of 2007." These findings are consistent with the experience of power wheelchair providers. They illustrate the fundamental problems that occur when confusing and contradictory policies are applied to the claims process and when standardized Medicare documents approved by the federal Office of Management and Budget are not used. "The OIG study does not illustrate a problem with provider compliance but rather it reflects the obstacles providers face with Medicare documentation and its paperwork requirements, " stated Tyler J.

Health Bill Negotiators Consider Applying Medicare Tax To Investment Income, WSJ Reports

News outlets explore some of the unsettled and sticky policy questions - such as what taxes might pay for it, and whether mandates to buy coverage should be included - in the health overhaul legislation. The Wall Street Journal : "House and Senate negotiators are considering applying for the first time the Medicare payroll tax to investment income as part of a compromise to pay for a health overhaul. The extra Medicare tax would apply only to the wealthy and could allow congressional Democrats to reduce the sting of a tax on high-cost insurance plans, said Democratic aides and others briefed on the negotiations" (Vaughan and Meckler, 1/12). NPR : House and Senate lawmakers are attempting to merge their legislation, but "key disputes" remain. "One example are the so-called 'health care exchanges, ' the new marketplaces where individuals and small businesses would be able to shop for health insurance, " something both groups agree on in principle but handle quite differently. The Senate would allow states to manage their own exchanges and keep the exchange available only for the uninsured and small businesses, while the House would consider opening exchanges to more people later on and manage them at the federal level (Rovner, 1/12).

Hospital Error Rates Climb In California

Hospital error rates in California climbed by more than 300 cases last fiscal year after a 2006 law required public reporting of hospital errors in that state, the Sacramento Business Journal reports. In all there were "1, 538 serious and preventable events reported by California hospitals for the fiscal year ended June 30. ... The numbers are up from the first year, when 1, 224 incidents were reported statewide and 93 in the four-county region." Medicare has stopped paying for some errors such as when the wrong surgery is performed and "reduced payments to hospitals if patients got complications from a preventable mistake." The Institute of Medicine in a landmark report a decade ago reported that "up to 98, 000 people die in U.S. hospitals each year due to preventable mistakes" (Robertson, 1/8). This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.

New Law Eases Restrictions On Assets, Income For Extra Help Program

Effective January 1, 2010, several changes to the law make it easier for older people and people with disabilities to qualify for Extra Help, the federal program that helps people with Medicare pay for their prescription drugs. Under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), people who apply for Extra Help will no longer be required to count life insurance policies as an asset, and money and services they receive from family and friends to help cover their living expenses will not count as income. The law will make an additional 1 million people with Medicare eligible for Extra Help. "These changes will greatly simplify the application process and broaden access to the Extra Help program, " said Joe Baker, president of the Medicare Rights Center. "All too often, older adults and people with disabilities have to split pills or skip doses to afford their prescription drugs. These changes will ensure that more Americans have access to the drugs they need.

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