universal health

CMS proposes more flexible Medicaid rules

Mon, 25 Feb 2008 06:59:58 -0500

CMS has proposed new rules that would give states more latitude in designing their Medicaid programs. The rules, which address provisions of the Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006, would give states the ability to build Medicaid programs that work more like their local private health plans. CMS also has issued proposed regs, based on DRA provisions that will allow states to change premiums and cost-sharing rules. The new regs may mean that families with incomes of 100 to 150 percent of the poverty level may see some cost-sharing, while individuals with incomes of 150 percent or more of the poverty level could end up paying monthly premiums.

To learn more about the CMS regs:
- read this Healthcare Finance News article

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TX, NJ hospitals settle Medicare allegations

Tue, 11 Dec 2007 06:59:57 -0500

Hospitals in Texas and New Jersey agreed this week to pay almost $10 million to settle charges of making improper Medicare claims. One facility, Warren Hospital of Philipsburg, N.J., agreed to pay $7.5 million to settle charges that it had inflated Medicare charges to boost its outlier payments. The hospital will enter a corporate integrity agreement with the HHS Inspector General's Office. Meanwhile, Harris Methodist-HEB Hospital in Bedford, TX agreed to pay $1.9 million to address questions over a lease agreement with the physician. The parent company for the hospital, which reported the potential problem, will be required to submit periodic compliance reports. Both of these cases arose from whistle-blower lawsuits.

To find out more about these cases:
- read this Modern Healthcare piece (reg. req.)

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AZ hospital, MDs pay $6.7M to settle Medicare charges

Tue, 06 Nov 2007 06:59:55 -0500

An Arizona hospital and two affiliated medical groups have agreed to pay the U.S. Department of Justice $6.7 million to settle charges that they billed Medicare improperly. The DoJ had contended that the facility, Phoenix's Arizona Heart Hospital, inappropriately billed Medicare for procedures related to experimental grafts for aneurysms, as the grafts were considered experimental or procedures involved didn't follow approved protocols.

The hospital, which is majority-owned by MedCath Corp., is also co-owned by physician groups AHI Cardiovascular Surgeons and Arizona Heart Institute. The two groups paid $900,000 of the total settlement amount. MedCath had previously announced that it would pay $5.8 million to settle clinical trial issues at one of its hospitals, though it didn't name the facility at that time.

To learn more about the settlement:
- read this Modern Healthcare piece
- read this Charlotte Business Journal article

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Community Health discloses further federal scrutiny

Thu, 01 Nov 2007 07:59:56 -0400

Community Health Systems (CHS) has disclosed in securities filings that the U.S. Department of Justice is investigating three of its hospitals on charges that the New Mexico facilities caused the state to submit false federal claims. The DoJ is attempting to determine whether the facilities submitted inappropriate claims with the state's program for reimbursing hospitals for indigent care, CHS says. The current actions by the DoJ expand on an ongoing civil investigation, touching on CHS hospitals in Arkansas and South Carolina, which first kicked off in February 2006.

CHS, which acquired Triad Hospitals in July for $6.97 billion, also reported net income of $10.5 million on revenue of $2.35 billion, up from $8.2 million net income on revenue of $1.12 billion in the same quarter last year.

To find out more about CHS's operations:
- read this Modern Healthcare piece

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Feds want state's Medicaid bucks back

Thu, 24 May 2007 20:01:36 -0400

Federal investigators are calling for the state of Missouri to pay back at least $8 million in Medicaid funding, arguing that the state's provider tax doesn't follow federal law. The state, which has been fighting with the feds since last year, imposes a tax on hospitals, nursing homes, pharmacies and healthcare management firms that generates about $1.1 billion per year. The state has leveraged that money to pull in $1.8 billion in Medicaid money from the federal government. The feds are charging that Missouri shouldn't have collected as much Medicaid money as it did, given that it collected charges on items like hospital cafeteria revenue which aren't related to patient care. It's also arguing that the state shouldn't have changed the tax plan without getting federal approval. The state's position, meanwhile, is that it has done nothing wrong; it hasn't yet repaid the $8.2 million investigators have requested.

To find out more about the dispute:
- read this News-Tribune piece

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MA exempts 20% of uninsured from mandate

Thu, 12 Apr 2007 20:01:37 -0400

Bowing to public pressure, Massachusetts officials are planning to exempt almost 20 percent of uninsured adults from the state's health insurance mandate. Under the state's reform law, all adults would have to have health insurance by July 1, and they'd face a penalty if they didn't have insurance by December 31. However, officials have concluded that even bare-bones, high-deductible insurance will be too expensive for about 60,000 people who make too much to qualify for state subsidies, so in the interests of keeping the rest of the plan on track, they're carving out exceptions for these people. The state's Connector Authority, which is administering the rollout of the mandate, is also looking at expanding subsidies for 62,000 of the state's low-income individuals and families. While the new exceptions will prevent the state from achieving its full-coverage goals, they shouldn't take too much momentum away from the state's reforms. Even if 60,000 citizens don't buy in, the new mandate will push out coverage to 99 percent of the state's population.

To learn more about the exemption:
- read this piece from The Boston Globe

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Calif. considers fines for uninsured

Tue, 10 Apr 2007 20:01:38 -0400

California Gov. Arnold Schwarzenegger (R) is considering some aggressive steps to push all citizens into health insurance plans. Under this proposal--one of several being considered by the administration--the state would track down people who refuse to buy health insurance, force-enrolled in a plan and fined until they pay the premiums. Schwarzenegger has also proposed attaching the wages of people who don't buy into a health plan, or boosting their state income tax debt. To find the uninsured, the administration would use state or private databases to pick out citizens who went without health coverage for 60 days or more. In penalizing the uninsured, California would be following in the footsteps of Massachusetts, but Massachusetts officials are only imposing a small tax penalty on those who don't have coverage.

These ideas have greatly upset some interest groups that Schwarzenegger would like to win over, including the California branch of the Service Employees International Union, which is arguing that the proposal would hit people in transition with penalties they can't afford. Schwarzenegger's plan would offer subsidies to the poor, but most others would be own their own, facing premiums that could hit $1,200 per person each year even for high-deductible plans.

To learn more about California insurance proposals:
- read this Los Angeles Times piece

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MA health plans keep cutting prices

Sun, 01 Apr 2007 20:01:37 -0400

Spurred by state authorities who said that premiums weren't affordable enough, insurers have done a second round of price-cutting on policies aimed at uninsured but employed citizens. Right now, it's estimated by about 200,000 Massachusetts residents don't get employer-sponsored health coverage, but also earn too much to qualify for state subsidies. To get some of this business, health plans had made bids for participation which came in below standard market premiums. However, Gov. Deval Patrick (D) and members of the Commonwealth Health Insurance Connector Authority weren't happy with health insurers' bids for the "Commonwealth Choice" program, which averaged $302.79 per month for a 37-year-old. Some of the highest-priced plans were eliminated from the process.

The remaining plans, which include Harvard Pilgrim Health Care, Tufts Health Plan, Blue Cross Blue Shield of Massachusetts and Neighborhood Health Plan, cut premiums by an average of 8 percent during this round, some by trimming benefits. The plans had already imposed large annual deductibles and co-pays, with maximum out of pocket limits typically at $5,000 for individuals and $10,000 for families. Regardless of how prices turn out, the high deductibles should remain an issue. With consumers picking up policies that require substantial out of pocket spending, providers may still end up with large unpaid bills, which defeats one major purpose for instituting universal coverage.

To learn more about health plan price jockeying:
- read this piece from The Boston Globe

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MA mulls changes to insurance requirements

Mon, 19 Mar 2007 20:01:36 -0400

Facing loud complaints from citizens whose health coverage doesn't measure up, Massachusetts state officials are looking at dropping a core rule defining on what coverage qualifies under its new insurance mandate. Officials are now proposing that the state allow health plans that have lifetime payout caps to qualify for the mandate. Right now, plans don't meet the law's requirements if a lifetime cap is in place. However, the officials still intend to leave in place other benefit requirements, including that qualified plans have drug coverage with no more than a $250 individual deductible. However, the officials are now suggesting that the new standards be phased in over time, to give employers and individuals time to upgrade existing coverage. This won't address complaints from some Bay State employers, however, who argue that companies with adequate plans in place shouldn't be asked to make any changes.

To learn more about the status of Massachusetts reforms:
- read this piece from The Boston Globe

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MA approves new health plans

Sun, 11 Mar 2007 20:01:35 -0400

Gearing up for new rules requiring all residents to carry health insurance, Massachusetts has officially approved a group of policies tailored to be accessible to the uninsured. Starting in May, a total of 28 different plans will be offered by seven insurers. Participating health insurers include Blue Cross and Blue Shield of Massachusetts, Harvard Pilgrim Health Care, ConnectiCare, Fallon Community Health Plan, Health New England, Neighborhood Health Plan and Tufts Health Plan. Monthly premiums for the new policies range from $122 per month to more than $800 per month, depending on how old the policyholder is and what level of coverage they choose.

Whether they choose these new policies or opt for other existing products, citizens must buy some kind of policy by the year end, or lose a $200 per year tax exemption. Individuals who make less than 300 percent of the federal poverty level--or about $30,000--will get subsidies that offset the monthly premium. About 100,000 of the state's uninsured have already gained coverage through subsidies or expanded Medicaid coverage.

To learn more about the plan:
- read this USA Today piece
- read this piece from The Boston Globe

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