Archive for the ‘Short Takes On News & Events’ Category

Business Groups, Consumer Advocates Draw Lines In The Sand About Essential Benefits

The essential health benefits (EHBs) countdown is on for 2016.

That’s when this provision of the Affordable Care Act, which sets out 10 specific health services that must be covered by plans sold on the exchanges, will likely be  reviewed by the Department of Health and Human Services. Business interests and consumer advocates are already making their positions clear – the former pushing for greater consciousness of premium costs and the latter looking to safeguard consumers’ coverage.

During a July 21 Capitol Hill briefing, members of the Affordable Health Benefits Coalition, a business interest group including the U.S. Chamber of Commerce and the National Retail Federation, said they would push to reshape essential benefits, arguing that current regulations have led to unaffordable hikes in insurance premiums.

Current policy requires plans cover emergency services, pre- and post-natal care, hospital and doctors’ services, and prescription drugs, among other things. The rule lets states decide how specifically to interpret those categories.

“What I hope is that they tear down the existing EHB and rebuild it from the bottom up,” said Neil Trautwein, employee benefits policy counsel for the National Retail Federation, in an interview. Trautwein said the group would lobby both members of Congress and White House officials starting in 2015, in addition to making sure this issue is part of congressional candidate’s talking points in November’s midterm elections.

But consumer advocates will be working on a separate path in the months ahead.

(more…)

Wednesday, July 23rd, 2014

Medicare Modifies Controversial Hospice Drug Rule

In response to strong criticism, Medicare officials are modifying rules intended to prevent the agency from paying twice for the same prescriptions for seniors receiving hospice care.

Under the rules that took effect in May, hospice patients or their families could not fill prescriptions through their Part D drug plans until first confirming that the prescriptions were not covered by hospice providers.  Drugs related to palliative and comfort care are supposed to be covered under the fixed rate payments to the hospice.

Medicare announced Friday that the rules would be revised so that the additional authorization would be required for only four types of medications:  pain relievers, anti-nauseants, laxatives, and anti-anxiety drugs that are “nearly always” considered hospice-related.

“Medicare really tried to address our concerns quickly and effectively,” said Terry Berthelot, a senior attorney at the Center for Medicare Advocacy. “They really did a good job and even though it’s not perfect, it’s so much better.”

The four drug categories were identified in a 2012 investigation by the Department of Health and Human Services’ inspector general. Investigators found that Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit. Part of those overpayments also were for  prescription drugs used to treat pulmonary problems and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. Beneficiaries paid nearly $4 million in copayments, the report by the Department of Health and Human Services’ inspector general found.

“Based on discussions with stakeholders, we are adjusting our rules so that beneficiaries enrolled in hospice will continue to have access to their medications while balancing recommendations by the Inspector General meant to safeguard the Medicare program,” said Medicare spokesman  Raymond Thorn.

Medicare officials revised the rules after meeting in late June with beneficiary advocates, hospice providers, insurers offering Part D drug plans and pharmacists.

Medicare generally pays drugs for diabetes, heart disease or other chronic conditions still used by hospice patients but not directly related to their terminal illness. Those are covered by Medicare Part D prescription drug plans, which are heavily subsidized by Medicare, with beneficiaries picking up roughly 25 percent of the bill.

Contact Susan Jaffe at Jaffe.KHN@gmail.com

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Friday, July 18th, 2014

Biggest Insurer Drops Caution, Embraces Obamacare

This KHN story can be republished for free. (details)

UnitedHealthcare, the insurance giant that largely sat out the health law’s online marketplaces’ first year, said Thursday it may sell policies through the exchanges in nearly half the states next year.

“We plan to grow next year as we expand our offering to as many as two dozen state exchanges,” Stephen Hemsley, CEO of UnitedHealth Group, the insurance company’s parent, told investment analysts on a conference call. He was referring to coverage sold to individuals.

The move represents a major acceleration for the company and a bet that government-subsidized insurance, sold online without regard for pre-existing illness, is here to stay. UnitedHealthcare sells individual policies through government exchanges in only four states now.

Even analysts who follow the company closely seemed surprised.

“You’re making a really big move,” Kevin Fischbeck, an analyst for Bank of America, told the company’s executives. “You’re going to do a couple dozen states. You’ve really moved in. What’s giving you the confidence … that it’s going to be stable next year?”

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Thursday, July 17th, 2014

Registered Nurses Increasingly Delay Retirement, Study Finds

Despite predictions of an impending nurse shortage, the current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement, a study by the RAND Corp. found.

The study, published online Wednesday by Health Affairs, notes that the RN workforce, rather than peaking in 2012 at 2.2 million – as the researchers predicted a decade ago – reached 2.7 million that year and has continued growing. The trend of nurses delaying retirement accounted for an extra 136,000 RNs in 2012, the study suggests.

Shifts in retirement benefits and “economic uncertainty in general” could have contributed to their decisions to extend their careers, said David Auerbach, the study’s primary author and a policy researcher at RAND.

Furthermore, Auerbach said, some researchers have “found RNs were especially attached to the mission of what they do.”

“They get a lot of satisfaction from their job and don’t want to leave it,” he said.

The surge in RNs, and in particular in RNs working beyond the age of 50, could hold significant implications for how patients receive their health care and how they relate to their health providers.

(more…)

Wednesday, July 16th, 2014

Obamacare Help Was In High Demand, Survey Shows

Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans.

Navigator Nini Hadwen, right, works with Marta Aguirre as she shops for health insurance in Florida (Photo by Joe Raedle/Getty Images).

Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them.

Guess what? People looked for help on the decision.

During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average. The assisters and navigators included 28,000 full-time-equivalent workers across the country, funded by federal and state governments as well as outside sources, the survey found.

But those assisters were not distributed equally across states.

(more…)

Tuesday, July 15th, 2014

Avoid The Rush! Some ERs Are Taking Appointments

This KHN story also ran on Southern California Public Radio. It can be republished for free. (details)

Three times within a week, 34-year-old Michael Granillo went to Northridge Hospital Medical Center because of intense back pain. Each time, Granillo, who didn’t have insurance, stayed for less than an hour before leaving without being seen by a doctor.

“I was in so much pain I wanted to be taken care of now,” said Granillo, who lives in Reseda and runs a hot dog cart business. “I didn’t want to sit and wait.”

On a recent Wednesday morning, he woke up feeling even worse. This time, Granillo’s wife, Sonya, tried something different: Using a new service offered by the hospital, she was able to make an ER appointment online, using her mobile phone.

When they arrived at the hospital, he was seen almost immediately.

Michael Granillo speaks to a doctor at Northridge Hospital Medical Center (Photo by Anna Gorman/KHN).

“That was my last resort and it worked,” she said. “He would have probably been at home in pain if not for the service.”

In an era of increased competition driven by the nation’s health law, hospitals in California and around the country are hoping online ER appointments will help attract patients anxious to avoid long waits in a crowded and often chaotic environment.

“It makes for a happier camper,” said Susan Dubuque, a national expert in hospital marketing. “When it comes to health care, consumers want more control over everything.”

The system, adopted by Northridge and other hospitals in the Dignity Health chain about a year ago, is intended only for patients who don’t have life-threatening or debilitating emergencies. To check in online, patients must explain the reason for their visit and check a box that they can wait for treatment.

Patients having chest pain or trouble breathing, for instance, are instructed to call 911 or go directly to an ER. Those with an ankle sprain or a fever, for instance, might be able to make an appointment.

When patients get to the hospital, they still may be bumped by more seriously ill patients.

(more…)

Monday, July 14th, 2014

Feds Demand Medicaid Backlog Fixes By Six States

This KHN story can be republished for free. (details)

Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health  coverage.

The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee.

“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.

The agency sent letters June 27 requesting the plans, giving states 10 days to respond. It is unclear if any have submitted plans yet. The letters was first reported by InsideHealthPolicy, a trade publication.

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Thursday, July 10th, 2014

Report: Adults With Serious Mental Illnesses Face 80% Unemployment

This KHN story can be republished for free. (details)

Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003.

That’s an unemployment rate of more than 80 percent.

“It isn’t surprising,” says Sita Diehl, director of state policy at NAMI and author of the report.  The problem has less to with the workers themselves, she says, and more with the organizations that provide services for people with serious mental illness.  “We knew that mental health services really took it on the chin during the recession. Employment rates had already been dismal to begin with, and when the supports were eroded, people with mental illness lost support and lost jobs.”

Rates of unemployment for people with mental illnesses varied greatly by state – from 92.6 percent in Maine to 56 percent in Wyoming.

Most adults with mental illness want to work, and six in 10 can succeed with the right supports, according to the report. Yet only 1.7 percent received supported employment services in 2012.

Without proper supports, many end up on expensive public programs including Supplemental Security Income (SSI) and Social Security Disability Income (SSDI). People with mental illnesses make up the largest and fastest growing group for both programs.

There are, however, several evidence-based programs to help individuals with mental illnesses find jobs and maintain them.

(more…)

Thursday, July 10th, 2014

CMS May Soften Paperwork Requirements For Home Health Care

This KHN story can be republished for free. (details)

Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized.

For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what’s referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound.

Home health agencies have pushed back against these requirements, saying Medicare contractors have denied them payments if physicians’ summaries are too short and not descriptive enough. And physicians have little incentive to do it a second time since the patient has already received care, according to home health sources. Hospital physicians may also not have enough of a full picture of the homebound status of a patient to write detailed summaries, and primary care physicians might not be in the know if a patient becomes homebound after a hospitalization.

(more…)

Wednesday, July 9th, 2014

Advocates Say California Is Rejecting ‘Free Money’ To Renew Poor People’s Insurance

This KHN story can be republished for free. (details)

Consumer advocates and some legislators were surprised and frustrated when California health officials recently refused a $6 million donation to help people re-up their Medi-Cal health coverage.

Now two senators have proposed an unusual solution: a bill to force the state to accept the offer from The California Endowment.

Photo by Calsidyrose via Flickr

Sens. Ed Hernandez and Mark Leno, both Democrats, said the money from the health care philanthropy is needed to help people through the process of keeping their health coverage. Moreover, taking the money would make the state eligible for another $6 million in matching funds from the federal government, they say.

“I can’t see leaving money on the table,” Hernandez said Thursday. “It doesn’t cost us a penny.”

The state Department of Finance, however, has said it doesn’t need the money. “We think this is just a duplication of efforts,” Keely Boster, chief deputy director of the department, said in a legislative hearing last month.

The state is already faced with a backlog of new Medi-Cal applicants because of the program’s expansion under the federal health law. Now, advocates say, it is imperiling continued access for existing beneficiaries.

“It’s a head scratcher to me,” said Kristen Golden Testa, health director of The Children’s Partnership, a nonprofit child advocacy organization. “Free money to help keep people covered seems to make a lot of sense to me.”

(more…)

Friday, July 4th, 2014

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