A selection of health policy news from Minnesota, Georgia, Colorado, Montana, Texas, Florida and Connecticut.
MPR: PCA Pay Disparity Unconstitutional, Rules Minn. Appeals Court
The state's effort to reduce pay for some personal care attendants has hit a snag. The Minnesota Appeals Court ruled Monday that the state's attempt to pay PCAs who care for relatives 20 percent less than other personal care attendants is unconstitutional. "They have the same training, they have the same experience, they're limited to the same number of maximum hours," said attorney David Bradley Olsen, who represents 11 agencies and several personal care assistants who sued over the matter. ... PCA's are often parents or grandparents who care for an adult child or relative for $10 an hour, Olsen said (Aslanian, 12/17).
The Associated Press: CO Gov. Wants $18.5M To Expand Mental Health Care
Gov. John Hickenlooper is asking Colorado lawmakers for $18.5 million to expand mental health services, including opening five urgent care mental health centers, as a response to this summer's mass shooting at an Aurora theater. The governor's office said Monday that the services Hickenlooper and state health officials are proposing are aimed at redesigning and strengthening Colorado's system for taking care of the mentally ill, an issue that has received more attention in the wake of the July's shootings (Moreno, 12/17).
Modern Healthcare: Seeking Data Access And Lower Costs, Ga. Health Systems To Launch Insurance Plan
Two Georgia health systems will enter the insurance market in a bid for greater control over patients' medical data and benefits design. Executives said the move is necessary to better coordinate care. Piedmont Healthcare in Atlanta and WellStar Health System in Marietta said they agreed to launch a health plan in about a year. The venture continues a string of deals pairing insurers with providers as the industry reacts to policy changes that are expected to payments to hospitals and physicians and increase financial incentives for lower-cost, higher-quality medical care. Insurers have recently acquired or announced deals for hospitals, medical groups and other providers. Humana acquired Concentra, an urgent-care and occupational-care provider; UnitedHealth Group bought Monarch HealthCare; and insurer Highmark bid to acquire West Penn Allegheny Health System in Pittsburgh (Evans, 12/17).
MPR: Blue Cross And Blue Shield MN Names New CEO
The state's largest commercial health insurer, Blue Cross and Blue Shield of Minnesota, has named a new CEO. Former Aetna executive Michael Guyette takes over the helm of Blue Cross and Blue Shield Jan. 7. The Eagan-based non-profit has had a quick succession of CEOs in the past year and a half. Guyette replaces Scott Lynch who filled in as interim president and CEO after the board of trustees ousted Ken Burdick after only six months on the job. Burdick had replaced Patrick Geraghty who took over as CEO of Blue Cross and Blue Shield of Florida (Stawicki, 12/17).
The Associated Press: Montana Supreme Court Upholds Lower Court, Rejects Request From Gay Couples For Equal Benefits
The Montana Supreme Court on Monday rejected an "overly broad" request that gay couples be guaranteed the same benefits as married couples, but left the door open for advocates to modify their case and try again. The plaintiffs promised to do so, declaring they are "on the right side of history" and will inevitably win (12/17).
California Watch: Report Estimates Health Plan Overbilled Medicare
Medicare may have overpaid an estimated $424 million to PacifiCare of California's Medicare Advantage plan based on risk assessments that in many cases made patients seem sicker than they were, according to a federal oversight agency. Medicare Advantage plans send patient diagnosis codes to Medicare, which boosts plan rates if clients are affected by serious medical conditions (Jewett, 12/17).
The Texas Tribune: State, Drug Company At Odds Over Pre-Term Birth Therapy
The distributor of a drug designed to prevent pregnant women from delivering premature babies has sued a number of states, and Texas could be next. The drug, Makena, which is marketed by St. Louis-based KV Pharmaceutical, is the only version of 17-alpha hydroxyprogesterone caproate, or "17P," FDA-approved to treat women at high risk of premature delivery. But its high cost — especially compared with an unbranded drug produced by “compounding pharmacies” that customize medications — has prompted some state Medicaid programs to refuse to offer it (Ramshaw, 12/18).
Also see related KHN story: Insurance Policies Favoring Compounded Drugs For High-Risk Pregnancies Draw Scrutiny
Health News Florida: FL Medicaid Doctors To Get 105% Raise
Florida is one of five states that pay primary-care doctors so little for treating Medicaid patients that those doctors will get a raise of more than 100 percent when a federal subsidy kicks in on Jan. 1, according to a new study. The raise, which brings Medicaid pay up to the level of Medicare for two years, is part of the Patient Protection and Affordable Care Act. The idea is to lure more doctors into primary care and make it worth their while to care for those insured by Medicaid, the joint state and federal program for the very poor. The federal government pays for Medicare, the program for the elderly and disabled, and determines the regional pay rates. But states determine the reimbursement rates for Medicaid by deciding how much to contribute (Gentry, 12/18).
Also see related KHN story: Questions Linger About Implementing Doctors' Medicaid Pay Raise
Stateline: Connecticut Health Agency Fights Desperation Among The Uninsured
At 68, Maureen Smith has short, blonde hair, fashionable dark-framed glasses, and a soft, measured way of speaking that is the aural equivalent of comfort food The last is a particularly valuable trait because Smith frequently finds herself on the opposite end of the telephone with someone at the edge of desperation, if not a good deal beyond it. It might be a mother distraught after her teenage son has been rushed to an emergency room following a suicide attempt and her insurance carrier balks at paying for his hospital admission. It might be an elderly man enraged over a $75,000 hospital bill for a hip procedure that his insurer says it will not cover because it regards the operation as "experimental." Or it might be a young woman in tears because her insurance company will not pay $8,000 for a "safety bed" for her five-year old son whose cerebral palsy causes him to thrash about at night, keeping his parents sleepless and watchful out of fear that he will hurt himself (Ollove, 12/18).