Health Care Reform News Around the Nation for Nov. 10

Arizona

Since 2003, Arizona has approved less than one in five appeals from consumers whose insurance companies refused to pay for a claim or approve a medical procedure, the AP/Arizona Daily Star reports.

Arizona, which examines dozens of cases annually, is one of 44 states that provides independent review of health insurance coverage disputes, according to the AP/Daily Star.

The state Department of Insurance said appeal reviewers read insurance policies, check medical records and research laws to determine each case. According to the AP/Daily Star, officials contend low percentage of approvals is in large part because the cases are "long-shot challenges that don't jibe with the terms spelled out in insurers' contracts."

Critics contend that the appeals program offers little protection for consumers, the AP/Daily Star reports (AP/Arizona Daily Star, 11/04).

Florida

Thousands of children in Florida's KidCare program over the past five months may have been improperly dropped from the program's rolls because of a glitch in the state's computer system, the Daytona Beach News-Journal reports.

According to the News-Journal, Rich Robleto -- executive director of Florida Healthy Kids, which administers KidCare -- said 62,500 children left the program or were terminated from May to October, about 25,000 more than normal.

Child advocates and officials with Florida Healthy Kids said that notices to some families about premium due dates or enrollment renewal were sent late or not at all. In other cases, letters were not properly sent to inform parents that additional documentation was required to maintain coverage.

Robleto said that some of the enrollment data may not have transferred properly when the new system was put in place in May.

Florida Healthy Kids officials have started contacting the families of all 62,500 children, although it is unknown how many children were affected by the problem. The Florida Healthy Kids board recently reinstated some of the policies effective Nov. 1, for at least 30 days, until staff can determine that the cancellations were not caused by the computer problem, Robleto said (Circelli, Daytona Beach News-Journal, 11/5).

Minnesota

HHS has granted Minnesota a waiver to allow the state to continue providing coverage for some parents through June 2011 under the State Children's Health Insurance Program, according to Gov. Tim Pawlenty (R), the AP/St. Paul Pioneer Press reports.

The Bush administration has opposed the use of SCHIP funds for adults, but under the waiver the state will use SCHIP funds to cover kids and use Medicaid to cover about 18,000 parents, according to the AP/Pioneer Press.

Without the waiver, the state would have lost up to $130 million in federal matching funds over the next three years (AP/St. Paul Pioneer Press, 11/6).

New Jersey

This month, New Jersey Assembly member Paul Moriarty (D) introduced a bill that would prohibit New Jersey hospitals from being reimbursed for follow-up care of serious medical errors, the AP/Bergen Record reports.

The legislation would prohibit insurance reimbursement for treatment related to 12 hospital-acquired conditions, including objects left inside a body during surgery, surgical-site infections, urinary tract infections from a catheter and receiving incompatible blood.

A separate proposal, sponsored by Moriarty and other Assembly members, would require the state Department of Health and Senior Services to release an annual report of preventable errors that occurred at individual health facilities.

The bill also would allow patients to compare health care facilities in specific categories (Santi, AP/Bergen Record, 11/3).

Utah

Last month, insurance companies in Utah announced a new product prototype, NetCare, that is designed to provide coverage to state residents between jobs and costs less than COBRA coverage, the Salt Lake Tribune reports.

NetCare will cost substantially less than the price of the average large-group premium because the coverage does not include all the benefits currently required by the state.

NetCare would offer individual or group plan coverage for up to 12 months for employees transitioning off their employer's insurance plan. After one year, plan members would have to reapply as an individual and be evaluated.

The plan will focus on providing beneficiaries with incentives for maintaining healthy lifestyles, as well as discounts and savings for preventive care. Plan members would be eligible for up to $300 worth of preventive care annually for a $5 copayment.

Out-of-pocket costs for most services, including hospital and maternity care, would be limited to 30% after the deductible is met. Generic prescription drug copays would be $15 and the plan would cover half of the cost of brand-name drugs.

Insurers also called on lawmakers to address the root causes of increasing health care costs (Rosetta, Salt Lake Tribune, 11/1).

Wisconsin

Last month, Wisconsin received federal approval to expand its BadgerCare Plus program to provide basic health coverage for low-income childless adults who are not eligible for other state health programs, the Milwaukee Journal Sentinel reports.

The BadgerCare Plus program -- which previously was limited to children, families with children, and people with disabilities -- will be extended to include adults with incomes up to 200% of the federal poverty level.

The plans, which will be administered by private managed care companies, will not cover branded drugs, home health care, chiropractic services and some durable medical equipment. Residents who apply must complete a health assessment and receive a physical examination within one year of enrolling.

According to the Journal Sentinel, the goal of the program is to provide primary care to prevent more costly specialty care or hospitalization in the future.

The program will cost the state about $40 million annually, with the rest of the funding coming from the federal government.