Health Care Reform News Around the Nation for the Week of Sept. 22

Florida

An estimated 51,000 children in the Florida Healthy Kids program will have to switch HMOs and possibly physicians starting on Oct. 1, Florida Health News reports.

The change comes after the program for the first time asked HMOs across the state to submit bids in all 67 Florida counties.

Jennifer Kiser Lloyd, chief external officer for the program, said the state in August mailed letters to the families of the 51,000 affected children alerting them of the change.

The change will not affect the types of benefits provided, but it could affect access to physicians, prescription drug benefits and prior authorization policies. To help prevent problems, Florida Healthy Kids requires incoming HMOs to coordinate care with outgoing providers.

In addition, Lloyd said HMOs have been encouraged to share information on long-standing prior authorizations and referrals. She said that the top issue for families will be whether their primary care physicians are in the new HMO network (Sexton, Florida Health News, 9/16).

Massachusetts

Earlier this month, the Massachusetts Department of Public Health ordered all hospital emergency departments in the state to stop diverting ambulances to other hospitals as part of an effort to relieve ED overcrowding by January 2009, the Boston Globe reports. Hospitals on diversion status only accept trauma and burn patients and walk-ins, but patients with other ailments are diverted to a different hospital.
Under the new rule, diversions will be prohibited in nearly all cases except in the event of a serious internal emergency, such as a fire.

Alasdair Conn, chief of emergency services for Massachusetts General Hospital, said the new rule likely will be a serious challenge for hospitals that have long relied on the practice (Kowalczyk, Boston Globe, 9/13).

Rhode Island

At least eight congressional leaders, including the entire Rhode Island delegation, have written letters to officials urging more disclosure and transparency in negotiations between Rhode Island Gov. Donald Carcieri's (R) administration and CMS officials about the state's request for a "global Medicaid waiver" that would permit broad changes to the state's Medicaid program, the Providence Journal reports (Peoples, Providence Journal, 9/16).

 

In adopting a global waiver, the governor would agree to limit Medicaid spending to $12.4 billion through 2013.

State Department of Human Services Associate Director Murray Blitzer said that if the state runs out of its allotted funds before the five-year mark it will lose matching federal funds, which would force the state to pay the program's full cost or cut services.

In exchange for capping spending, the state would receive broad authority to change services, such as nursing home care, subsidized transportation for the elderly and beneficiaries with disabilities, health insurance for low-income children and parents, and prescription drug coverage for seniors.

If approved, the waiver is expected to save the state an estimated $67 million this year (California Healthline, 8/4).
Rhode Island Department of Human Services Director Gary Alexander said state officials will meet with CMS officials in the next few weeks to formally begin negotiations for the proposal.

Early last week, a spokesperson for Sen. Jay Rockefeller (D-W.Va.) confirmed that Bush administration officials had scheduled a private briefing for congressional leaders later in the week to discuss the proposal (Providence Journal, 9/16).

Utah

Utah's Medicaid preferred prescription drug list in its first year has reduced spending by nearly $546,000, but the savings fell about $2.75 million short of original estimates by the Utah Department of Health, according to Michael Hales, the director of the state Division of Health Care Financing, the Salt Lake Tribune reports.

According to health department Director David Sundwall, the full savings of the program was not achieved in part because of changes to legislation that created the preferred drug list.

The Tribune reports that state lawmakers were concerned Medicaid costs could increase if beneficiaries had complications or reactions with preferred drugs, and they approved an amendment to the bill that allows physicians to write "dispense as written" on prescriptions, rather than requiring prior authorization.

In addition, Hales said that the full savings projections were not met this fiscal year because drugs were added to the list over several months. He said that in 2009 all drug classes will be included on the list and administrative costs will be lower, which could reduce Medicaid spending by nearly $1.2 million.

Sundwall said he intends to ask lawmakers to reinstate the prior authorization requirement for physicians to prescribe drugs that are not on the preferred list.

In addition, the state health department currently is working with the Utah Medical Association to approach physicians who most frequently prescribe drugs not on the list. The health department also will request that the state Legislature redefine "psychotropic" so additional drug classes can be placed on the list (Rosetta, Salt Lake Tribune, 9/18).