N.J. hospitals could manage care rather than treat uninsured in ER, under governor’s proposal TRENTON, NJ—New Jersey hospitals would be able to manage the care of uninsured residents who come to their emergency rooms, rather than immediately treating them, under a plan announced by the governor. Hospitals would continue to receive state and federal money for uncompensated care, but they would be able to refer patients to doctors, clinics and treatment centers in the interest of providing more appropriate care at a lower cost. "This will allow hospitals to provide care in the most appropriate setting, which has not been possible in the past," says State Health Commissioner Len Fishman. In 1996, New Jersey distributed $310 million to 75 hospitals to help pay for the medical care of more than 100,000 uninsured people. The plan must receive federal approval before it can be implemented.Recently, the state reported that its uninsured rate had increased from 13% in 1995 to 14.2% in 1996. New York Times, Dec. 13, 1996 Joint venture of Green Spring and CMG to handle Medicaid mental health for 400,000 in Maryland ANNAPOLIS, MD—Mental health care for 400,000 Medicaid recipients in Maryland will be managed by a joint venture of Green Spring Health Services, Inc. of Columbia, MD. and CMG Health Inc. of Owings Mills, MD. The venture is called Maryland Health Partners. Maryland recently won federal approval to move its Medicaid population into managed care. Mental health services will be managed separately by this joint venture, and some uninsured residents also will be covered under the program. Green Spring, founded by Blue Cross and Blue Shield of Maryland in 1989, currently provides behavioral health services to 1 million public-sector clients. CMG has a public sector enrollment of 750,000 Baltimore Sun, Dec. 27, 1996 KY doctors win back $52 million in Medicaid fees in settlement between state and Medical Assn. FRANKFORT, KY—Kentucky doctors have succeeded in getting cuts in provider payments restored to the Medicaid program. As part of a settlement reached with the state, not only will $52 million in reimbursements be restored to the current budget, but physicians will be compensated for cuts covering the 1995-96 fiscal year. The $104 million settlement was negotiated between the state and the Kentucky Medical Association, which filed the suit. Unisys, the company which handles billings for the state Medicaid program, is notifying doctors of the settlement. Payment distribution is expected to be completed by the end of January. In making the cuts, the state had cited a 208% increase in Medicaid payments to doctors over five years. During the same period, there was a 52% increase in Medicaid-eligible residents. Cincinnati Post, Dec. 17, 1996 Wisconsin plans overhaul of long-term care on a par with governor’s welfare reform MADISON, WI—Wisconsin Gov. Tommy Thompson is planning an overhaul of the state’s long-term care system that will rival his overhaul of the state’s welfare program. Still under discussion and likely to be introduced in the spring, the program would blend federal and state money for Medicaid and other assistance programs and individualize long-term care services, with the goal of keeping people out of costly nursing homes whenever possible. Changes for the $2 billion program would be phased-in in 1998. Meanwhile, the governor has abandoned a controversial program that might have sent 400 disabled men and women and frail elderly to nursing homes. In an effort to control long-term-care spending, the state planned to cap home health care for those on Medicaid to the typical monthly cost of nursing home care. Medicaid beneficiaries would not have been able to exceed that spending level. The change was expected to impact the disabled population the most. Gov. Thompson says the state will, instead, save $500,000 through voluntary case management and care coordination. The home care caps were expected to save over $2 million annually, but were not implemented because of a court order requiring the development of administrative rules to cover the home care cost ceiling. Capital Times, Madison, WI, Dec. 17, 1996, Dec. 26, 1996 Maryland doctors back plan to require consent of patients before commission collects data BALTIMORE—Maryland’s medical society, the Medical and Chirurgical Faculty of Maryland, is likely to support legislation that would require informed consent by patients before patient data is collected by the Health Care Access and Cost Commission (HCACC). The commission and the medical society had been working on a compromise, but that compromise fell through. Currently, the commission, which obtains patient information from insurance companies for its statewide database, codes patient names as a confidentiality protection. The HCAC had recently agreed to code doctor names as well in an attempt to avoid the informed consent battle. A group of civil libertarians and doctors has been battling the database, saying the information could be misused and privacy breached. "We continue to believe that informed consent in the case of data anonymously collected is not necessary," says John Colmers, executive director of the HCAC. Baltimore Sun, Dec. 21, 1996 Tennessee mental health centers say statewide managed mental health needs $70 million more NASHVILLE, TN—The TennCare Partners program is underfunded by more than $70 million, the director of an organization representing 28 private, non-profit mental health centers told a joint legislative committee on mental health in Tennessee recently. Launched July 1, TennCare Partners is a managed care program for behavioral health services for low-income residents. Two behavioral health companies manage the program statewide. Dick Blackburn, of the Tennessee Association of Mental Health Organizations in Nashville, says not only is the program seriously underfunded, but it has unraveled the "safety net." "It is obvious by any reasonable measure, the TennCare Partners program is a failure," Mr. Blackburn said in a prepared statement, adding that lawsuits are "likely." Behavioral health care companies blamed some of the problems on fluctuating enrollment in TennCare. One non-profit mental health agency, Spectra Healthcare Systems, says it might close its doors in 1997 because of a shortfall in funds. Spectra president Sloan Young says the agency has been expected to provide outpatient mental health services for less than $35 per month under TennCare Partners, which is "impossible." A possible buyer of Spectra is San Diego-based PMR Corp., which develops and manages programs for the seriously mentally ill. The Commercial Appeal, Dec. 16 and Dec. 20, 1996 TennCare hopes to reopen enrollment to uninsured NASHVILLE, TN—Tennessee is hoping to hark back to the early days of TennCare, the state’s Medicaid managed care program, in at least one respect: the state would like to open enrollment again to the uninsured. TennCare automatically covers Medicaid-eligibles and uninsurable people, but it also was intended to cover the working uninsured who met the income guidelines. However, the number of working uninsured has dropped from 443,000 to 290,000 since the program began in 1994 and no new enrollees have been accepted. Many people were dropped when they could not be contacted by the state or when they failed to pay sliding scale premiums. State officials say opening enrollment is important to keep the program viable. State Finance Commissioner John Ferguson says a major priority in his budget this year will be reopening TennCare to the uninsured. The Commercial Appeal, Dec. 16, 1996 Washington State legislators look for money to add 70,000 residents to Basic Health Plan OLYMPIA, WA—Enrollment in Washington State's subsidized insurance program, the Basic Health Plan, was capped at 130,000 last fall to avoid a huge deficit, but legislators are scrambling around to find more money. Health care leaders of both parties want to boost enrollment to 200,000, a goal agreed upon in 1995 by the same legislature that scrapped many of the 1993 insurance reforms. At that time the BHP was revised so that the state pays more and individuals pay less based on a sliding scale. The average monthly state subsidy for per individual BHP member is $93. Some 65% of families have incomes below 124% of the federal poverty level. Funding for BHP comes from a special account called the Health Services Account. Its revenues are raised mostly from alcohol, tobacco and health insurance premium taxes. The state has also been using the account to fund Medicaid coverage for children. Some legislators want to go to the general fund for Medicaid coverage costs, a move that is contested by other legislators. Seattle Post-Intelligencer, Dec. 13, 1996, WSMA Reports, Washington State Medical Association newsletter, Nov. 1996 NJ to fund care for up to 1,500 Medicaid clients in assisted living residences and other facilities TRENTON, NJ—Over the next three years, New Jersey will be funding care for up to 1,500 Medicaid clients in assisted-living residences, adult foster-care programs, and other facilities. Only a handful of seniors have been placed through the program so far, which mirrors a national trend to move away from expensive nursing home care. The state is trying to recruit other Medicaid-eligible seniors for the program. The state's average reimbursement for nursing home care is about $37,000 per year. For alternative-care facilities, the reimbursement would be from $14,600 to $18,250 a year. In the last five to seven years, the percentage of nursing home residents statewide increased from 58% to 73%, according to the New Jersey Association of Health Care Facilities. The Record (Bergen County, New Jersey) Dec. 30, 1996 MD doctors seek delay in plan to give consumers on-line access to malpractice claims data BALTIMORE, MD—Maryland's largest medical society wants the Board of Physician Quality Assurance (BPQA) to delay plans to give consumers on-line access to a database on physicians until it can give its input. The physician group and BPQA will meet later this month. The database would include malpractice claims filed against physicians. In a letter to the BPQA, Alex Azar, president of the Medical and Chirurgical Faculty of Maryland, says his group was not aware of the board's plans until it read about them in a newspaper report. In a letter to the board, Dr. Azar expressed concerns about the "wide dissemination of information that holds the potential for confusion rather than enlightenment, including frivolous malpractice actions that are filed and later dismissed." In Massachusetts, consumers recently began using a physician profile service which includes only malpractice claims that were resolved against a doctor. The information must be obtained by mail or fax. The profiling being planned in Maryland would be an on-line service. Michael Compton, executive director of BPQA, says all malpractice claims filed in the state go to the state’s health claims arbitration office. Since 1989, consumers have been able to obtain claims information and other information about physicians by contacting BPQA. Three years ago, BPQA started developing a database so that hospitals could access the information electronically. Mr. Compton says the BPQA thought it would save staff time and paperwork if consumers could also access the information on-line instead of getting it through the mail. Since 80% of malpractice claims are dismissed in favor of physicians, Mr. Compton says he understands why physicians may feel it is misleading and may be concerned about wider access. Baltimore Sun, Dec. 18, 1996, Medical and Chirurgical Faculty of Maryland letter, State Health Watch.