Clip files / Local news from the states

This column features selected short items about state health care policy.

Supreme Court justice blocks late-term abortion bans

WASHINGTON, DC—Enforcement of Illinois and Wisconsin laws prohibiting certain late-term abortions has been put on hold by Supreme Court Justice John Paul Stevens.

The justice’s action challenges a 7th U.S. Circuit Court of Appeals decision upholding the laws, but is consistent with a September ruling from a separate appeals court throwing out similar laws in Nebraska, Arkansas, and Iowa. The conflicting results suggest that the Supreme Court will agree to step in to resolve the issue.

—Associated Press/VoxCap, Nov. 30

DC Medicaid slow in making court-ordered DSH payments

WASHINGTON, DC—The DC government is struggling to pay more than $30 million in overdue Medicaid payments it owes five district hospitals.

The so-called disproportionate share payments are due to the hospitals under DC statute for serving a greater than average number of low-income patients. In defending the District of Columbia in a suit brought by the hospitals, Paul Offner, former District Medicaid chief now with Georgetown University Medical Center, said the city did not make timely disproportionate share payments because it would have been a financial hardship. An enraged District Court Judge Stanley Sporkin called the District’s position "contrary to common sense" and on Nov. 1 ordered the payments to be made.

Washington Business Journal, Nov. 8, 15

Tennessee governor proposes downsizing TennCare

NASHVILLE—Gov. Don Sundquist in late November unveiled the latest in a series of strategies to rein in TennCare, the controversial health care program that covers nearly a quarter of the Tennessee’s residents.

Major changes include temporarily closing enrollment to all but uninsured children and the Medicaid eligible, limiting TennCare benefits and increasing premiums for many of the program’s participants. Some of the changes that address the operations of managed care organizations and behavioral health organizations likely will require federal approval of a change to Tennessee’s Section 1115 waiver. Others, such as those that deal with administrative efficiencies, will go into effect Jan. 1.

The 12-steps proposed by Mr. Sunquist are the following:

• Temporarily close TennCare enrollment to adults who are not eligible for Medicaid. This category includes those who have higher incomes than are permitted under traditional Medicaid guidelines and those whose health conditions have made them "uninsurable."

• Revise the TennCare benefits package, including limits on prescription drugs and home health services for adults.

• Increase premiums for adults with family incomes at or above 200% of poverty.

• Assume control of the pharmacy program.

• Eliminate deductibles and implement a flat copay system for enrollees.

• Reverify current non-Medicaid members and strengthen program integrity by further reducing fraud and abuse.

• Amend contracts with managed care organizations (MCOs) and behavioral health organizations (BHOs) to eliminate advertising expenses and implement an administrative cap on MCOs.

• Standardize provider billing procedures and requirements for electronic filings

• Prohibit MCOs and BHOs from waiving enrollee copayments and offering additional benefits other than cost-effective alternatives.

• Improve due process and education procedures for enrollees.

• Establish a "Pediatric Primary Care Provider Pool" to improve access to preventive health screenings for children.

• Make TennCare organizational improvements, including greater provider input.

In November, state officials released $60 million in provider payments, part of a $128 million boost approved by the legislature for the fiscal year ending June 30, 2000.

—Office of the Governor, Nov. 30; Nashville Tennessean, Nov. 12

HCFA approves expansion of California’s CHIP

WASHINGTON, DC—The Health Care Financing Administration has approved an expansion of California’s Children’s Health Insurance Program, that state officials hope will cover an additional 132,000 children by 2001.

The amendment raises the eligible family income in Healthy Kids, California’s separate CHIP initiative, from 200% to 250% of the federal poverty level. The original plan, approved in 1998, established Healthy Kids and expanded Medi-Cal, California’s Medicaid program. As of November 1999, the original plan had enrolled more than 230,000 children.

The amendment also expands retroactive coverage for medical services from 30 days to 90 days prior to enrollment in the Healthy Families Program and permits applying Medi-Cal income deductions when determining the income level of Healthy Families Program applicants.

—HCFA release, Nov. 23