A project of the Galen Institute

Issue: "Social Impact"

Narrow Networks Bill Passes Floor Vote

David Gorn, California Healthline
Fri, 2014-08-29
"The Assembly this week approved a bill to limit narrow networks in California's health plans. The legislation already passed a Senate vote and is expected to get concurrence today on the Senate floor and move to the governor's desk for final approval. SB 964 by Sen. Ed Hernandez (D-West Covina) directs the Department of Managed Health Care to develop standardized methodologies for health insurers to file required annual reports on timeliness compliance, and requires DMHC to review and post findings on those reports. It also eliminates an exemption on Medi-Cal managed care plan audits and requires DMHC to coordinate those plans' surveys, as well. "I introduced the bill in response to complaints we’ve heard about inadequate networks in the Medi-Cal program, as well as at Covered California," Hernandez said.

Cover Oregon turnaround consultant's bills grew to $600,000-plus as exchange obstacles multiplied

Nick Budnick,The Oregonian
Fri, 2014-08-29
"The price tag of the Cover Oregon health insurance exchange fiasco continues to grow. As Clyde Hamstreet, the corporate turnaround expert hired to lead Cover Oregon in April, wraps up his work he leaves behind a stabilized agency – and a hefty bill. Initially signed to a $100,000 contract, Hamstreet ended up staying longer than expected, with two associates joining him at Cover Oregon after Gov. John Kitzhaber essentially forced out three top officials there in a public display of house-cleaning. Through July, Hamstreet has billed $598,699 on an amended $750,00 contract. He hasn't submitted his August invoice. He says the price tag was driven by the exchange's increasing needs, as his firm stayed longer and did more than initially planned. "We didn't do this job to make a lot of money off the state," he said Thursday. "Our philosophy was to try and help get the boat righted and try to help clean things up and basically help the state. ...

As many as 1 in 5 exchange enrollees affected by technical problems, staff concedes

Carol Ostrom, Seattle Times
Fri, 2014-08-29
"A lack of transparency in describing and fixing technical problems became an issue in Thursday’s Washington Health Benefit Exchange Board meeting. Board member Bill Hinkle grew testy at what he said was mutual staff back-patting and excuses for the problems still plaguing thousands of accounts. “C’mon you guys, let’s quit blowing smoke here,” Hinkle said. “I’m tired of patting people on the back….We’re not doing great yet.” Board member Teresa Mosqueda pressed staff for numbers of enrollees affected by technical problems. “We really need to have the data in front of us to manage some of these issues,” she said.

Reform Update: Facing ACA mandates, insurers diversify into technology

Beth Kutscher
Modern Healthcare
Fri, 2014-08-29
"Health insurance companies, now required to spend the lion's share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they're increasingly putting money into technology ventures where they expect to realize higher returns. The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans. Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them. "That's been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We're really seeing it on a national scale.

Beware Of Higher Charges If You Go To An Out-Of-Network Emergency Room

Michelle Andrews
Kaiser Health News
Fri, 2014-08-29
"When you need emergency care, chances are you aren’t going to pause to figure out whether the nearest hospital is in your health insurer’s network. Nor should you. That’s why the health law prohibits insurers from charging higher copayments or coinsurance for out-of-network emergency care. The law also prohibits plans from requiring pre-approval to visit an emergency department that is out of your provider network. (Plans that are grandfathered under the law don’t have to abide by these provisions.) That’s all well and good. But there are some potential trouble spots that could leave you on the hook for substantially higher charges than you might expect.

More Data to Be Withheld from Database of Physician Payments

Charles Ornstein, Pro Publica
Fri, 2014-08-29
"A new problem has emerged with the federal government's Open Payments system, which is supposed to go live Sept. 30 and disclose payments to physicians by pharmaceutical and medical device companies. A couple weeks ago, the U.S. Centers for Medicare and Medicaid Services said it would be withholding information on one-third of the payments, citing data inconsistencies in company submissions. Now, a source familiar with the matter tells ProPublica that CMS won't disclose another batch of payments: research grants made by pharmaceutical companies to doctors through intermediaries, such as contract research organizations.

Talks on Pennsylvania Medicaid plan said to be nearing end

The Associated Press
Thu, 2014-08-28
"An announcement could be made soon on Pennsylvania Gov. Tom Corbett's plan to use billions of federal Medicaid expansion dollars under the 2010 healthcare law to subsidize private health insurance policies, a spokeswoman said Wednesday. Kait Gillis, a state Department of Public Welfare spokeswoman, said negotiations with the federal government are in the final stages, but details remain under wraps. HHS officials did not immediately respond to a request for comment Wednesday, and the federal agency consistently has declined to publicly discuss details of Corbett's plan. The 124-page plan was formally submitted in February, and closed-door negotiations began in April after a public comment period."

Why that one Democratic Obamacare ad didn’t signal a new trend

Matea Gold
The Washington Post
Thu, 2014-08-28
"When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it's become clear: there's little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign. "It’s basically the first pro-Obamacare ad we’ve seen by a vulnerable Democrat for months," said Elizabeth Wilner, senior vice president of Kantar Media Ad Intelligence, whose Campaign Media Analysis Group tracks political advertising. "It’s like seeing a unicorn – it just doesn’t happen very often.""

The obscure part of Obamacare that takes on executive pay

Jason Millman
The Washington Post
Thu, 2014-08-28
"We all know Obamacare is a pretty big law, with plenty of obscure provisions that don't get much attention. For one, the law targets big executive pay packages at health insurance companies — and based on data released Wednesday, the provision is already going a long way. Companies have long been able to deduct salaries to top executives from their federal tax bills, although since the early 1990s — in an effort to reduce excessive pay — the government has limited the amount to $1 million. Starting last year, a piece of the Affordable Care Act lowered the limit to $500,000 for health insurers (although the $1 million limit still applies to the rest of corporate America). It also eliminates the tax carve out for what tends to be much more lucrative performance pay, like stock options, for health insurers.

Consumers deal with insurance deadline, site glitches

Jayne O'Donnell, USA Today
Thu, 2014-08-28
"Hundreds of thousands of people risk losing their new health insurance policies if they don't resubmit citizenship or immigration information to the government by the end of next week -- but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying. Consumers are being forced to send their information multiple times, and many can't access their accounts at all, immigration law experts and insurance agents say. The Centers for Medicare and Medicaid Services sent letters to about 310,000 consumers two weeks ago, telling them they need to submit proof of their citizenship or immigration status by Sept. 5 or their insurance will be canceled at the end of the month. CMS spokesman Aaron Albright says letters were sent only to people for whom the government has no citizenship or immigration documentation.

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