A group of states with a combined population of just under 50 percent of the U.S. population is trying to circumvent the process by which insurers publish premium rates before those published rates reach the marketplace. Ordinarily, individual states would have to receive the approval from their regulatory bodies (insurance commissioners) to review and approve or disapprove rates before they are published in the market. Doctor Pundit readers may recall that one of California’s major insurers, Wellpoint, lowered rate increases after intense media and political pressure forced smaller increases by approx. 7 percentage points.

That state’s IC action has led its lawmakers to consider applying the same statutes to group and individual plans on the open markets. The entire Wellpoint saga couldn’t have come at a worse time for the insurer. With an Arnold Schwarzenegger-approved massive budgetary deficit amid a national slumping economy and presidential push for reform going in high gear, the provider became the poster child for insurance reform in the overall drive of the Obama admin’s push for healthcare reform — garnering critical public support in advance of the law — in the process. States and the HHS would have the power to scrutinize insurance providers considering increases of 10 percent or more.

Insurers are quick to criticize this latest managed care regulatory act, accusing governments of focusing on perceptions of profits by insurers instead of what truly drives healthcare costs — healthcare delivery and utilization. Looks like they may have to get used to things playing out this way, as other states — such as Connecticut, Maine, Massachusetts and New Mexico — are either rejecting rates or adopting legislation to give state insurance commissioners additional rate review authority. | LINK

Related posts:

1. Citing Insurers’ Rate Hikes, Obama Takes Message for Reform to Public Again Any momentum gained by President Obama when the issue of...
2. PA Governor Announces Investigation of Insurers’ Rate Hikes It apparently takes a financial stimulus of a different kind...
3. HHS Desires Insurer Rate Review HHS is issuing guidelines on the process of reviewing rate...

The U.S. Supreme Court will decide if doctors, hospitals, pharmacies and others who provide services to California Medi-Cal recipients can have their payments cut by the state. Medi-Cal, the state’s Medicaid program, is being targeted by Gov. Jerry Brown for 10 percent cuts in reimbursements. Previous attempts to close the $25B state deficit from health welfare and education programs have hit roadblocks with lower federal courts denying the action. About 7M Californians receive their health care through Medi-Cal and about 57 percent of the state’s doctors participate in the program. Make no doubt about it, this case has implications in the wake of a symbolic rejection of President Obama’s signature domestic initiative by the GOP-led House today; since Medicaid funding is generated, in part, by federal dollars — a high profile decision on this case will only add fuel to fire to either side on just how far federal spending should go for states facing similar budget deficit emergencies.

The nation’s highest court must determine if the Medicaid Act gives the federal government unfettered freedom in setting payment rates for providers. Previously, the Ninth Circuit said California’s proposed changes were were trumped by federal law. California says that it has a role in deciding the breadth of cuts in spending on its Medicaid program. Patient advocacy groups and providers, unsurprisingly, are on the sides of the lower courts, concerned that healthcare access for California’s uninsured and working poor will plummet in the wake of the alternative ruling by the U.S. Supreme Court. Can private entities and citizens — unhappy with the level of spending on partially state-funded programs — sue the state to hold on to a current reimbursement structure against the backdrop of state-mandated cuts? | LINK | Case LINK

Related posts:

1. Supreme Court to Hear Univ. Of MN Case Involving Tax Policies on Medical Residents’ Earnings Medical residents are students of medicine. Medical residents are physicians...
2. SCOTUS Won’t Hear Challenge to Reform Law Unsurprising, but still worth noting. The U.S. Supreme Court on...
3. Debt Ceiling Deal Rattles Healthcare Delivery Prospects, Social Security and Medicaid Spared The initial spin on the recently squared away budget deal...

CMS has informed state Medicaid directors the terms of qualification for federal matching funds for administrative costs toward information technological infrastructures. Specifically, states must comply with the following stipulations: administration of Medicaid incentive payments to Medicaid eligible professionals and eligible hospitals; oversight of the Medicaid electronic health record (EHR) Incentive Program; and the pursuit of initiatives that encourage the adoption of certified EHR technology for the promotion of health care quality and the electronic exchange of health information.

Besides the latter bullet point above, the entrance of individual states into EHR IT initiatives carries with it a commitment to Medicaid funds in this era of reform. Some states are already on board, like California — whose governor couldn’t be more excited to get the ball rolling.

“What we are launching today is a new era for healthcare,” Schwarzenegger said. “Through a simple broadband link, this state-of-the-art system will save lives by instantly connecting people from across the state, including under-served and rural areas, with the best and brightest doctors. The California Telehealth Network marks the beginning of a new digital highway that will fundamentally change the future of how healthcare is provided.”

Others, like Minnesota, are leaving some state government agencies — and patients they serve — in a lurch.

Millions of dollars in health care funds seemingly destined for Minnesota after last week’s emergency session of Congress have yet to clear a final hurdle: the signature of Gov. Tim Pawlenty, an outspoken critic of the new federal spending.

UPDATE: In an unsurprising PR move, leading Dem candidate for Pawlenty’s job come November — former one-term U.S. Senator Mark Dayton — wants Pawlenty to just accept fed funds. | LINK

Related posts:

1. MN Governor Announces Plan to Allow Interstate Purchase of Health Coverage Today Minnesota’s governor, who just happens to be a potential...
2. PA Governor Announces Investigation of Insurers’ Rate Hikes It apparently takes a financial stimulus of a different kind...
3. Minnesota’s Governor Finally Accepts Fed Matching Funds for Healthcare Delivery Take all the ingredients: term-limited governor, stalwart GOP ideologue in...

• Hey, most donors of kidneys lead perfectly healthy lives. So, go ahead and donate!
• FDA approves first topical gel for the treatment of urge urinary incontinence.
• Will Obama’s stimulus be given to some states’ fractured healthcare systems? Not soon enough for some in the Boston metro area.
• A woman recently gives birth to octuplets. Heroism or bad medicine?
• California will ask for the removal of a state prison medical overseer to regain control over its medical care delivery.

Gov. Arnold Schwarzenegger and Attorney General Jerry Brown asked the federal courts Wednesday to block a plan to build new medical facilities at state prisons and give control of the prisons’ health care system back to the state. In a filing in U.S. District Court, Brown said the court-appointed receiver in charge of the system “is spending exorbitant sums to create a medical care system that exceeds industry standards and provides more than medical care.”

Related posts:

1. Thursday Newswire: Obama’s New Choice for HHS Sec’y & More Obama appears to be nearing choice for HHS Secretary. Gov....
2. Friday Newswire: The FDA & Medical Device Approval & More Minnesota man gets prison time for trying to scam one...
3. Tuesday Newswire: MN Nurses Overwhelmingly Approve Move to Strike & More It’s on. The mega union only needed 66%. They got...