Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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December 31, 1997
CT attorney general sues BCBS of Connecticut, demanding assets be distributed to charity
HARTFORD, CT—Connecticut filed suit Dec. 2 against Blue Cross Blue Shield of Connecticut and Anthem Insurance Companies, Inc., claiming that their Aug. 1 merger subverted Blue Cross’ charitable purpose.
The lawsuit, filed by a Hartford law firm representing Attorney General Richard Blumenthal, asks Hartford Superior Court to bar the companies from distributing the assets privately and direct that they be given to a charitable organization. The suit also asks for unspecified punitive damages.
Blue Cross Blue Shield, which had assets of $606 million as of June 30, said it would vigorously contest the suit and immediately launched a direct-mail and advertising campaign charging that the lawsuit could deprive its 900,000 policyholders and members "of the monies needed to stand behind their claims."
The state’s suit is the latest of several legal actions challenging the merger of the two companies. The North-Haven-based insurer is now called Anthem Blue Cross and Blue Shield of Connecticut. Late last month, a Hartford Superior Court Judge refused to dismiss lawsuits filed in September by state Comptroller Nancy Wyman, the Connecticut Employees Union Independent SEIU Local 511, and a West Hartford law firm.
The lawsuits deal with concerns that the merger will eventually allow the transfer of assets from the Connecticut company to its new parent.
The Hartford Courant, Dec. 11, Dec. 3, Nov. 27, 1997.
Minnesotans in self-funded plans have most to gain from federal adoption of managed care bill of rights
ST. PAUL, MN—The two million residents in Minnesota who obtain their insurance from self-funded plans would have the most to gain from adoption of the presidential advisory commission’s bill of rights on managed care.
Minnesota has a bill of rights. passed by the Legislature this year, which offers protections to residents in managed care plans and in indemnity plans.
"The beauty of the Clinton plan is that it would pull in the self-insureds," said Tom Williams, health services analyst with the managed care systems section of the Minnesota Health Department. "It will level the playing field in the marketplace, which will be good."
One of the differences between the state’s bill of rights and the federal bill of rights is a provision in the federal proposal requiring direct access to specialists for patients with serious medical conditions.
"We don’t know what serious medical conditions’ means," Mr. Williams said, "but in the state’s Patient Protection Act, there is a requirement that if the health plan requires a referral to a specialist, it must have a plan that lets people know how to obtain a referral."
"The federal proposal also calls for a mechanism for consumers to appeal denials of care by their health plans to a neutral party. Minnesota legislators dropped this clause from the state’s bill of patient rights, but a new proposal may be re-introduced in the 1998 session.
St. Paul Pioneer Press, Nov. 25, 1997
Minnesota doctors challenge health plans to cover more smoking cessation treatments and programs
ST. PAUL, MN—On the eve of the state’s annual "Don’t Smoke Day," the Minnesota Physician-Patient Alliance, a nonprofit organization formed by more than 700 physicians in July, charged that the three biggest health plans in the state weren’t doing enough to help their members quit smoking.
"They’re locked into this we don’t do this, we don’t do that,’ and if that’s where they’re starting from, that’s no way to get their patients to stop smoking," said Dr. Neal Holtan, a specialist in preventive medicine who is director of the St. Paul Public Health Department.
The MPPA wants the plans to cover all smoking cessation therapies, from nicotine patches and stop-smoking classes to promising new drugs such as Zyban, an anti-depressant.
All three plans bristled at the accusation that they don’t do enough to get people to quit smoking. Dr. Rob Jeddeloh, director of clinical health improvement for Allina Health Plans, the parent company of Medica, said he has put a proposal before upper management to cover nicotine patches. He said about 20% of the plan’s members smoke and the original estimate to cover patches had been pegged at $2 million. But because not all smokers would want to use them, that estimate has been ratcheted down to $500,000.
Blue Cross Blue Shield covers the cost of physician counseling during a trip to the doctor’s office. However, products like the nicotine patch and nicotine gum are now available without prescription and the insurer does not cover over-the-counter drugs, a spokesperson said.
HealthPartners has concentrated on keeping people, especially teenagers from starting to smoke and has developed counseling programs for smokers who want to quit, said Dr. Leif Solberg, clinical director of research for the Group Health Foundation in HealthPartners.
"If all those treatments went away tomorrow, we would see little or no change in smoking cessation rates," he said.
St. Paul Pioneer Press, Nov. 19, 1997
Arizona counties get relief from long-term- care costs
PHOENIX, AZ—Arizona lawmakers gave some fiscal relief from long-term-care costs to Arizona’s 15 counties during a special session of the Legislature. The counties have been complaining for years that the escalating cost of the Arizona Long Term Care System (ALTCS) was slowly pushing them into bankruptcy.
The annual cost of ALTCS has exploded to $450 million in recent years, with two-thirds funded by the federal government and the remaining one-third funded by the counties. Counties say their share of the costs has been rising by as much as 10% a year while their revenues have increased by just 6% per year. Many of them have been forced to significantly increase their property taxes. One county which has little taxable property revolted by not paying its bill to the state.
The state has promised to assume responsibility for the program in the near future, but, in the meantime, the state will pay half the cost of any increase in the long-term-care program. Lawmakers also approved a change in the formula so counties would only pay for the services they use.
Arizona Republic, Oct. 28, Nov. 15, 1997
Connecticut ob/gyns press health plans to cover new screening test for cervical cancer
AVON, CT—An organization of 133 obstetricians/gynecologists called Women’s Health Connecticut has sent letters to 12 leading insurers and HMOs urging that they pay for a new screening test for cervical cancer.
ThinPrep, developed by Massachusetts-based Cytyc Corp. and approved last year by the Food and Drug Administration, misses fewer serious lesions and has fewer false positive results than pap smears, said doctors in Women’s Health Connecticut. Recent studies, they said, show ThinPrep has a 65% higher rate of cancer detection than Pap smears.
Samples are gathered the same way, but they are processed differently. The different process results in fewer positive results that may be due to inflammation or benign atypical cells.
While a ThinPrep screen is more expensive, costing $40-$45 compared with $20-$25 for a pap smear, use of the test could spare many women needless anxiety and save insurers money. The more accurate test would forego the need for follow-up visits and further testing.
Hartford Courant, Nov. 25, 1997
NYC’s public advocate says poor compliance
with state’s new managed care bill of rights is norm
NEW YORK—New York’s 1996 Managed Care Bill of Rights "is observed in the breach," said New York City’s public advocate, Mark Green, in announcing the results of a survey by his office to check compliance with the new law. "Our 350-plus calls and letters quantified that HMOs are routinely refusing to supply mandated information to potential consumers."
Another survey by a coalition of 200 consumer advocacy organizations announced similar findings. Among the problems, the studies found that patients are paying greater out-of-pocket costs for drugs they wrongly think are covered by their plans, and are failing to seek specialty care because they do not know if it is covered.
To insure that all consumers get the information they need, Mr. Green urges in his report that the state Health Department and the state Insurance Department conduct their own surveys and fine companies that violate the law.
In its report, the New York City Task Force on Medicaid Managed Care recommends creating a centralized ombudsman program to provide an independent source of information and assistance to all managed care consumers.
"The system as it exists is chaotic and therefore potentially hazardous to consumers," said Elisabeth Benjamin, a staff lawyer at the Legal Aid Society. "People don’t know how to get help and nobody is centrally collecting data. Meanwhile, community-based organizations are overwhelmed trying to act as advocates for consumers, without the proper funding."
But, a spokeswoman for the HMO Council and Conference of New York said that adding ombudsmen would be counterproductive. "Another layer of bureaucracy isn’t always helpful and may be even more confusing," said the spokeswoman, Amy Nacinovich.
New York Times, Dec. 5, 1997
New Jersey psychologists seek speedy trial on suit over their loss of MCC Behavioral Care contracts
HACKENSACK, NJ—Seeking a speedy hearing in federal court, the New Jersey Psychological Association and seven psychologists who filed a lawsuit against one of the nation’s largest managed behavioral health care companies, have agreed to limit their lawsuit to three of eight original counts.
The lawsuit will proceed on three counts—that MCC Behavioral Care, Inc., a subsidiary of CIGNA located in Eden Prairie, Minn., terminated the therapists when they exercised their professional judgment and asked for more sessions than MCC wanted to allow, that MCC hindered the psychologists’ ability to earn a living, and that the fired therapists should have received a full and fair hearing. The therapists said they were dropped from MCC’s network because they were considered "not managed care compatible."
The Record, Bergen County, NJ, Nov. 26, 1997
New Jersey debates plan to replace charity care reimbursement system with new taxes and fees
TRENTON, NJ—The battle over how to reimburse private hospitals for charity care has moved to the next stage in the wake of a report by a 36-member advisory committee appointed by Gov. Whitman.
The committee’s proposals included raising the cigarette tax by 25 cents per pack, from the current 40 cents, and imposing a mixture of employer and hospitals fees. The committee said the process would produce the roughly $300 million needed each year for charity care. "Using general-fund revenues could increase accountability and oversight through the annual budget process," it said.
According to Kala Ladenheim, a charity care researcher at George Washington University’s Institute for Health Policy Outcomes and Values, as of last year, 27 states had an explicit system for helping hospitals defray the cost of charity care. The rest largely left hospitals to swallow the cost themselves, often by grafting a small surcharge onto other patients’ bills, she said.
New Jersey has been among the minority of states with a formal system that dedicated a separate pool of money to the cause. Its four-year-old Health Care Subsidy Fund, financed largely by a surplus in the state unemployment fund, once was seen as a promising alternative. But, most states now look to an alternative that is considered more reliable—a mixture of special taxes or fees, which are funneled through the general budget back to hospitals.
Philadelphia Inquirer, Nov. 25, 1997.
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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