Clip files / Local news from the states
Help available for implementing CHIP from National Academy for State Health Policy
PORTLAND, ME—A collection of the Children’s Health Insurance Program (CHIP) case studies and a user’s guide have been released by the National Academy for State Health Policy (NASHP) to help state officials with program implementation and evaluation.
The user’s guide, Framework and User’s Guide for State Evaluation of the Children’s Health Insurance Program, is intended to help states meet a mandatory March 2000 deadline for evaluation of their CHIP plans. While its use is voluntary, the user’s guide was designed by a workgroup of state and federal officials, who have petitioned states to use the framework as a way of standardizing data collection and analysis.
Copies of the report are available through the academy at (207) 875-6354.
—NASHP release, Aug. 13
President Clinton announces initiatives to boost Medicaid and CHIP enrollments
ST. LOUIS—On-site reviews by federal workers are among the initiatives announced by President Clinton recently to gig states into boosting enrollment in Medicaid and the Children’s Health Insurance Program (CHIP).
Mr. Clinton also used a speech at the National Governors Association to make a pitch for greater involvement in school-based outreach and increased funding for health insurance from states’ tobacco settlements.
While saying CHIP is too new to "rush to judgment" on its success, Mr. Clinton called on states to improve the level of data reporting to the federal government. "We can’t improve the program or know what’s wrong with it unless we know how many children have signed up for it," he said.
—White House release, Aug. 8
Fort Worth loses provider-sponsored Medicaid HMO, Harris Methodist
FORT WORTH, TX—The second-largest Medicaid HMO in the Fort Worth metropolitan area is leaving the market.
The announcement by the provider-sponsored Harris Methodist Health Plan gives 13,450 plan enrollees 90 days to choose among the four remaining Medicaid plans in the area.
The largest, Americaid Community Care, has 23,300 of the 40,000 Medicaid enrollees in the six-county service area.
The announcement from Harris, which has participated in the Medicaid managed-care program since its rollout three years ago, did not explain why it was dropping the HMO. The overall average monthly per member per month payment in the Tarrant area will be $186.17 for each member in fiscal 2000, up from $174.72 in fiscal 1999.
—Fort Worth Star-Telegram, Aug. 26
UNOS halts attempt to exclude Illinois from Midwest referral region
CHICAGO—The United Network for Organ Sharing (UNOS), the Richmond, VA-based agency that oversees the distribution of donated organs, halted in late August an attempt by four Midwest states to establish a referral region that excludes Illinois.
Minnesota, Wisconsin, and the Dakotas have crafted a plan that trims Illinois from the existing five-state referral region. The four states had been negotiating with Illinois for inclusion in the agreement for when the directive came from UNOS. The agency also directed members in the five states to enter into a formal conflict resolution process.
Under the proposed program, livers would be distributed to the sickest patients within the four-state area without regard to state boundaries. States donating the organs would expect reciprocity at some future date.
The plan follows recommendations from the Institute of Medicine, which concluded that catchment areas should contain at least 9 million people to increase the allocation of livers to patients with the most urgent need for transplants. The four states — with a total population of 11 million — are currently part of a transplant region with Illinois, which has a population of nearly 12 million.
—American Hospital Association release, Aug. 30; St. Paul Pioneer Press/AP, Aug. 15
New York recruits help of maternity staff to ensure women in labor know HIV status
ALBANY, NY—Hospital maternity staff in New York are required to offer an HIV test to all women in labor who did not get one during prenatal care.
The requirement, which went into effect Aug. 1, is designed to move New York closer to universal prenatal HIV counseling and testing, says a letter from Health Commissioner Antonia Novello, MD, MPH, to the state’s health care providers. In 1997-98, about 58% of the women delivering had been tested. State officials estimate that about 200 women deliver each year without learning their HIV status.
The results of the HIV tests are to be returned as soon as possible, no later than 72 hours. If a woman refuses testing, testing will be done on the infants with the results returned in about the same time period.
—Letter from NY Health Commissioner Antonia Novello, June 1999
Washington state insurer agrees to pay fines for denying ER claims; three other targeted companies continue to negotiate
SEATTLE—QualMed Washington will pay a $250,000 fine and the cost of up to 113 denied emergency room claims under an agreement reached with state regulators over the interpretation of the state’s "prudent layperson" statute.
Negotiations are ongoing with Aetna U.S. Healthcare, Regency BlueShield and Premera Blue Cross over whether they complied with laws requiring payment for emergency room visits a "prudent layperson" would consider an emergency.
State Insurance Commissioner Deborah Senn is maintaining that more than half of the emergency-room claims denied by the insurers in the first four months of 1998 should have been paid. She said QualMed did not intentionally break the law, but rather denied the claims because of insufficient medical notes from emergency-room doctors.
QualMed, the state’s fifth-largest health insurer with more than 132,000 subscribers, will change its policies for processing claims and give doctors more say over what constitutes medical emergencies.
—Seattle Times, Aug. 20
Compliance officers meet in Chicago
Health Care Compliance Association: Third Annual Compliance Institute, Oct. 24-27, Chicago Marriott. For more information, call (888) 580-8373 or visit the Web at www.hcca-info.org.
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