Roundup: Texas probes Xerox in Medicaid overbilling; Miss. abortion clinic fights to stay open

The Wall Street Journal: Xerox Eyed In Texas Medicaid Probe
Texas authorities are investigating whether Xerox Corp. played a role in allowing dentists to allegedly overbill the state's Medicaid system by millions of dollars. Like many states, Texas contracts with Xerox to process forms submitted by dentists, who seek a determination about whether procedures they intend to perform are covered by Medicaid, a federal-state program that insures lower-income people. The company evaluates whether the planned procedures are medically necessary (Koppel, 9/3).

Los Angeles Times: Crackdown On Small-Business Healthcare Self-Insurance Faces Delay
Efforts to more closely regulate a controversial form of healthcare self-insurance being sold to small employers ran into business opposition in the final weeks of the Legislature's session and got shelved for now. But California Insurance Commissioner Dave Jones and other backers of the crackdown on company self-insurance vow to bring back the legislation, possibly during a special session on healthcare expected in December (Terhune, 9/4).

The Associated Press: Retirees To Rural Areas Won't Find Docs
Nina Musselman had no trouble finding a family doctor when she retired to rural Oregon nine years ago to be closer to her children. But then that doctor moved away, leaving her to search for another who would take Medicare. After a year of going from doctor to doctor, she finally found one who stuck (Barnard, 9/2).

The Associated Press: Feds Want More Time On Maine Medicaid Cut Request
The federal government on Friday responded to the governor's request to allow cuts in Medicaid programs, but rather than provide concrete answers it asked for more time to study the matter. Cuts due to take effect Oct. 1 would eliminate Medicaid coverage for 19- and 20-year-olds, remove 1,825 people from the Medicare Savings Program and increase eligibility requirements for non-disabled, non-pregnant adults on Medicaid (Adams, 8/31).

Kaiser Health News: California Pilot Offers Caveats For Moving 'Dual Eligibles' To Managed Care
As federal officials evaluate state proposals to move millions of the nation's poorest and sickest individuals into managed care plans, they might consider a recent report from the California HealthCare Foundation. The report analyzed California's year-long transition of 240,000 low-income seniors and people with disabilities from fee-for-service plans into managed care as part of a federally approved demonstration project. Beneficiaries had to pick a managed care plan, or the state assigned one to them (Carey, 9/4).

Politico Pro: Miss Abortion Clinic Fights To Survive
Mississippi's lone abortion clinic won a six-month reprieve from a new state law threatening its existence this spring. But now, it's buried in paperwork as it fights to stay open. The law, which went into effect in July, requires all physicians on the clinic's staff to be certified OB-GYNs with hospital admitting privileges. The Jackson Women's Health Organization went to court and a federal judge granted a partial preliminary injunction, giving the clinic six months to try to comply without a penalty from the state (Smith, 8/31).

California Healthline: Support Fades For Healthy Families
The Legislature never had a chance to hear arguments in favor of reinstating the Healthy Families program. The last day of the legislative session came and went on Friday with no movement on the two bills that would have reversed the planned conversion of nearly 880,000 children from Healthy Families to Medi-Cal managed care plans. A statement from the California Children's Health Coverage Coalition -- a collection of six children's advocacy groups in California -- said lawmakers missed a chance to restore a successful program and save money for California (Gorn, 9/4).

Milwaukee Journal Sentinel: ERs In Milwaukee County Restricting Opioid Prescriptions
Emergency room departments in Milwaukee County are adopting new guidelines that discourage doctors from prescribing narcotic painkillers to patients with chronic pain. The effort is designed to stem a growing epidemic of prescription drug abuse as addiction and fatal overdoses from painkillers have skyrocketed across the country. Emergency doctors are frequently confronted by patients asking for refills of prescription painkillers such as OxyContin, Vicodin and Percocet (Gabler and Fauber, 9/2).

Milwaukee Journal Sentinel: Walker Seeks Federal Extension Of SeniorCare
Gov. Scott Walker on Friday sought from federal officials an extension of the state's popular prescription drug program for seniors. The SeniorCare program depends on authorization from the federal government that runs out at the end of this year and will be handled by President Barack Obama's administration. "I am committed to making sure SeniorCare remains available to those who need it. Today, the (state) Department of Health Services, with my full support, submitted a renewal request to keep SeniorCare intact through 2015," Walker said in a statement (Stein, 8/31).

Kansas Health Institute News: First Franchise Dental Practice Opens In Kansas
Last year, in an attempt to bring services to underserved communities, Kansas liberalized rules against corporate ownership of dental practices. And on Aug. 28, amid promises to serve hundreds of low-income clients, Colorado-based Comfort Dental opened its first Kansas franchise here in a strip shopping center along the busy State Avenue corridor. The company has a simple philosophy, said founder and chief executive Dr. Rick Kushner: "Be open, make it cost less and be nice to people" (Sherry, 9/3).

WBUR: How's Mass. Doing On Children's Mental Health? Um, We Don't Know
The school year is just beginning, but the state has already been slapped with a "Needs Improvement" on a critical aspect of children's mental health care. It got a great big fat F for its efforts -; or rather, the lack thereof -; to collect data on what's being done in children's care and the outcomes it brings. Massachusetts leads on many health issues, but gathers so little data on children's mental health care that the Children's Mental Health Campaign coalition found it simply couldn't issue a report card on an array of aspects of children's care as it had planned. Instead, it is calling attention to the lack of data and its attendant problems. Actually, it issued not so much an F as an Incomplete -; something like "No grade is possible when you have turned in no papers and taken no tests" (Goldberg, 9/4).

WBUR: Tufts, Vanguard To Launch New Health Insurance Program
Tufts Medical Center, its physicians, and the for-profit Vanguard Health Systems are sponsoring the first member-run health insurance plan in Massachusetts. Tufts and its partners won federal approval and $88.5 million dollars to launch a new health insurance option -; Minuteman Health -; around lower cost hospitals and providers with benefits designed by the members. And members will decide how to spend surpluses or profits, says Minuteman Health board chair Ellen Zane. "The surpluses will either go back to reducing the cost of the premiums or enhancing the benefits in the products. That is a major difference for this kind of product in the market," Zane said (Bieber, 8/31).

The Boston Globe: Tufts Medical Center To Help Start Member-Owned Insurance Plan
Tufts Medical Center, its physician group, and the publicly traded parent company of MetroWest and St. Vincent hospitals have been awarded an $88.5-million loan by the federal government to create what would be the state's only member-owned health insurance plan. The nonprofit Minuteman Health Initiative expects to offer coverage in Eastern and Central Massachusetts starting in January 2014, and its backers said its ownership structure would help the initiative lower costs (Conaboy, 9/1).

http://www.kaiserhealthnews.orgThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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