The Colorado Rural Health Center and ClinicNET are celebrating the 5th annual Safety Net Clinic Week (SNCW) August 18th through the 22nd! In an effort to raise awareness about the diversity and impact of Colorado's healthcare safety net, this week is devoted to educating public officials and the community about these vitally important healthcare clinics - federally certified Rural Health Clinics (RHCs) and Community Safety Net Clinics (CSNCs).
RHCs and CSNCs provide access to primary care serves for individuals and families that are low-income, underinsured and uninsured and to those residing in rural and frontier communities. Patients who are uninsured and do not qualify for public insurance are often asked to pay for services as a flat fee or on a sliding fee scale based on their income level, and some clinics are free.
More information about SNCW 2014 will be coming soon. Think about hosting an open house or offering tours to your elected officials. It’s a great opportunity to showcase what you do to provide access to health in your community!
Wednesday, June 25, 2014
340B Drug Discount Program Under Scrutiny
The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25 to 50 percent discount. Participants can then charge higher rates to insured patients and keep the additional revenue.
To qualify for the program, hospitals and clinics must meet federal requirements, such as non-profit status, serving a certain percentage of low-income or uninsured patients or receiving federal grants. The Affordable Care Act broadened the type of facilities that can qualify for the 20-plus year program, including Critical Access Hospitals, the smallest rural hospital.
Growth in the program is raising alarms among drug makers and some members of Congress who say that some facilities should not be eligible and that the money they receive from the discounts is not always being plowed back into patient care. The Health Resources and Services Administration (HRSA) runs they program, and Administration officials have promised to propose clearer rules for the program. Proposed regulations had been expected as early as this month, but a recent federal district court ruling has put into question whether HRSA has that authority.
Despite the ruling, HRSA says they plan to move forward with the proposed regulation, and it has been expected to touch on several areas, including eligibility and contracting.
Growth in the program is raising alarms among drug makers and some members of Congress who say that some facilities should not be eligible and that the money they receive from the discounts is not always being plowed back into patient care. The Health Resources and Services Administration (HRSA) runs they program, and Administration officials have promised to propose clearer rules for the program. Proposed regulations had been expected as early as this month, but a recent federal district court ruling has put into question whether HRSA has that authority.
Despite the ruling, HRSA says they plan to move forward with the proposed regulation, and it has been expected to touch on several areas, including eligibility and contracting.
- Eligible patients: Patients who have a “relationship” with a 340B hospital or clinic are eligible to receive the discounted 340b drugs. But exactly what constitutes such a relationship isn’t clearly defined. “There’s always been a discussion about who truly is a patient of a covered entity and who truly can receive a 340B drug,” said David Ivill, a 340B expert with the law firm McDermott Will & Emery.
- Eligible facilities: Currently if a clinic is included in an eligible hospital’s Medicare cost report it can qualify for 340B drug pricing. Analysts expect a new regulation would provide more clarity on which facilities qualify and which ones don’t. While one part of a qualifying 340B hospital might serve large number of poorer patients, an affiliated clinic could see mostly insured patients. Under current rules both qualify to receive the discounted drugs.
- Contract pharmacies: Some providers in the 340B program can contract with outside pharmacies, like Walgreens, to give patients the flexibility of filling their prescriptions at locations that may be more convenient than a hospital pharmacy. A report released in February by the HHS Inspector General found inconsistencies in how some contract pharmacies determine who is eligible for the discounts and in how they conduct the oversight activities that HRSA recommends. In a statement, a HRSA spokesman said the agency has followed up individually with pharmacies identified in the report “to determine necessary next steps.”
Missouri Bill Aims to Reduce Workforce Shortage by Allowing New Route to Become “Assistant Physicians”
Missouri may soon allow licensed medical school graduates to practice medicine and prescribe drugs without having completed a residency.
The proposal (Senate Bill 716), which has passed the state legislature and awaits the governor's signature, aims to address the issue of providing adequate healthcare in rural and other underserved areas of the state.
Under the bill, graduates of accredited medical schools could become “assistant physicians” and provide primary care services in rural or medically underserved areas if they haven't completed residency training. However, they must have completed the first two steps of their medical licensing exam. A collaborating physician would be responsible for all services rendered by the assistant physician.
Under rules from the Centers for Medicare and Medicaid Services, an assistant physician would also be considered a physician assistant. Read the article in Modern Healthcare here (requires a free subscription).
The proposal (Senate Bill 716), which has passed the state legislature and awaits the governor's signature, aims to address the issue of providing adequate healthcare in rural and other underserved areas of the state.
Under the bill, graduates of accredited medical schools could become “assistant physicians” and provide primary care services in rural or medically underserved areas if they haven't completed residency training. However, they must have completed the first two steps of their medical licensing exam. A collaborating physician would be responsible for all services rendered by the assistant physician.
Under rules from the Centers for Medicare and Medicaid Services, an assistant physician would also be considered a physician assistant. Read the article in Modern Healthcare here (requires a free subscription).
Colorado Division of Insurance Releases First Look at Health Plans for 2015
The Colorado Division of Insurance released preliminary information this week from plans submitted by health insurers for Affordable Care Act (ACA) coverage in 2015. Rate and benefit information for the 2015 plan year was submitted to the Division of Insurance (DOI) on June 6th. Since that time, DOI staff has been conducting initial reviews to check the filings for completeness.
According to the preliminary study of rate filings provided by the DOI, Colorado residents and small businesses could face anywhere from a 10 percent increase in their health insurance premiums next year to a 10 percent drop in prices.
Commissioner of Insurance Marguerite Salazar commented, “We are pleased to see such a high number of carriers and plans. Rates seem to be holding relatively steady, which means we will continue to see a strong market in 2015 that will provide Colorado consumers with many options for health insurance.”
Over the summer, the Division of Insurance staff will examine each plan to make sure it is in compliance with the requirements of the Affordable Care Act and state and federal laws. The DOI will review the rates to ensure they are not excessive or inadequate. In addition, the DOI will also verify whether the plans meet the federally defined metal tier coverage levels: bronze (60% of medical expenses paid by the plan), silver (70%), gold (80%) and platinum (90%). These percentages are referred to as “actuarial value.”
According to the preliminary study of rate filings provided by the DOI, Colorado residents and small businesses could face anywhere from a 10 percent increase in their health insurance premiums next year to a 10 percent drop in prices.
Commissioner of Insurance Marguerite Salazar commented, “We are pleased to see such a high number of carriers and plans. Rates seem to be holding relatively steady, which means we will continue to see a strong market in 2015 that will provide Colorado consumers with many options for health insurance.”
Over the summer, the Division of Insurance staff will examine each plan to make sure it is in compliance with the requirements of the Affordable Care Act and state and federal laws. The DOI will review the rates to ensure they are not excessive or inadequate. In addition, the DOI will also verify whether the plans meet the federally defined metal tier coverage levels: bronze (60% of medical expenses paid by the plan), silver (70%), gold (80%) and platinum (90%). These percentages are referred to as “actuarial value.”
During the review period, Colorado consumers can submit public comments on the filings, which will be reviewed and considered by the Division of Insurance. The DOI will complete its review in September, then notify carriers and Connect for Health Colorado of the approved plans for 2015. Once approved, final plans will be posted on the DOI’s website. DOI will also provide summary information and charts detailing the number of approved carriers and plans for 2015, both on and off Connect for Health Colorado. Read the press release from the DOI here.
Wednesday, June 11, 2014
AMA Calls to Give Veterans Access to Private Sector Health Providers
According to the American Medical Association (AMA), veterans facing long wait times for healthcare at government hospitals should have access to private doctors.
The AMA, the largest doctor’s group in the U.S., voted at its annual meeting yesterday to ask President Obama to give veterans access to private-sector health providers until a backlog at the Veterans Administration is reduced. More than 57,000 veterans waited longer than 90 days for an initial appointment at VA medical centers, according to an audit released yesterday. Read the article in in Bloomberg News here.
The AMA, the largest doctor’s group in the U.S., voted at its annual meeting yesterday to ask President Obama to give veterans access to private-sector health providers until a backlog at the Veterans Administration is reduced. More than 57,000 veterans waited longer than 90 days for an initial appointment at VA medical centers, according to an audit released yesterday. Read the article in in Bloomberg News here.
New Report About Narrow Networks Released by McKinsey Center
Roughly half of the products sold on exchanges in 2014 were narrow-network plans, according to a study by the McKinsey Center for US Health System Reform (read the study here). In the largest city in each state, that figure jumped to 60 percent.
The vast majority of exchange customers had a choice between broad- or narrow-network plans, the McKinsey study found. Broad network plans were available to 90 percent of potential customers, while narrow-network plans were an option for 92 percent of that population. Read the rest of the article in Modern Healthcare here (requires a free subscription).
Creating rules around network adequacy are difficult for rural areas as a balance must be struck to create standards strong enough for meaningful access protections, but flexible enough to be achievable for the Qualified Health Plans. This discussion won't be over any time soon.
New Study From CHA Shows Impact of Medicaid Expansion on Hospital Volumes
A new study from the Colorado Hospital Association (CHA) shows the impact of Medicaid expansion on hospital volumes in the 26 states that chose to expand Medicaid eligibility under an option offered through the Affordable Care Act. The study shows that the Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014. At the same time, the proportion of self-pay and overall charity care declined in expansion-state hospitals. You can listen to the article on Colorado Public Radio here, and read the study from CHA here.
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