Managed Care Contracting & Provider Payment

Judge Issues Order in Hospital Medicaid Rate Appeal, But Refuses to Bar Payment Cuts

On Friday, March 2^nd, the judge hearing the case brought by ten New Hampshire hospitals against New Hampshire’s Medicaid Program, issued an order requiring the Commissioner of the New Hampshire Department of Health and Human Services (“NHDHHS”) to begin public hearings on the current Medicaid rates.   This order will likely be the first of many shoes to drop. 

New Hampshire Proposed Insurance Regulations Would Increase State Control over JUA

On May 24, 2010, the New Hampshire Insurance Department proposed changes to the regulations governing the New Hampshire Medical Malpractice Joint Underwriting Association (“JUA”).  These proposed changes are the latest in the ongoing struggle for control over the funds of the JUA.  What follows is a brief history of the issue, followed by a summary of the changes to the rules as proposed by the Department of Insurance.

New Hampshire “HIPAA” legislation debated; NH House Bill 580 would replace previous medical records law with broad patient rights.

NOTE:  SEE UPDATE ON STATUS OF NEW HAMPSHIRE HOUSE BILL 580, BELOW.

Current law recognizes that medical records are the property of the patient and allows the patient to obtain a copy of the records.  Current law forbids a provider from disclosing “confidential communications or information” about a patient without patient consent, except as provided for by law or to protect the welfare of the individual or the public interest.  Current law also forbids using any patient identifying information for sales purposes without the patient’s written authorization.  

The proposed legislation would continue these provisions and would recognize a broader right of patients to control access to their information and to be able to find out who has had access to that information. 

 

1st Circuit Upholds New Hampshire Law Banning Disclosure of Physician Prescribing Information

This past November 18^th, the 1^st Circuit overturned a lower Court decision and held that an “innovative” New Hampshire approach aimed at curbing increasing drug prices was not an un Constitutional abridgement of free speech.  The law prevents companies that mine prescription data from selling it to pharmaceutical companies for use by their drug detailers to attempt to influence prescribing patterns. 

New Hampshire adopts “HealthFirst” Standard Wellness Program for Small Businesses

This past spring, New Hampshire passed a law creating HealthFirst, a health insurance program offering a standardized set of benefits intended to emphasize wellness.   The law is intended to create an affordable form of health insurance for employers with between 1 and 50 employees.  HealthFirst will focus on wellness and the role of the primary care physician in effectively managing care.  The product, which is designed to launch on October 1, 2009 is said to resemble a product offered in Rhode Island, which has saved small employers 15% of premiums.

Quick Post: Connecticut Passes Law Prohibiting “Silent PPOs”

Connecticut joins approximately 12 other states restricting the selling of a physician’s discount.  The law requires any entity contracting with a physician, group, physician network, IPA organization or PHO to disclose the contracting entity’s intent to sell or lease contract rates, including providing a list of potential “customers” on request.  It requires all ID cards to provide a web address or toll free number access to the discount can be verified at the time of service.  It also requires the contracting entity’s right to sell that discount to terminate when the provider contract ends.   

Thank you to Marla Hirsh for passing this information along!

For a link to the bill, Click Pub. L. 08-126

Blue Cross of Massachusetts announces Initiative to Pay Global Capitation

Tuesday’s Boston Globe (01/22/08) contained an announcement that Blue Cross of Massachusetts was launching a program to pay "doctors and hospitals a flat sum per patient each year”.

Battle Over Commercial Use of Prescribing Information Moves to Maine & Vermont

This is a quick update on the issue of whether drug representatives can have access to physician's prescribing data.

Last January 30^th, I posted on a pending lawsuit challenging New Hampshire's law limiting access to information on physician drug prescribing habits. Link to original Post In May, I updated you on the decision striking New Hampshire’s law as an overbroad restriction on speech. Link to 1^st Update.

Doctors Bring Class Action to Stop Ranking System

Following the theme of yesterday's post about the New York AG's attempts to block the launch of UnitedHealth's Premium Program, Tuesday's Hartford Courant ran an article about a class action filed in July by the Fairfield County Medical Association against CIGNA and United HealthCare.

New Hampshire’s Ban on Selling Prescription Information Stricken

Hello,

I’ve been running with several deadlines and have missed some interesting developments. I’ll try to catch up with my posting over the next few days – if that’s possible.

First:
On April 30^th a federal District Court for the district of New Hampshire struck down a New Hampshire law preventing the sale of information about physicians’ prescribing patterns. The court found the law violated the 1^st Amendment.