Archive for October, 2017


New Rules Facilitate Integration of Physical, Behavioral Care

New federal regulations are facilitating better integration of physical and behavioral health services for the Medicaid population.

Two developments, in particular, are advancing this integration:  the 2016 Medicare managed care rule and a 2016 rule implementing the Mental Health Parity and Addiction Equity Act of 2008.  Together, these rules encourage providers to perform comprehensive assessments of their patients, increase flexibility for providers in how they use Medicaid payments, and pave the way for improvements in the use of information technology that foster better integration of physical and behavioral medical care.

A new issue brief from the Commonwealth Fund presents in greater detail how these new regulations, in combination with other legislation and regulations, are facilitating a more integrated approach to the delivery of physical and behavioral care to the Medicaid managed care population.  Go here to see the brief “Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care.”…

AMA: Health Insurance Concentration in Urban Areas Threatens Competition

Too much market share by insurers in urban areas can inhibit competition, and according to the American Medical Association, there is too little competition among insurers in too many urban markets today.

According to a new AMA study,

  • 69 percent of 389 metropolitan statistical area-level markets are “highly concentrated”
  • in 89 percent of MSAs, at least one insurer issues at least 30 percent of commercial health insurance policies
  • in 43 percent of urban MSAs, a single insurer owns at least 50 percent of the market

In a statement accompanying release of the report, an AMA spokesperson explained that

After years of largely unchallenged consolidation in the health insurance industry, a few recent attempts to consolidate have received closer scrutiny in the past…Previous versions of the AMA study played a key role in efforts to block the proposed mega-mergers by helping federal and state antitrust regulators identify markets where those mergers would cause anti-competitive harm.

See a Healthcare Finance News report on the AMA study here and go here for a link to the AMA study itself, titled Competition in Health Insurance: A Comprehensive Study of U.S. Markets, 2017 Update.

Survey Says: More Than One in Four Underinsured

28 percent of insured adults under the age of 64 were uninsured in 2016, according to a Commonwealth Fund survey.

The survey also found that:

  • More than half of the uninsured are insured through their employer.
  • Nearly one in four insured through their employer are underinsured.
  • More than one in four Medicaid recipients were underinsured.
  • Half of the underinsured report problems paying their medical bills.
  • Individuals with higher deductibles are more likely to report problems paying their medical bills.
  • More than 45 percent of the underinsured report skipping care they need because of cost.
  • Low-income people and those with chronic health problems are more likely to be underinsured.

Learn more about the survey’s findings, its implications, and possible means of addressing these problems in the Commonwealth Fund report How Well Does Insurance Coverage Protect Consumers from Health Care Costs?, which can be found here.…

Despite Uncertainty, States Plan to Raise Medicaid Rates

Even though events in Washington leave the future of Medicaid unclear, 44 states still intend to raise at least some of their Medicaid rates in 2018.

Inpatient payments to hospitals are not among the major targets of the planned rate increases:  only 17 states plan to increase Medicaid inpatients payments while the others plan to keep those rates as they are or even reduce them.

Learn more about trends in Medicaid enrollment, spending, and rates in the Kaiser Family Foundation’s annual survey of state Medicaid programs, the results of which can be found here.…

PA Governor Vetoes Medicaid Work Requirement

Pennsylvania Governor Tom Wolf has vetoed a bill that included a requirement that certain Medicaid recipients either work or search for work.

 Learn more about the governor’s veto, and his reason for doing so, in this Associated Press news report.