In Texas, Humana is upset they have to comply with the prompt pay statute. Humana believes they will have to raise rates in order to cover the "overpayments" made due to their own negligence. Of course there wouldn't have to be a statute if the HMOs paid in a timely manner. The next item the physicians are going after is the unexplained downcoding and bundling by the insurers.
The fight between the California Department of Managed Care and the HMOs is heating up. The Department has dropped several charges against Kaiser but continues with the $1.1 million fine. The state dropped the charge regarding the untimely ambulance services and its service center. Top
The new year brings new laws promulgated by those that know, the legislature and governor. It should be noted that the Governor vetoed almost all legislation that cost the state money.
On January 1, 2002 the new California nursing staffing ratios were supposed to be released. Due to the usual infighting between the employers and nursing union the ratios will not be available for several months. There will then be a public comment period of 45 days.
The federal House and Senate have each passed legislation to help the national nursing shortage. The Senate calls for $136 million in scholarships and aid for students. Of course there would also be a new bureaucracy, a commission to recommend further action. The House does not have a dollar amount attached but offers financial aid to those who agree to work in public hospitals after graduation. The House Bill also makes the GAO responsible for the study on the nursing shortage and mandates public service announcements promoting nursing. There seems to be bilateral agreement that some type of help will be passed during the next term. Top
Starting on January 1, Medicare now covers nutritional services for diabetics and renal patients. The patient will need a referral from their primary or coordinating physician. Depending on how this flies, the program may be extended to those with high cholesterol and high blood pressure.
The other new covered area is pain management. There will be a new classification of physician using a special code stating they are pain management specialists. The new code will help patients locate these "specialists".
In probably the most important area, patient care and the removal of the hassle factor, HHS has appointed a 27 person panel to hear from treating professionals. The purpose is to streamline and delete unduly burdensome governmental regulation. They hope to recommend both specific changes and broad reforms. The panel will be headed by a practicing cardiologist from Mayo Clinic, Dr. Douglas Wood. The group will be holding meetings for input throughout the country and will also be taking input at http://www.regreform.hhs.gov Does it take 27 people to screw in the light bulb? Top
Governor Davis woke up after his original decision to scrap $25 million for trauma care. With the state looking at a $12 billion shortfall mostly due to his inept handling of the power problem, Davis vetoed any legislative act that would cost money. Now he realizes trauma saves lives. He also realized that both sides of the aisle wanted the money in the budget.
The Department is also pushing for a requirement that HMOs cover all out of area emergency maternity services. There is no need for a pregnant female to be deprived of her right to travel. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.