Friday, December 02, 2005

Missouri Department of Social Services 10/28/2005

Division of Medical Services Announces Children's Health Insurance Changes
Jefferson City - The Department of Social Services' Division of Medical Services announced today that it will not impose 1) a thirty-day waiting period after enrollment, or 2) a six-month waiting period for coverage when families with children eligible for the State Children's Health Insurance Program fail to pay a premium and their incomes are over 150% but less than 225% of the federal poverty level (FPL).
"What this means is that families responsible for the one percent or three percent premiums will not have to wait six months to be reinstated if for some reason they fail to make their premium payment. Reinstatement will occur as quickly as possible upon receipt of payment and the appropriate verifications. This will minimize the disruption in children's health insurance coverage," said Dr. Michael Ditmore, Director of Medical Services.
The state regulation as currently written can be read to apply the thirty-day waiting period after enrollment or the six-month waiting period for coverage to families with incomes between one hundred fifty percent and two hundred twenty-five percent of the FPL if they failed to pay premiums due to SCHIP by November 30. The Division of Medical Services is preparing a proposed regulation to limit these provisions to children in families with an income of more than two hundred twenty-five percent of the FPL.
"As written, state statute is silent to the extension of the thirty-day waiting period after enrollment and the six-month waiting period for coverage for children in families with incomes between one hundred fifty percent and two hundred twenty-five percent of the federal poverty level," said Billie Waite, attorney for the Division of Medical Services. “Division of Medical Services will be making the necessary modifications to ensure that the state regulation is in precise alignment with the statutory language."
The thirty-day waiting period and the six-month waiting period for failure to pay a premium have been a part of SCHIP since its inception for families with incomes over two hundred twenty-five percent of poverty. The latter provision was designed as a deterrent to discontinuing employer sponsored coverage in favor of Medicaid.
SCHIP families formerly had co-payment responsibilities, which were dropped in favor of the premium approach under current law. The Division of Medical Services gave families from September 1 to September 30 to pay their first premium so that coverage could continue uninterrupted. If families did not pay their premium by September 30 coverage for their children stopped, but cases remained open for a sixty-day grace period. On September 1, approximately 27,000 families owed premiums for over 48,000 children. As of October 25, payments were outstanding for about 12,300 children.
The Department is reinstating coverage for these children immediately upon receipt of payment and urges families to continue to make the premium payments as quickly as possible. For a family of four with two children making about $30,000 a year, the premium is $12.00 a month per child for full health insurance coverage. After paying the premium, the family has no further out of pocket expenses. "It is not unreasonable for families with incomes at this level to bear some responsibility for the cost of their children's care. This is reasonable, affordable health care coverage and a good investment for parents and caregivers in their children's health. We certainly hope families will take advantage of this affordable coverage," Ditmore added.

Thursday, December 01, 2005

BCBS Press Release 10/18/2005

New Blue Cross And Blue Shield Association Quality Initiative To Support Hospital Performance Improvement
Reports To Help Employers And Hospitals Promote More Consistent Healthcare Quality

CHICAGO – October 18, 2005 – To encourage the use of publicly available quality data for the improvement of hospital care, the Blue Cross and Blue Shield Association (BCBSA) today announced a new national Network Hospital Measurement pilot program that will provide quarterly performance reports to hospitals and employers. This information represents an important first step toward helping consumers receive more consistent, effective care.

The reports are based on publicly available clinical measures from the Centers for Medicare and Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations. They also include publicly available patient safety indicator measures from the Agency for Healthcare Research and Quality. The reports provide a framework for continued collaboration with BCBS Plans’ network hospitals to help establish additional national benchmarks for high-quality care.
"Our healthcare system has vast amounts of information about quality and clinical evidence that if organized correctly and efficiently will result in better, more affordable care," said Scott P. Serota, BCBSA’s president and CEO. “Making this knowledge work to benefit providers, employers and consumers is the founding principle of the Blues’ vision for a better future healthcare system.”

National studies on healthcare quality have shown that our healthcare system lacks consistency in how scientifically proven care is delivered across the country. For example, a 2003 RAND Corporation study showed that patients get recommended, evidence-based care only about 55 percent of the time.

The BCBS national performance pilot adopts 18 established evidence-based measurements. Some of the measures are surprisingly simple, such as making sure that a heart attack patient receives aspirin upon arrival at the hospital, or that a pneumonia patient receives advice on quitting smoking.

The Network Hospital Measurement pilot creates no new reporting burden on healthcare providers. The program reorganizes the data into a more efficient information resource to support localized hospital efforts to improve care quality in collaboration with Blue Cross and Blue Shield companies.

“Our mission is to improve the consistency of these proven, evidence-based treatments at hospitals across the nation,” Serota said. “This program is designed to collaboratively elevate the quality of care delivered by hospitals in the Blue Cross and Blue Shield Plans’ networks.”

Quarterly data reports are being provided by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) the nation's predominant standards-setting and accrediting body in healthcare. An independent, not-for-profit organization, JCAHO has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by healthcare organizations since 1951.

“This initiative is creating a whole new way of looking at quality data,” said Dennis O’Leary, president and CEO of JCAHO. “The Blues are taking existing quality data and adding context, creating a valuable tool for hospitals that can help them provide more effective care for their patients.”

Eighteen Blue Cross and Blue Shield companies, representing more than 80 percent of the collective 93 million Blue subscribers, are participating in the Network Hospital Measurement pilot program, drawing on the experience and strength gained from decades-long partnerships between healthcare professionals and Blue Cross and Blue Shield companies. Collectively, Blue Cross and Blue Shield companies contract with more than 90 percent of all physicians in the country and 80 percent of all hospitals.

Wednesday, November 30, 2005

Cover The Uninsured Press Release 9/14/2005

As employees pay 29% of monthly health insurance premiums,
business owners worry that rising costs will force workers to join ranks of uninsured
Poll of business leaders released at Capitol Hill summit of lawmakers and CEOs
Washington, DC – Faced with rising health care costs, small, medium and large businesses say they must continue to
pass a portion of the increased costs on to their employees by requiring them to pay a mounting share of the
premiums, co-pays, or deductibles, a new survey of business leaders shows. Four in five business owners (79
percent) who anticipate increases in their health care costs say they are concerned about their employees’ ability to
shoulder the projected increases.
The Robert Wood Johnson Foundation today released “Attitudes of Business Leaders Regarding Health Care
Coverage” at a Capitol Hill briefing led by legislators, governors, and Fortune 500 executives. The survey of more
than 600 business owners and benefits managers whose companies currently pay for at least some health insurance
benefits shows that companies of all sizes expect health care costs to jump an additional 12 percent over the next
year. Business owners surveyed say they will ask their employees to pay an average of 21 percent of the increase.
Survey respondents estimate that their employees currently pay, on average, 29 percent of the cost of their own
health insurance premiums – up six percentage points from 2003.
According to figures from the Kaiser Family Foundation and the Health Research Educational Trust, also released
today, premiums average $10,880 annually for family coverage ($907 per month) in 2005, and $4,024 ($335 per
month) for individual coverage.
“Business leaders know firsthand how important it is to offer health insurance, both because it improves the health of
the workforce and because it makes their businesses more attractive to employees,” said Risa Lavizzo-Mourey, MD,
MBA, president and CEO of the Robert Wood Johnson Foundation. “Small and mid-sized companies have long
struggled to provide affordable health insurance for their employees, but now large companies with thousands of
employees are finding it difficult to offer affordable health coverage. Our nation’s leaders need to act on this issue
before more and more working Americans find themselves unable to afford health care coverage.”
The survey was conducted by Public Opinion Strategies, Alexandria, Va., and has a margin of error of +/- 3.89
percent. It shows:
• Employers worry that their workforce may drop insurance because of rising costs. More than one-third
(35 percent) of businesses that report an expected increase in health care costs say it is likely their employees
would consider dropping their health care coverage because of this increase in out-of-pocket costs.
• Businesses are focused on affordability of health care. The goal of ‘making health care more affordable’ is
a top priority among businesses, with half (53 percent) citing this as the most important health care goal that
should receive the greatest attention in health care reform efforts.
• Business leaders support a range of policy proposals. Among a range of policy proposals tested, business
owners and benefits managers expressed strong support for granting tax credits to small businesses that offer
insurance coverage, and for allowing the self-employed and small businesses to band together to purchase
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insurance. When asked which ideas would help “a lot” to increase the number of Americans with health
coverage, business leaders responded:
o Allowing the self-employed and small businesses to purchase private health insurance at group rates.
o Providing tax incentives for small businesses to encourage them to provide health coverage to their
employees. (41%)
o Enrolling more Americans who are eligible for government-funded health care programs. (27%)
o Expanding Medicaid coverage to include a greater number of lower-income Americans. (26%)
o Providing tax credits for low-income Americans to help them afford private insurance. (23%)
o Allowing Americans to set up tax-free health savings accounts. (21%)
The survey released today underscores what some of the nation’s top business leaders, health policy analysts, and
labor economists have been saying for many months: As the price of health care coverage continues to rise, fewer
businesses, individuals, families, and government programs can afford to pay for coverage – and more Americans
will be forced to go without health insurance. According to numbers released last month from the U.S. Census
Bureau, nearly 46 million Americans had no health insurance in 2004. The Census reported that the percentage of
Americans who receive their health insurance from employer-sponsored coverage declined significantly between
2003 and 2004.
“Businesses in America have a long tradition of offering comprehensive health care benefits to their employees,
which is how most Americans receive health care coverage, but this practice is increasingly in danger,” said Lavizzo-
Mourey. “Large businesses are having to redefine the terms of their plans in order to keep offering benefits, and
many small and medium-sized businesses are forced to stop offering coverage altogether.”
To help small business owners identify and evaluate their health coverage options, a free, downloadable resource, the
Guide to Health Insurance Options for Small Business, is available at The guide was
prepared by the Robert Wood Johnson Foundation, in collaboration with the Healthcare Leadership Council and with
guidance from the U.S. Chamber of Commerce, America’s Health Insurance Plans, and the Blue Cross Blue Shield
Association. The guide provides small business owners with key information on coverage – various plan options, tax
advantages for providing employee coverage, tools to help estimate the cost of providing coverage, information on
employee cost-sharing, and more. The poll results released today can also be found at
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest
philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of
organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the
Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of
those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime.
For more information, visit

Tuesday, November 29, 2005

HS Change Press Release 11/18/2005

Growing Pressures Converge in Hospital Emergency Departments (EDs)
On-Call Coverage, Primary Care Use and More Seriously Mentally Ill Patients Strain Eds
News Release
Nov. 18, 2005
FURTHER INFORMATION, CONTACT: Alwyn Cassil (202) 264-3484 or [email protected]
WASHINGTON, DC—Converging pressures in hospital emergency departments (EDs)—ranging from persuading specialists to provide on-call coverage to dealing with growing numbers of patients with serious mental illness—have the potential to compromise access to emergency care and spur already rapidly rising health care costs, according to a study released today by the Center for Studying Health System Change (HSC).
The rising pressure in emergency departments is a result of larger forces throughout the health care system, including financial incentives that reward specialist physicians for performing more procedures outside general hospitals; diminishing access to primary care; declining funding for community-based mental health services; and financial pressures on hospitals to pursue business strategies of seeking higher-paying patients and services, the study found.
"Failure to deal with these underlying problems in the health care system threatens to compromise access to emergency care for patients and add to rising health care costs," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
Numerous reasons were cited for specialist physicians' waning interest in taking ED on-call coverage: the perceived higher risk of malpractice litigation, lack of reimbursement for uninsured patients, opportunity costs in terms of time away from their practices and late and unpredictable hours.
"Historically, emergency on-call coverage has been part of a physician's obligation in return for hospital admitting privileges, and as specialists provide more services outside general hospitals, they are less dependent on having privileges at general hospitals," said HSC Senior Researcher Ann S. O'Malley, M.D., coauthor of the study with HSC Health Research Assistant Anneliese M. Gerland; HSC Senior Researcher Hoangmai H. Pham, M.D.; and HSC Senior Consulting Researcher Robert Berenson, M.D., of the Urban Institute.
Along with providing stand-ready capacity to respond to life-threatening injuries and illnesses ranging from head traumas to heart attacks, emergency departments also serve as the care provider of last resort for insured and uninsured patients alike who cannot access care elsewhere. Emergency departments are the one place in the U.S. health system where—under federal law—people can't be turned away regardless of their insurance status or ability to pay.
In the face of these pressures, ED visit rates continue to grow steadily. During the past decade, the number of ED visits nationally rose 26 percent—from 90 million to 114 million in 2003—much faster than the 11 percent growth in the U.S. population during the same period.

Monday, November 28, 2005

Weiss Ratings Press Release 2/7/2005

Higher Co-Pays for Drugs and Doctors Cited asMost Significant Change to Health Insurance Coverage

JUPITER, February 7, 2005 – More than 58 percent of consumers cite higher co-payments for prescription drugs and physician visits as the most significant change to their health insurance coverage during the past year, according to a recent online survey conducted by Weiss Ratings, Inc., the nation’s leading independent provider of ratings and analyses of financial services companies, mutual funds, and stocks. Higher prescription drug co-pays were cited by 34.3 percent of consumers polled, while 23.8 percent indicated higher co-pays for physician visits.
The results of the online survey were based on voluntary responses from 915 individuals visiting the Weiss Ratings website ( Presented with the question, "How has your health insurance coverage changed most this year?," respondents were asked to vote once for one of five choices. The following is a summary of all responses received:
How has your health insurance coverage changed most this year?
• Higher prescription drug co-payments 34.3%
• Higher physician visit co-payments 23.8%
• Other 15.7%
• Changed provider 15.0%
• Loss of health insurance 11.3%
"Skyrocketing healthcare expenses have forced insurance companies and hence employers to pass more costs onto their employees, resulting in higher co-pays," commented Melissa Gannon, vice president of Weiss Ratings, Inc. "This trend is likely to continue as consumers are forced to take more responsibility for an inefficient healthcare system."
Weiss Ratings, Inc. reviews more than 8,000 stocks daily, including all those traded on the New York Stock Exchange, the American Stock Exchange, and Nasdaq. Weiss also issues investment ratings on more than 12,000 mutual funds, covering equity, fixed-income, and closed-end funds, and provides financial safety ratings on more than 15,000 financial institutions, including banks and insurance companies. It is the only major rating agency that receives no direct or indirect compensation from the companies it rates for issuing its ratings. Revenues are derived strictly from sales of its products and custom research solutions to consumers, institutions, businesses, libraries, and governmental agencies.

Sunday, November 27, 2005

Utah Dept of Health Press Release 11/24/2004

Utah Families Thankful for Health Care Coverage
Utah Department of Health Announces CHIP Open Enrollment –
Parents Can Also Apply for PCN during the Open Enrollment
(Salt Lake City, UT) – As families throughout Utah prepare to gather around the
Thanksgiving table, they traditionally take stock of things in their lives for which they are
most thankful, such as; family, friends, health and freedom. A Utah Department of
Health (UDOH) survey indicates that Utahns are thankful for the comfort health care
coverage provides, as fewer families stated they went without insurance because they felt
it was safe to do so. This makes Thanksgiving the ideal time for the UDOH to announce
the upcoming open enrollment for Utah’s Children’s Health Insurance Program (CHIP),
Monday, January 10 – Tuesday, January 25, 2005.
During this CHIP open enrollment, parents may also apply for the Primary Care Network
(PCN). Parents, grandparents, teachers, coaches and others can now obtain materials and
applications. CHIP/PCN will accept all eligible Utah children and parents who apply for
CHIP/PCN in January 2005.
“Utah Department of Health research indicates that Utahns place a high priority on
obtaining health insurance,” says Scott Williams, M.D., Executive Director, UDOH.
“CHIP offers peace of mind for parents regarding their children, but many parents
themselves are without health insurance. We are pleased to accept applications from
families for both CHIP and PCN, so that we can help the whole family and process both
applications at the same time.”
Learn more about CHIP or PCN call1-877-KIDS-NOW to receive an application by mail
or to find a UDOH eligibility office in your area.
– Utah Families Thankful for Health Care Coverage
Beginning January 10 and ending January 25, applications will be accepted in person,
online at or by mail between January 10 and January 25. The
dates and length of this enrollment period were determined by how many children are
enrolled in the program and the available funding.
What is CHIP?
CHIP is a health insurance plan for children funded jointly by the federal and state
government. To receive CHIP, children must qualify based on family size and household
income. For example, a family of four earning up to $37,700 a year may qualify. To
qualify, children must also be younger than 19, U.S. citizens or legal residents and not
currently covered by health insurance. Once enrolled in CHIP, families may be required
to pay premiums of up to $25 every three months. Premiums and small co-pays make it
possible for CHIP to insure more children.