In Washington…
President Clinton signs the BBA relief bill… A 292-60 vote in the House of Representatives and a voice vote in the Senate propelled the Benefits Improve -ment and Protection Act of 2000 (BIPA) to President Clinton’s desk this week. He promptly signed it. The measure returns $54 million to Partners over the next five years.
MedPAC issues troubling hospital margin data… At its December 14 meeting, MedPAC reported that the average overall Medicare margin for teaching hospitals rose from 14.6 percent in 1998 to 15.4 percent in 1999. The average for all hospitals went from 6.0 percent in 1998 to 5.9 percent in 1999. The overall Medicare margin is based on all major fee for service Medicare costs, including inpatient, outpatient, skilled nursing, and home health services. MedPAC cited two reasons for stronger teaching hospital margins - higher average inpatient margins (24 percent in 1999) and better cost control. Teaching hospital costs per case are rising more slowly than other hospitals.
And on Beacon Hill…
Health care task force agrees hospitals need help . . . The blue-ribbon panel examining the state’s health care system this week recommended both short- and long-term action to address the deteriorating financial condition of Massachusetts hospitals. In releasing its interim report, the task force recommended that hospital Medicaid rates be increased. Other suggested short-term interventions include a fund for “distressed hospitals” to be financed by the state and private payers, and a revolving loan fund that would be supported by a hospital assessment.
DPH issues managed care and hospital regulations… At this week's Public Health Council meeting, the Department of Public Health (DPH) issued emergency regulations to implement portions of the state’s new managed care law, effective January 1, 2001. The rules provide several patient protections, including streamlined appeals, clarifications regarding coverage and guidelines requiring input from practicing physicians when HMO's set out to define medically necessary services. The rules also ensure that health care providers have a right to represent patients in an independent appeal of adverse determinations. Finally, they prohibit involuntary dis-enrollment of providers in certain circumstances and impose restrictions on certain contract terms between carriers and providers.
An additional set of regulations imposes obligations on hospitals that plan to discontinue essential health services. . . As under current policy, hospitals must give 90 days’ notice of intention to terminate a service. Under the new regulations, DPH must hold a public hearing at least 45 days before the service is scheduled to end. If DPH determines that discontinuing the service would affect access to the service within the hospital's service area, the hospital will be required to submit a plan to ensure continued access.