D.C. Could Learn A Lot From Healthcare Accomplishments in State Legislatures
While it is said D.C. is slow to make progress on healthcare, individuals are stepping up with a plan noting that “The health of our nation is more important than any political party.” With changes and advancements in healthcare, the state of Colorado is implementing a new law that gives Colorado officials the authority necessary to pursue related federal waivers as needed. The rural areas of our state are experiencing a problem of unaffordable coverage due to insurer competition and limited/nonexistent coverage and state officials are ready to overcome these issues.nnUnited States of Care is a nonpartisan, 501(c)(3) organization dedicated to the goal of every American having access to quality and affordable healthcare.nn”The health of our nation is more important than any political party or partisan victory. United States of Care will chart a path toward a long-term healthcare solution, starting by checking allegiances at the door and putting the patient—our citizens—first.” Dr. Bill Frist, former U.S. Senate majority leader and current USofC board member, said these words at our founding just one year ago. We continue to live by them.nnWith Washington, D.C., slow to make progress on healthcare, we have looked to the laboratories of our democracy—the 50 state governments—to lead our nation and help us chart a path advancing healthcare for everyone. Recently, we have seen significant progress in state legislatures across the country. Acting as a resource, facilitator, convener and technical expert, USoC has connected with healthcare leaders, advocates and others in over 30 states and has formally engaged with partners in Connecticut, Minnesota and New Mexico to support advances in healthcare delivery—learning best practices to share with other states.nnThroughout America and across income groups, Americans say affording healthcare is their most important financial problem. The majority of Americans, across party lines, are concerned about surprise medical bills, prescription drug prices, and coverage for those with pre-existing conditions. This is why state leaders are responding to their constituents’ concerns and seeking policies to make our healthcare system work better for everyone.nnThis unifying feeling—that healthcare is out of reach and unaffordable to many even when one has insurance—eclipses political party and is moving state legislatures across the country to address it. Each state is different, however, and the way lawmakers fix issues—ranging from skyrocketing prescription drug costs to finding ways to make additional coverage choices available and protecting people from financial devastation due to surprise medical bills—is unique in every state.nnThe progress being made state-by-state is a promising march toward the ultimate goal of every single American having access to quality, affordable healthcare regardless of health status, social need or income. Our 2019 State Health Policy Progress analysis hows examples of meaningful progress in 14 states across the country.nnThese state successes are emerging from across the country and from all types of states.nn
nnColorado enacted bipartisan legislation directing two state agencies to develop a plan for creating a competitive state insurance plan by Nov. 15, 2019. This new law gives Colorado officials the authority necessary to pursue the federal waivers required to implement the plan. The main goal is to take on the problem of unaffordable coverage in regions of the state, overwhelmingly rural, where insurer competition and affordable coverage is limited or nonexistent.nnColorado also entered 2019 as one of six states with a “C” grade on enforcement of mental health parity. To remedy this, Colorado passed bipartisan legislation to step up requirements for mental health and physical health services to be covered equally. The legislation also increases much needed enforcement and oversight of mental health parity laws.nnMinnesota, the only state with legislative chambers controlled by opposite parties, showed that state leaders can come together across party lines to address pressing problems. Policymakers were faced with the expiration of the state’s provider tax, which helps pay for MinnesotaCare, Medicaid and other vital services that provide care to over 1.2 million Minnesotans.nnLeaders from both parties came together to maintain this crucial funding source and extend the state’s reinsurance program for an additional two years. In Minnesota, reinsurance has reduced premiums by 20% in the individual insurance market. The state also reached a consensus on laws to improve mental health access, lower prescription drug costs, expand access to telehealth, address the opioid crisis, and strengthen elder care protections.nnComplete and original article published on modernhealthcare.com.
As difficult as it may be, embracing change is essential to growing as an individual, being a better employee and a better person than you were yesterday. Focusing on a positive perspective when faced with difficult challenges or changes can help us adapt when we are pushed out of our comfort zones. The following article focuses on this subject and includes great examples of situations that require adaptability and excercises to help you improve your acceptance to change.nnScientists tell us the adaptive ability of any system is usually gauged by its response to disruptions or challenges. In the case of the human system, a.k.a. you and me, adaptive abilities mean you are a person who is flexible in handling change, juggling multiple demands, and navigating new situations with innovative ideas and approaches.nnIs This Me? nnThink about these statements, and choose A or B:n
Health insurance premiums have been an ongoing topic of discussion for Colorado government leaders, medical professionals, insurance companies and patients. With continuous changes throughout the industry, the latest development includes the drop of health exchange premiums. Read the article below for more information recently released and the expectations to come.nnWestern Slope families could save nearly $9,000 a yearnnFor the first time since Colorado started its health insurance exchange, the prices people pay for coverage are expected to drop — by a statewide average of 18.2% — next year if the federal government approves a new state program called reinsurance.nnFor families on the Western Slope, who pay some of the highest insurance premiums in the country, the savings is expected to be nearly $9,000 a year. The Colorado Division of Insurance projects the average savings for Pueblo County at $6,696 annually and $3,369 for metro area residents.nn“I mean, that’s just transformational in terms of saving families money,” Gov. Jared Polis said at a press conference Tuesday.nnReinsurance is basically a pool of $260 million in state and federal money that Colorado plans to use in 2020 to help cover some of the most expensive medical bills among the 250,000 people in the state’s individual market. The idea is that this alleviates some of the burden on insurance providers, which in turn lower their premiums.nnMinnesota’s reinsurance program, for example, dropped its individual premiums by 11.3% and Alaska’s declined by 26%.nnColorado’s reinsurance program is still waiting on final approval from the federal government, but Colorado Insurance Commissioner Mike Conway said he’s all but certain that will happen this fall. Seven states already have federal waivers.nnThe final rates for 2020 health insurance premiums will be released in late September or October.nn“We’ve been working on this for years … ,” said Sen. Bob Rankin, R-Carbondale. “But my caution on this is this doesn’t do anything to really lower the cost of health care.”nnThe news that insurance premiums on the exchange could see a double-digit drop received praise from both the Colorado Hospital Association and Colorado Consumer Health Initiative.nn“We are pleased that the Insurance Commissioner is projecting a decrease in premiums on the individual market for 2020, as it reflects the many efforts by hospitals and providers to take ownership of their portion of the total cost of care,” said Steven Summer, president and chief executive officer of the hospital association, in a prepared statement.nnThe Consumer Health Initiative “expressed cautious optimism” at the expected drop in premiums while warning thatif the Affordable Care Act — also known as Obamacare — is struck down in its latest legal challenge, it could “destabilize everything” by removing health insurance coverage for many Coloradans.nn“We hope the federal Department of Health and Human Services will quickly approve Colorado’s reinsurance program, which is basically insurance for insurance companies that ultimately helps reduce insurance premiums for consumers,” said Adam Fox, director of strategic engagement, in a statement. “Without reinsurance, consumers will face average increases of 0.5 percent and continue to face very high premiums.”nnOriginal 
Anthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.nnEffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*nnFor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)nnNOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL. nn*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.n
Anthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.nnLaboratory Services done in the Provider’s OfficenAnthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)nnAnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.nnPathology codes are excluded from this adjustment.nnAnthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.nnInformation from Anthem Blue Cross Blue Shield and HMO Colorado.