News in brief - Oct. 8, 2007

Remaining Medicare private plans get green light

All seven major health insurers offering Medicare private fee-for-service plans have received federal approval to start marketing the products once again.

The insurers agreed in June to stop promoting the private fee-for-service products until they completed a comprehensive review of their marketing procedures. Medicare seniors had complained that plan agents signed them up for the plans without their consent or failed to tell them that their physicians might not accept the coverage. Three of the companies received the go-ahead in August from the Centers for Medicare & Medicare Services; the remaining four gained approval in September.

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Nebraska physicians developing universal coverage plan

A task force created by the Nebraska Medical Assn. is almost finished crafting a plan to ensure that everyone living in the state has access to affordable, high-quality health care, according to the panel's co-chairs, internists Richard L. O'Brien, MD, and John Benson Jr., MD.

The Health Care Reform Task Force, created by the NMA in January, expects to finish its proposal by the end of the year. It's planning to recommend requiring individuals to have basic health insurance. It is likely to require insurers to offer coverage to everyone, no matter their medical condition; to guarantee policy renewals; to use community-rated premiums; and to offer plans with medical homes. Physicians would be paid for evidence-based, nationally accepted, medically necessary services. Consumers' out-of-pocket expenses would be limited to 10% of income or less, based on a sliding scale.

The plan has the potential to jump-start health reform in the 2008 state legislative session if NMA delegates approve it and lawmakers react well to it, Dr. Benson said. The task force will have its proposal financially analyzed before presenting it to the NMA, Dr. O'Brien said.

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Physician group wins case for higher pay for inmate care

Utah's Salt Lake County has a responsibility to compensate doctors fully for emergency care they provide to prisoners, instead of paying them at lower Medicaid rates, the state Supreme Court ruled in September. "In providing medical care to inmates, the county is not acting as a passive third party to a primary relationship between the physicians and the inmates. Instead, the county has complete control over when and where medical services are provided, and therefore dictates the means by which its constitutional obligation is fulfilled," the unanimous opinion states.

The case will head back to a trial court to decide the "reasonable value" of the treatment Emergency Physicians Integrated Care gave to local prisoners between 2000 and 2004. The physician group sued Salt Lake County for failing to reimburse doctors the usual and customary charges for their services, and for failing to make any payments at all for some inmate care.

EPIC executives were not available for comment. The Salt Lake County District Attorney's Office declined to comment on the ruling. County officials in court documents denied any legal responsibility to pay for the services beyond state Medicaid rates.

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