August 2007

DHS debates OHP Standard options

While the Division of Medical Assistance Programs debates when it will reopen the Oregon Health Plan Standard, advocates are up in arms about enrollees losing coverage when their eligibility changes. Current rules require new mothers or teens who turn 19 to provide the Department of Human Services with detailed documentation to switch to OHP Standard within 30 days after they no longer qualify for OHP Plus or OHP Children’s Health Insurance Program. If DHS is not contacted by the deadline date, individuals are considered ineligible for OHP Standard and will not be able to apply until the program re-opens to new applicants.

“This should be a seamless process,” said Karen Berkowitz of the Oregon Law Center, which is mulling a possible lawsuit. “DHS is wedded to paperwork. People get [their benefits] terminated and they are forced to reapply.”

Insurers hike individual rates

A year ago last July, Regence BlueCross BlueShield of Oregon signaled what insurance regulators thought was a sea change in the individual health insurance market when it reduced premiums 15 percent. A year later, the state’s largest insurer bumped those rates back up by 12 percent, effective July 2007 to June 2008.

Although some competitors were uneasy about following the lead of the state’s largest insurer in the past, few are showing any qualms this time around.

On average, premiums for individual plans are increasing from between 9 percent and 11.9 percent, according to David Ball, a health and life actuary with the Oregon Insurance Division. Small and large groups are up slightly more, Ball said. Most rates go into effect Oct. 1, while some, such as Regence, start earlier.

OHP could be latest to join EHR craze

When it created the Oregon Health Plan, Oregon was the first state in the nation to tinker with Medicaid. Now state policy makers may once again be on the cusp of innovation.

A group that includes Dr. Jody Pettit, the state’s health IT coordinator, and Omnimedix, the Portland nonprofit that helped create Dossia, recently applied for a $5.5 million Medicaid Transformation grant. The Oregon group would use the money to create a health record bank for Medicaid members.

On the Record with Gov. John Kitzhaber

When former Gov. John Kitzhaber travels to Montana next month, he’ll have more than fly-fishing on his mind. The Archimedes Movement founder is traveling east to shore up support for his community focused plan for health care reform. After Senate Bill 27 failed to get a vote in the Oregon legislature, Kitzhaber has re-focused part of his efforts on building support outside the Beaver State. A trip to Montana is strategic since Sen. Max Baucus (D–MT) sits on the U.S. Senate Committee on Finance, along with Oregon Sens. Ron Wyden (D–OR) and Gordon Smith (R—OR) and Sen. Maria Cantwell (D–WA), where Archimedes is also gaining momentum. Oregon Health News editor-in-chief Tim Stumm recently sat down with the emergency room physician at his Portland office to find out what’s next for Archimedes and whether the former governor has any desire to return to the political world.

OHN: Can health care reform occur without altering Medicare?

JK: No, it can’t. Medicare, if not changed, is economically unsustainable. It doesn’t pencil out. It’s not a criticism of the program. The people who created the program couldn’t possibly have anticipated the huge demographic shifts. We couldn’t have predicted the huge growth in medical inflation and technological advances.

CON office responds to Ascend application

Ascend Health Corporation has some work to do if it wants to open a psychiatric hospital in Oregon. The state’s certificate of need office recently found several holes in an application submitted by the Delaware-based company in January. Ascend hopes to build an 82-bed, $6.8 million psychiatric hospital on a site formerly occupied by the Cedar Hills Hospital.

The most notable questions still lingering are how much charity care the hospital will offer, whether it will treat Medicaid patients, and what will happen to patients needing emergent care, since the hospital does not plan to have an emergency room, according to a letter signed by Jana Fussell, the state’s certificate of need coordinator.

Also in this issue...

• Providence, Asante butt heads over radiology venture
  
• Regence edges out ODS, PacificSource for OMIP bid
  
• OHSU’s liability cap remains intact after failure of several bills
  
• Shake-up in Salem likely as legislature prepares for special session
  

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