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Michigan Lawmaker Introduces Bill Requiring State Health Plans to Cover Cutting-Edge Cancer Treatments

This story was originally published by ProPublica.

By ROBIN FIELDS & MAYA MILLER
Spurred by a ProPublica story about an insurer that denied coverage of the only therapy that could have saved the life of a 50-year-old father of two, a Michigan lawmaker a bill early this month requiring health plans in the state to cover cutting-edge cancer treatments.

In February 2020, Forrest VanPatten died fighting Priority Health, one of Michigan’s largest health insurers, over its refusal to pay for CAR-T cell therapy, his last-chance treatment. The therapy works by genetically reengineering patients’ own cells, then infusing them back into the body to beat back their disease.

Michigan has long required insurers to [Read More]

Michigan Lawmaker Introduces Bill Requiring State Health Plans to Cover Cutting-Edge Cancer Treatments2024-03-12T16:26:50-04:00

ADELMAN’S ANALYSIS: The High Cost  of Consolidation

By SUSAN ADELMAN, MD
On Oct. 19, 2023, the Free Press announced that Henry Ford Health and Ascension Michigan would form a joint venture. This will join Ascension’s Southeast Michigan hospitals with the Ascension Genesys Hospital in Grand Blanc and the Henry Ford hospitals, creating a system with more than 550 sites of care.  Among the eight Ascension hospitals are two Providence Hospitals, St. John Hospital, two Macomb Oakland Hospitals, River District Hospital, and the Brighton Center for Recovery. Joining them will be five Henry Ford hospitals and Health Alliance Plan. This all must pass antitrust review, but I cannot recall any of the mergers in Michigan failing to get approval.

Remember, [Read More]

ADELMAN’S ANALYSIS: The High Cost  of Consolidation2024-03-12T16:23:33-04:00

Watershed Moment As Community Health Workers Make It To Prime Time

By EWA MATUSZEWSKI
I believe we witnessed a breakthrough in getting the role of the community health worker (CHW) into the vernacular of common healthcare terms. That’s because I saw a news story about CHWs on local television – not a healthcare special or a “news hour” but standard local news programming. Thank you, Henry Ford Cancer Institute, for sharing with WDIV (the local NBC affiliate in Detroit,) how your mobilization of healthcare workers in the hospital setting is putting patients and their families at ease by helping navigate some of the non-clinical aspects of illness, hospital stays and care coordination.

The timing of the local news piece couldn’t have been better [Read More]

Watershed Moment As Community Health Workers Make It To Prime Time2024-03-12T16:21:12-04:00

COVID-Related Service Audits Create Problems For Primary Care Providers and Labs

By JENNIFER COLAGIOVANNI
Wachler & Associates, P.C.

Nearly four years after the COVID-19 pandemic began, healthcare providers continue to see payor audits and demands for repayment of services provided during the pandemic, primarily related to COVID-19 testing and lab services, as well as for evaluation and management (E/M) office and telehealth visits. Despite the fact that these services served a critical public health function during the pandemic, constantly changing and often unclear guidelines governing coverage and documentation of these services have created fertile ground for payors to allege after-the-fact that providers were not entitled to payment.

The audit issues asserted by payors tend to relate to the process used by the provider rather [Read More]

COVID-Related Service Audits Create Problems For Primary Care Providers and Labs2024-03-12T16:17:56-04:00

Providers Face Government Scrutiny Over COVID Coverage For Uninsured

By ANDREW L. SPARKS
Dickinson Wright

The Families First Coronavirus Response Act (FFCRA) was enacted in March 2020 as part of the government’s response to the COVID-19 pandemic. The FFCRA, among other things, provided funds for diagnostic testing and services for people without insurance for COVID-19. These funds were distributed through the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program (HRSA uninsured program). Providers seeking reimbursement under the HRSA uninsured program were required to enroll as a provider participant and check to ensure that patients were uninsured.

The HRSA uninsured program paid out more than $24.5 billion in claims. With the passage [Read More]

Providers Face Government Scrutiny Over COVID Coverage For Uninsured2024-03-12T16:19:01-04:00

LANSING LINES

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

Organ Donor Education May Be Mandatory Part Of 9th Grade

A pandemic-era change to Michigan’s driver’s training program means new drivers may wait in fewer Secretary of State lines, but reworked visit schedules means they will also be asked to opt in as an organ donor before completing an educational segment about the registry.

The solution? Rep. Felicia Brabec (D-Ann Arbor) proposed the creation of an hour-long organ donor education program for Michigan’s ninth graders.

Patrick Wells-O’Brien, vice president of communications and external relations for non-profit registry Gift of Life Michigan, said Michigan is in the middle of the [Read More]

LANSING LINES2024-03-12T16:09:35-04:00

State Of State: Family Leave And Drug Cost Lowering Proposals Left Out

Missing from the Gretchen Whitmer’s State of the State address late last month were her calls for paid family leave and prescription drug affordability – both items she wanted to see get done before the end of last year.

Whitmer’s August 2023 “What’s Next?” Address highlighted proposals she wanted moved in Lansing during the first year of a Democratic-led House, Senate and executive office in 40 years.

The “clean energy” by 2040 proposal and the elimination of numerous state abortion regulations were both endorsed by the governor in her August speech and passed before mid-November. Whitmer’s priorities for paid family leave and a prescription drug affordability board were left behind, and didn’t [Read More]

State Of State: Family Leave And Drug Cost Lowering Proposals Left Out2024-02-13T17:40:26-05:00

Health Plans Can’t Dodge Paying For Expensive New Cancer Treatments, Says Michigan’s Top Insurance Regulator

By ROBIN FIELDS & MAYA MILLER
ProPublica/Co-published with The Capitol Forum

In a victory for many cancer patients in Michigan, the state’s top insurance regulator told health plans last month that they cannot deny coverage for clinically proven cancer treatments, and she made it clear for the first time that this includes cutting-edge genetic and biologic therapies.

The move follows weeks of questions from ProPublica and pressure from state lawmakers after the news organization reported in November that an insurer there refused to pay for the only treatment that could save the life of Forrest VanPatten, a 50-year-old father of two, even though a state law requires insurers to pay for proven cancer drugs.

Internal [Read More]

Health Plans Can’t Dodge Paying For Expensive New Cancer Treatments, Says Michigan’s Top Insurance Regulator2024-02-13T17:38:20-05:00

ADELMAN’S ANALYSIS: TikTok Challenges Present Health Risk

By SUSAN ADELMAN, MD
We all have heard that Tik Tok should be banned, but usually for political reasons. Few in the medical community realize the medical and public health dangers that kids are exposed to when they go on this platform. Along with alluring dance routines are enticing challenges to do completely ridiculous, unbelievably dangerous pranks—dangerous to the self and to others. Does anyone older than a teenager know what these challenges are? Let us go through some of them.

One is so dangerous and has caused so many deaths that Tik Tok has put up a warning message on their platform – the Blackout Challenge.  In this one, the child [Read More]

ADELMAN’S ANALYSIS: TikTok Challenges Present Health Risk2024-02-13T17:35:40-05:00

COMPLIANCE CORNER: LARA Ramps Up Efforts To Remove Obstacles Preventing Foreign-Trained Healthcare Providers From Practicing In Michigan

By: Jesse Adam Markos, Esq.
Wachler & Associates, P.C

Michigan is currently facing a shortage of healthcare providers that has escalated to unprecedented levels.  In response, Michigan’s Department of Licensing and Regulatory Affairs (“LARA”) has taken steps to enhance efforts to recruit and retain providers.  One such step is the formation of a task force to identify obstacles that prevent Foreign Trained Medical Professionals (“FTMPs”) from practicing in Michigan and to create recommendations to improve the efficiency and effectiveness of the licensing process.  The resulting Michigan Task Force on Foreign Trained Medical Professional Licensing (“Task Force”) has done just that in its recently released Final Report.

As background, the Task Force was created [Read More]

COMPLIANCE CORNER: LARA Ramps Up Efforts To Remove Obstacles Preventing Foreign-Trained Healthcare Providers From Practicing In Michigan2024-02-13T17:33:46-05:00
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