This story was originally published by ProPublica.

By ROBIN FIELDS
A new study challenged the accuracy of public health data on deaths related to pregnancy and childbirth — and the narrative of high and rising U.S. maternal mortality rates. An unusual public dispute has ensued.

Series: Lost Mothers: Maternal Care and Preventable Deaths

The U.S. has the highest rate of deaths related to pregnancy and childbirth in the developed world. Half of the deaths are preventable, victimizing women from a variety of races, backgrounds, educations and income levels.

An unusual public dispute has erupted among leading maternal health experts over whether the striking rise of U.S. maternal mortality rates over the past two decades was the real deal — or a statistical mirage.

The challenge to what has been a long-held view among public health officials came from researchers behind a new study published in the American Journal of Obstetrics & Gynecology.

The study concluded that maternal death rates put out by the Centers for Disease Control and Prevention have been substantially inflated by misclassified data. Using an alternate way of counting deaths related to pregnancy and childbirth, the study found, U.S. maternal mortality rates would be far lower than have been reported. And they’d be stable, not rising.

The pushback followed soon after.

The [Read More]

By CHRISTINE SPOLAR

Gun violence has exploded across the U.S. in recent years — from mass shootings at concerts and supermarkets to school fights settled with a bullet after the last bell.

Nearly every day of 2024 so far has brought more violence. On Feb. 14, gunfire broke out at the Super Bowl parade in Kansas City, killing one woman and injuring 22 others. Most events draw little attention — while the injuries and toll pile up.

Gun violence is among America’s most deadly and costly public health crises. But unlike other big killers — diseases like cancer and HIV or dangers like automobile crashes and cigarettes — sparse federal money goes to studying gun violence or preventing it.

That’s because of a one-sentence amendment tucked into the 1996 congressional budget bill: “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

Its author was Jay Dickey, an Arkansas Republican who called himself the “point man” for the National Rifle Association on Capitol Hill. And for nearly 25 years the amendment was perceived as a threat and all but paralyzed the CDC’s support and study of gun violence.

Even so, a small group of [Read More]

By SUSAN ADELMAN, MD
When I was a surgery resident at Henry Ford Hospital, we greeted each patient on morning rounds in the same way. Good morning, Mr. Jones. Good morning, Mrs. Smith. How are you today? Or something like that. At least it was courteous and respectful. It did not matter if Mr. Jones was black or white, poor or rich. On our rounds, and in discussion of patients, staff doctors modeled color-blind treatment of their patients when they trained the residents. They even would call a child Mr. Jones, out of habit, then laugh, realizing it sounded silly. And Diversity, Equity, Inclusion training (DEI) had not been invented yet.

We learned at the bedside exactly what our parents had taught us. “Do unto others as you would have them do unto you.”  This comes from the Bible: the Golden Rule.

We knew that some medical conditions were commoner in certain ethnic groups. That is part of medicine. Children have children’s diseases. Older people have geriatric conditions. Those with some black heritage have a higher risk of sickle cell anemia, thalassemia, or prostate cancer.  The government Office of Minority Health elaborates that they also are more prone to “heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, [Read More]

By DANIEL AYYASH & SHEA MACE
Wachler & Associates, P.C.

Overview

In response to the enormous economic challenges faced by healthcare providers during the COVID-19 public health emergency (PHE), the Coronavirus Aid, Relief, and Economic Security (CARES) Act established the Provider Relief Fund (PRF) in an effort to provide financial support to providers across the nation. Congress allocated $178 billion to the PRF program, which was then disbursed to providers in multiple phases through general and targeted distributions. The Health Resources & Services Administration (HRSA), a subagency of the Department of Health and Human Services (HHS), was tasked with administering PRF disbursements and overseeing compliance with the program’s terms and conditions.

The primary compliance requirements attached to PRF distributions mandated that the funds only be used to prevent, prepare for, and respond to COVID-19, and that providers submit reports to HRSA regarding use of the funds. The reporting requirements, including the timeline for reporting, changed multiple times throughout the years following the program’s inception, creating significant confusion amongst providers.

Furthermore, while HRSA stated that providers who received PRF funds were required to accept a corresponding set of terms and conditions, all providers who retained those funds for longer than 90 days without contacting HHS or returning the funds were [Read More]

By BILLEE LIGHTVOET WARD, ESQ.
Dickinson Wright

The Food and Drug Administration (FDA) regulates foods and beverages, drugs and medical devices, biologics, dietary supplements, tobacco products, veterinary products, and cosmetics. Although these various product categories may appear to be clearly cut, the fact of the matter is that a product can very easily cross over from one product category to a different one as a result of issues such as in intended use, composition, labeling content or other claims, or other such issues that may seem to be inconsequential. At the earliest possible stage of product development, it is important to evaluate the identity of the product based on these and other factors, and to anticipate the manner in which the product will be marketed and advertised including, most significantly, the claims that will be made in relation to the product and its capabilities.

Product Classification. There are specific statutory definitions that ultimately dictate the categorization of a given FDA-regulated product. Consulting the applicable definitions and evaluating the specifics of a given product under applicable laws and FDA guidance documents is a technical and fact-specific exercise. Portions of the “drug” and “medical device” definitions help to illustrate how easily the lines can be crossed and result in [Read More]

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

DHHS Budget Asks: From Detroit Project To Chromotherapy Glasses

During the only House committee hearing over the two weeks of legislative spring break, Rep. Christine Morse (D-Kalamazoo)’s Appropriations subcommittee on Health and Human Services heard funding requests for everything from a new Detroit affordable housing and childcare campus to chromotherapy glasses.

Morse held the hearing to take public comment, which she said would be used to influence the budget-crafting process.

Among the requests heard was a $2.498 million ask to break ground on a combined housing and childcare project in downtown Detroit through MiSide, a Detroit-based nonprofit providing families with access to behavioral healthcare, employment, housing and childcare services.

Laura LeBlanc, executive director of philanthropy and external affairs with MiSide, said the nonprofit provides services to 25,000 people across Wayne County, and is looking to expand services in the Cody Rouge neighborhood of Detroit through a “healthy village initiative.”

LeBlanc said the first-of-its-kind program in metro Detroit will offer a combination of housing and childcare to a “community in desperate need,” using a freshly constructed two-tier campus.

“On the main level, it will offer 90 children access to child care, and then on the second floor we will [Read More]

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 cover proven cancer treatments, but according to internal emails, some Priority Health executives argued that CAR-T was a gene therapy, not a drug, and thus not subject to the state’s coverage mandate.

State Sen. Jeff Irwin, D-Ann Arbor, plans to file the new bill to make explicit that Michigan’s cancer treatment coverage mandate includes a new generation of genetic and immunotherapies, including CAR-T.

Earlier this year, Michigan’s top insurance regulator told health plans they had to cover these treatments. Irwin’s measure would codify that guidance, ensuring it’s not dependent on one regulator’s interpretation of the law. He said [Read More]

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, the Beaumont Health and Spectrum Health systems merged in 2022 to form what is now Corewell Health. This included Beaumont Hospital Royal Oak, Oakwood Hospital (Beaumont Hospital Dearborn), and the Beaumont hospitals in Grosse Pointe, Farmington Hills, Troy, Big Rapids, Blodgett, Butterworth, the Helen DeVos Children’s Hospital, plus 17 more hospitals in western Michigan.

Meanwhile, Trinity Health of Livonia, which itself was a merger of the Holy Cross and Mercy hospitals, has joined several other Catholic institutions to form MercyOne, which now operates 420 medical facilities, largely in Iowa but also beyond. And the eight hospitals [Read More]

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 as our nonprofit learning organization, Practice Transformation Institute (PTI), was celebrating the gradation of two cohort classes of CHWs the week the feature aired. We showed the clip at the graduation ceremonies as an example of how the need for community health workers was not only growing but gaining attention beyond the healthcare and public health environment.

I do hope I haven’t turned off readers with my many columns referencing CHWs. But it’s a message that bears repeating. And that’s ultimately how ideas including medical messaging stick: clinical, academic, community, word-of-mouth, media. The emergence of CHWs [Read More]

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 than issues related to any unique characteristics of a specific claim. Therefore, these allegations often lead to demands that the provider pay back a significant portion of reimbursements for the COVID-19 services they provided over a particular time period, often in the range of hundreds of thousands or even millions of dollars.

Audits of COVID-19 services have centered around several common issues:

E/M Visits:  E/M services were provided to assess symptomatic patients and those with known exposures, all against the backdrop of changing public health guidance and fluctuating positivity rates in local communities.  Depending on the practice [Read More]

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 of the Fiscal Responsibility Act of 2023 and the related rescission of program funds, no further payments will be provided. However, given the significant expenditure of funds, government investigations and enforcement actions of the HRSA uninsured program are likely to continue for the foreseeable future.

The Standards for Determining HRSA Uninsured Status

HRSA requires that providers verify and attest that, to the best of the provider’s knowledge, the patient was uninsured at the time of the claim submission. For claims related to COVID testing, treatment of positive cases, and/or vaccine administration, this means the patient did not [Read More]

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 pack nationally when it comes to state organ donor registries, with 4.5 million Michiganders on the registry, or 57 percent of the state’s population.

He added that 95 percent of those registry opt-ins come from the SOS questionnaire for new and renewal licenses, but those new registrations are now coming in much slower than usual, especially among young drivers.

Wells-O’Brien said only 21 percent of new drivers today are registering as organ donors, which he called “abysmally low” compared to other states, which are closer to 40 or 50 percent.

This could ultimately lead to registry numbers declining, [Read More]

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 make her vision for 2024 either.

Instead, she prioritized things like a $5,000 debut “Caring for MI Family Tax Credit” for a family’s caregiver expenses, two years of tuition free community college for high school graduates and a revamped pot of business incentive tools.

For economic development, Whitmer wants more renaissance zones – where businesses and entrepreneurs are awarded a period of tax exemptions – and a new “Innovation Fund” to deploy state investment into “high-growth startups” projected to boost significant career attraction and retention in the state.

Whitmer didn’t say anything about a prescription drug affordability board [Read More]

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 emails obtained by ProPublica showed that executives at Priority Health, the second-largest insurer in Michigan, had argued that the expensive treatment VanPatten needed was a gene therapy, not a drug, so the state’s mandate didn’t apply. VanPatten died in February 2020, still fighting for access to treatment. Priority Health’s associate chief medical officer had tried fruitlessly to convince his bosses that the company was required to cover the treatment, known as CAR T-cell therapy. He later told ProPublica: “We crossed the line.”

Forrest VanPatten’s widow, Betty, and their two adult children said they hoped the historic [Read More]

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 holds his breath, then a companion presses him against a wall until he passes out. The purpose is to attain a brief state of euphoria. Next, there is the Challenge to Tape the Mouth shut during sleep, supposedly because sleeping with the mouth open is hazardous. This can result in the child becoming hypoxic, even to the point of a cardiac arrest.

In the Skull Breaker Challenge, three people stand in a row, facing the camera. The two on the outside convince the one in the middle to jump, but when he does, they sweep his [Read More]

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 pursuant to Public Act 166 of 2022, and representatives from state government, higher education, hospitals, and other professional associations were invited to meet with LARA to help identify the issues confronting FTMPs.  Michigan is following in the footsteps of a number of states that have been actively turning to FTMPs, who were trained in other countries and have the experience and skills necessary to deliver healthcare services, to address provider shortages.

LARA believes that there are approximately 6,000 FTMPs in Michigan with sufficient training and degrees, who are ready and able to help alleviate the provider [Read More]

By SETH WAXMAN
Dickinson Wright

The United States Department of Justice (“DOJ”) and state law enforcement agencies have robust teams investigating and prosecuting health care fraud. Law enforcement often uses advanced data analytics and algorithmic methods to identify newly emerging health care fraud schemes. DOJ also employs nine regional strike forces located throughout the country to bring together groups of prosecutors, FBI agents, and key administrative agencies to combat health care fraud. Critical time will be lost, and important steps may be missed if an organization waits until an investigation is underway to decide how to respond to a government investigation.

6 Steps for Responding to a Search Warrant

1. Company policy

Health care companies should implement a written policy on how to handle government investigations. Attempting to put together a response on the fly is fraught with danger and will likely put the company at risk. For search warrants, the policy should include designating a lead person within the company, such as an experienced attorney or trained manager, to oversee the company’s response. There should also be a designated manager at each health care facility who is responsible for initially engaging with law enforcement and notifying the lead corporate official (these corporate leaders and managers are collectively referred [Read More]

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

Abortion Provider, Student Group Challenge Access Restrictions

A Michigan abortion provider and a pro-abortion rights student group filed a Michigan Court of Claims case challenging three abortion restrictions, including Michigan’s 24-hour waiting period.

Northland Family Planning Centers and Medical Students for Choice also challenge the dissemination of certain information to a patient before an abortion and prohibitions on the ability of advanced practice clinicians to perform abortions, according to the lawsuit filed recently.

“Through the RFFA, Michigan voters overwhelmingly declared that they will not tolerate paternalistic and medically baseless restrictions on abortion like those we are challenging in this case,” said Rabia Muqaddam, senior staff attorney at the Center for Reproductive Rights. “With this lawsuit, we hope to eliminate these harmful restrictions and ensure the state’s laws reflect the will of Michigan voters.”

The RFFA – Reproductive Freedom for All – is a constitutional amendment passed on Nov. 8, 2022.

Renee Chelian, executive director of Northland Family Planning Centers added: “Every day, and especially since Roe (v. Wade) was overturned, our providers and clinic staff work tirelessly to meet the needs of both Michigan residents and out-of-state patients.

“Despite our win with Proposal 3, patients continue to [Read More]

By JULIE APPLEBY
It’s winter, that cozy season that brings crackling fireplaces, indoor gatherings — and a wave of respiratory illness. Nearly four years since the pandemic emerged, people are growing weary of dealing with it, but the virus is not done with us.

Nationally, a sharp uptick in emergency room visits and hospitalizations for COVID-19, influenza, and respiratory syncytial virus, or RSV, began in mid-December and appears to be gaining momentum.

Here are a few things to know this time around:

What’s Circulating Now?

The COVID virus is continually changing, and a recent version is rapidly climbing the charts. Even though it appeared only in September, the variant known as JN.1, a descendant of omicron, is rapidly spreading, representing between 39% to half of the cases, according to pre-holiday stats from the Centers for Disease Control and Prevention.

Lab data indicates that the updated vaccines, as well as existing COVID rapid tests and medical treatments, are effective with this latest iteration. More good news is that it “does not appear to pose additional risks to public health beyond that of other recent variants,” according to the CDC. Even so, new COVID hospitalizations — 34,798 for the week that ended Dec. 30 — are trending upward, although rates are still substantially [Read More]

As of Dec. 2, Michigan was trailing behind last year’s administered flu shot numbers by more than 10 percent, which is a setback that’s caught the attention of the Michigan State Medical Society.

“The biggest risk would be to have a very severe flu season, with many severe illnesses requiring (hospitalization),” said Dr. M. Salim Siddiqui, MSMS president. “I think we all have a sense of what happens when our hospitals get overwhelmed by respiratory illness. For older patients and younger patients, there (would) be (concerns) about severe permanent complications and even death.”

During a recent roundtable discussion, lasting around 20 minutes, Siddiqui described the influenza vaccine as a way to avoid respiratory illness-related hospitalizations, preventing facilities from tapping out their capacities.

According to the state’s official Flu Dashboard, influenza vaccine coverage for youths – from six months through 4-years-old – has fallen from 41.4 percent and 31.6 percent during the 2021-22 and 2022-23 flu seasons, respectively, to 21.4 percent in the ongoing season.

As for those 65-years-old and older, vaccine coverage has dropped from 62.6 percent in the last season to 51.9 percent in the present-day 2023-24 influenza season – declining from more than 1.1 million vaccinated residents to 936,330.

Siddiqui said a survey found 27 percent of non-vaccinated individuals [Read More]

By PAUL NATINSKY
Until recently, I never gave much serious thought to mental health. As a member of that latch-key, seat-beltless, hose-hydrating generation born in the late ‘60s, I thought of mental health as a refuge of the weak and excuse-seeking. Worse, at times I thought of those with severe mental health issues as hopeless institution dwellers beyond the help of healthcare professionals. Even as I gained experience as a healthcare reporter and health policy professional in the state legislature, I hated working on mental health issues.

That’s a tough truth to admit to for a healthcare publication editor and I’ll probably pay a price for that. But it is important to illustrate how far attention to mental health has come in public and professional consciousness.

We see the quarterback of the national champion Michigan Wolverines meditating cross-legged, eyes closed, with his back against the goal post. We later see him consulting with the team psychologist on the sideline during the championship game (imagine that tableau during the Schembechler era!).

We see the suicides of beloved public figures such as actor and comedian Robin Williams used to draw attention to the horribly painful and self-negating effects of depression.

We see concern about the effects of “triggering” events on our fellow [Read More]

By SUSAN ADELMAN, MD
Since the beginning of the COVID epidemic, most physicians have been struggling to do the right thing when it comes to treatment and prevention. Part of this was because, in the beginning, a terrifying complex of symptoms hit our patients fast, with high lethality, high transmissibility and distressing urgency. We worked hard, under pressure, to diagnose, to figure out immediate treatments, to devise prevention strategies, to understand new vaccines, and, eventually, boosters. Now we have a great deal of information, but most of us in the medical profession still are hard-pressed to be confident in our recommendations about vaccines and boosters for all age groups. Meanwhile, some politicians, schools and employers still are trying to protect their constituents and employees with well-meaning but scientifically shaky mandates.

It is now time for the medical profession to stop, take a deep breath, and begin addressing COVID as it would address any other diagnostic or therapeutic dilemma, using evidence-based medicine. This is a systematized method of grading evidence to assess, say, the effect of an intervention or the results of clinical trials, usually using meta analysis of multiple studies. The quality of the evidence then is rated High, Moderate, Low or Very low. As an example, moderate [Read More]

By EWA MATUSZEWSKI
When a practicing physician dies, there is not only intense grief, but an entire gamut of professional details that require immediate attention. I recently faced this personal challenge and was admittedly adrift in confronting first and subsequent steps. Perhaps I should have known them already—but some of the medical associations and health plans I reached out to didn’t either. The question? Where is the checklist to guide me through the “un-credentialing” of a physician?

With the risk of identity theft high, it is imperative that no enterprising thief access physician credentials for nefarious purposes. Here is what I learned by creating my own checklist for steps that must be taken when a physician dies. (Note that information to “disenroll” applies to a retiring physician as well.) The following provide time-sensitive basics:

• Meet with the practice manager to create an action plan for the first 15 days.
• Assemble current employees to communicate pending changes in the practice and how their support is needed for a smooth transition.
• Send an announcement via the patient portal to active patients. Draft and send a letter via US mail to the patients as well. This is not necessary for a fully retired physician unless the successor practice leaders want to [Read More]
  

By SHEA MACE
Wachler & Associates, P.C.

On December 7, 2023, MDHHS announced that community health worker services now will be covered by Medicaid. The new policy is effective January 1, 2024, and chiefly applicable to the Medicaid Fee-for-Service (FFS) program. Medicaid Health Plans (MHPs) and Integrated Care Organizations (ICOs) must also comply by offering the full range of services described within the policy, although they may provide additional services beyond those specified and may develop review and prior authorization criteria different than Medicaid requirements.

CHW Overview

Community health workers (CHWs) are non-licensed but trained public health providers who have distinct knowledge and appreciation of the community they serve. They function as a liaison between community members, healthcare providers, and social services. CHW services must be delivered face-to-face and broadly include assistance with health system navigation, resource coordination, health promotion and education, and the use of screening and assessment tools.

Beneficiary need for CHW services must be recommended by a licensed healthcare provider, including but not limited to a physician, physician assistant, nurse practitioner, registered nurse, licensed master social worker, dentist, or psychologist. Necessity must be assessed and established by using a health risk or social determinant of health (SDOH) screening tool. Conditions that endorse the need for CHW services [Read More]

By KATHLEEN CAMPBELL WALKER
Recently, the president of the American Medical Association, Jesse M. Ehrenfeld, MD, stated in a national address that the physician shortage long-feared is here and that “It’s an urgent crisis…hitting every corner of this country—urban and rural—with the most direct impacting hitting families with high needs and limited means… Ninety percent of counties in the U.S. are without a pediatric ophthalmologist. Eighty percent are without an infectious disease specialist.”

All areas of the country rely in part on foreign medical graduate (FMG) physicians, who may be required to serve in qualifying health professional shortage areas (HPSAs) or medically underserved areas (MUAs) to transition to a career as a health professional in the United States. These FMG physicians are often admitted to the U.S. to engage in their medical graduate studies in J-1 nonimmigrant status and are subject to a requirement to return to their home country for two years before transitioning to a pathway to legal permanent residence (LPR) in U.S. (Some refer to his process as obtaining a “green card”)

For those J-1 FMG physicians who wish to transition to a pathway to LPR, they must determine if they can be approved for a waiver of this two-year obligation to return to [Read More]