The state’s new approach to revamp mental health services proposes to unite elements offered by entities that have been at odds with each other—private insurance companies and public behavioral health organizations.

Roughly two months after the Department of Health and Human Services ended the direct blending of physical and mental healthcare, DHHS Director Robert Gordon briefed lawmakers on a new physical-mental health integration approach.

Part of the proposal is the idea of creating multiple “specialty integrated plans” or SIPs, which the DHHS said in a press release today would “bring together the management skills of traditional insurance companies with the expertise and depth of behavioral health organizations.”

The association for the state’s Community [Read More]

By CARMEN HEREDIA RODRIGUEZ
Kathleen Hambleton once used to spend $100 a week on Marlboro Reds.
The 43-year-old nurse from Saxtons River, Vt., paid a high price for her addiction to smoking, undergoing multiple throat surgeries. The financial hit was also a big burden.

After lozenges, patches and hypnosis failed to help Hambleton quit, she tried vaping. She is convinced she is healthier now and spends less than $40 per month on her vaping supplies.

Vermont recently passed a 92 percent wholesale tax on vaping and e-cigarette products. Hambleton believes the sudden and sharp price hike is prohibitively expensive.

“When they imposed the 92 percent tax, I can’t affordably pay that,” she said. “No one [Read More]

Get Real On Pre-authorizations: Interoperability Is Key

By EWE MATUSZEWSKI
There is much left unsaid in the discussion of new Michigan legislation (“Health Can’t Wait”) that would curb insurance pre-approval rules in health care. Pre-authorizations are used not only to keep costs down, but to ensure that unnecessary testing (and physician shopping) is not performed on patients, especially a repeat diagnostic test where the initial test results are available.

Our organization submits at least 1,500 requests for pre-authorizations to payers per quarter, and denials are rare, sometimes zero. That’s because we use the primary care physician to coordinate patient care with specialists, as directed by those who follow the principles of the patient-centered [Read More]

MAPS Policy Leads To Drop In Controlled Substances Dispensed In Michigan

By JESSE ADAM MARKOS, ESQ.
Wachler & Associates, P.C.
Required registration and use of the Michigan Automated Prescription System (MAPS) has proven helpful in decreasing the amount of controlled substances dispensed in Michigan. Beginning last year, physicians in Michigan are required to register with MAPS and review MAPS patient-specific data before prescribing or dispensing a Schedule 2-5 controlled substance to a patient in a quantity that exceeds a three-day supply. These requirements, combined with other efforts to fight the opioid epidemic, have led to a dramatic decrease in the amounts of controlled substances dispensed in Michigan.

The Department of Licensing and Regulatory [Read More]

Double Your Signing Bonus, Double Your . . . Prison Dentists?
If the prospect of polishing prisoner teeth is not tantalizing enough to get more dentists at the Michigan Department of Corrections, the state is now looking to sweeten the deal by doubling the bonus money available for new hires.

Dentists hired for state prisons have been allowed a $5,000 bonus for several years now, but the DOC is now seeking approval for an additional $5,000 to be available once dentists complete their initial one-year probationary periods, meaning they can earn an extra $10,000 within the first year of employment.

DOC spokesperson Holly Kramer said the bonuses would be funded out of existing [Read More]

Language added to the state budget to trigger the statewide implementation of blended physical and mental health services is designed to put to rest the debate about how the blending of care should be done, according to the state’s health plans that favor the language.

“Everybody is tired of the issue. They’re tired of the persistent debate. They want action, they want integration, and they want, more importantly, improved outcomes,” said Dominick Pallone, executive director of the Michigan Association of Health Plans (MAHP), adding later, “The boilerplate debate is getting pretty old for everybody.”

But the state’s community mental health (CMH) organizations see the language as paving the way to “a full [Read More]

By JORDAN RAU
Medicare cut payments to 2,583 hospitals Oct. 1, continuing the Affordable Care Act’s eight-year campaign to financially pressure hospitals into reducing the number of patients who return for a second stay within a month.

The severity and broad application of the penalties, which Medicare estimates will cost hospitals $563 million over a year, follows the trend of the past few years. Of the 3,129 general hospitals evaluated in the Hospital Readmission Reduction Program, 83 percent received a penalty, which will be deducted from each payment for a Medicare patient stay over the fiscal year that began Oct. 1.

Although Medicare began applying the penalties in 2012, disagreements continue about whether [Read More]

Pay Raises For Health Workers Abound In DHHS Budget
A number of workers employed in state human services-related fields will be getting raises under the Fiscal Year 2020 budget approved for the Michigan Department of Health and Human Services by the Legislature Sept. 24.

SB 0139 earned the most Democratic support in the House, where it passed 64-44. The Democrats who crossed over to vote yes with Republicans were Reps. John Cherry (D-Flint), Abdullah Hammoud (D-Dearborn), Jon Hoadley (D-Kalamazoo), Rachel Hood (D-Grand Rapids), Leslie Love (D-Detroit), Laurie Pohutsky (D-Livonia), Karen Whitsett (D-Detroit) and Angela Witwer (D-Delta Twp.).

Rep. Steven Johnson (R-Wayland) voted no with most of the Dems. Reps. Brenda Carter (D-Pontiac) and [Read More]

By ANDREW B. WACHLER & KAITLIN A. NUCCI
Wachler & Associates, P.C

The Centers for Medicare and Medicaid Services has released its final rule with comment period regarding the disclosure of affiliations in the provider enrollment process. This rule will take effect on November 4, 2019. This rule provides the authority to revoke or deny enrollment based on the disclosure of any affiliations that CMS determines poses an undue risk of fraud, waste, or abuse. Although the plan is to have this rule be applicable to all providers, CMS is starting out with a phase-in approach, where the rule will be applied to initially enrolling or revalidating providers that CMS has specifically [Read More]

By ALLAN DOBZYNIAK, MD
We are developing new technological gimmicks to measure every activity throughout our day, blood pressure (BP), pulse (P), respirations, stairs climbed, walking time, calorie burn, sleep time, and on and on. Soon we will be device-covered from head to toe. To what end? There are shelves upon shelves of magical elixirs and pills to cure any symptom, prevent aging and definitely improve on God’s or nature’s original design. Can you imagine the size of the bag necessary to carry all of these magical medicinals?

Our health care providers are obsessing over preventive care, with hardly time anymore to treat sick people. Our government is determined to turn primary [Read More]