Pennsylvania health plan to withdraw from 17 counties on Sept. 30
Gateway Health Plan has notified the Pennsylvania Department of Public Welfare that, it will withdraw its Medicaid product from 17 counties in the department's Voluntary Managed Care Program, effective Sept. 30, 2010. The withdrawal will affect approximately 14,500 consumers in Cambria, Carbon, Clarion, Columbia, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour, Northumberland, Pike, Schuylkill, Somerset, Susquehanna and Wyoming counties. The counties contained about 5 percent of Gateway's membership, yet account for about a quarter of the company's losses. " "We've spent 17 years building our membership in those areas, but we're losing money at an alarming rate," said Mike Blackwood, president and CEO of Gateway.
Federal appeals court strikes down D.C.'s PBM fiduciary law
The U.S. Court of Appeals for the District of Columbia has struck down a district law that would have designated pharmacy benefit managers as fiduciaries. The court ruled that key portions of the law, Title II of the DC AccessRx Act of 2004, are unconstitutional. The ruling allows PBMs to continue to work to reduce the costs and improve the quality of prescription drug benefits, according to Mark Merritt, president and CEO of the Pharmaceutical Care Management Association.
Health Net fined $250,000 for data security violations
Connecticut Attorney General Richard Blumenthal has announced a $250,000 settlement with healthcare insurer Health Net and its affiliates over health data security breaches. Blumenthal charged Health Net with failing to secure private patient medical records and financial information on nearly a half million Connecticut enrollees and failing to promptly notify consumers endangered by the breach. This is the first action by a state attorney general for violations of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) since the Health Information Technology for Economic and Clinical Health Act (HITECH) authorized them to enforce HIPAA.
Patient payment guarantee program begins beta testing
A payment guarantee program for an electronic payment application will be beta tested at three healthcare provider sites. The program, designed to make healthcare providers more comfortable with extending terms for patients who can't pay their deductible in one lump sum, guarantees payment if patients default, said Mary Dees, president of Preferred Health Technology. PHT has been seeing a rise in its administration of automated payment extension plans, she said. After the month-long beta testing, PHT will conduct a full-scale rollout of the payment guarantee program.