News Headlines

News Headlines
Health care news from around the state and nation

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Obamacare Stocks Get A Supreme Court Surge
Yahoo! News

Investors learned last week that there can be some serious upside to having the nation’s highest court on your side.

Stocks of hospital operators and other healthcare-related companies rallied after the U.S. Supreme Court upheld a key piece of President Obama’s Affordable Care Act (a.k.a. Obamacare), which, according to Bloomberg, lifted “the main threat hanging over the industry’s prospects.”

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2016 OPPS Proposed Rule Updates Two-Midnight Rule
HealthLeaders Media

CMS is sharply accelerating its push toward moving outpatient payments from a fee-for-service model to a true prospective payment system with a number of its proposals in the 2016 OPPS proposed rule, including new comprehensive ambulatory payment classifications APCs (C-APC) and extensive APC consolidation and reconfiguration.

Highlights of the proposed rule include an update to the two-midnight rule and:

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Aetna Announces $37 Billion Merger With Health Insurance Rival Humana
National Public Radio

In what could prove the largest-ever merger in the insurance industry, Aetna has announced a $37 billion deal to acquire rival Humana.

The agreement, announced by the Hartford, Conn.-based Aetna, “would bolster Aetna’s presence in the state and federally funded Medicaid program and Tricare coverage for military personnel and their families,” according to The Associated Press.

Word of the cash and stock agreement comes a day after Centene said it would pay $6.3 billion to buy Health Net. According to the AP, the Centene-Health Net merger “would help Centene expand in the nation’s biggest Medicaid market, California, and give it a Medicare presence in several Western states.”

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Liberal Minority Won Over Conservatives In Historic Supreme Court Term
National Public Radio

It was a historic term, a surprisingly liberal term — and a nasty term.

That’s the essence of the tea-leaf reading about the U.S. Supreme Court term that just concluded. Astonishingly — though the court is dominated by conservative justices — the liberal minority, disciplined and united, drove the direction in a startling number of cases, while the conservatives splintered into multiple factions.

The numbers tell the story. The liberals won in 19 of the 26 closely-divided ideological cases and eight out of 10 of the most important ones. Those numbers were compiled by SCOTUSblog, the go-to Supreme Court online journal.

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Medi-Cal misfire: CalOptima seeks to rectify state billing error with $8.9 million in payments to O.C. health providers
Orange County Register

CalOptima, Orange County’s Medi-Cal insurance program for low-income residents, mailed checks this week totaling $8.9 million to nearly 500 health care providers to resolve a complicated state billing error that started in 2011.

In Orange County, 785 doctors, hospitals and other providers were erroneously reimbursed $15 million from the wrong fund for treating Medi-Cal patients, according to the state Department of Health Care Services. Instead, their claims should have been sent to CalOptima, which is state-funded but makes payments on behalf of local patients.

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Midwives able to accept Medi-Cal if new law approved
HealthyCal.org

In this story we go to Stockton where midwives are struggling to meet the high demand for their services. In California there is a shortage of Medi-Cal providers across the board, but especially for expectant mothers. In many areas of the state families are waiting weeks, maybe months before seeing a doctor for the first time in their pregnancy. Many turn to midwives who have to turn them away because they are not allowed to accept Medi-Cal patients.

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Health Insurance Companies Seek Big Rate Increases for 2016
New York Times

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.

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Vaccine opponents continue efforts against California law
Times-Standard

Opponents of California’s new law to boost vaccination rates among schoolchildren by strictly limiting exemptions are continuing to fight the legislation online and in public protests, even after Gov. Jerry Brown signed the bill into law this week.

Critics of the legislation are rallying around an effort by former state Assemblyman Tim Donnelly, who has filed paperwork for a ballot initiative asking voters to repeal the vaccine mandate, continuing their outspoken criticism on Twitter and other social media platforms, and holding rallies around the state.

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States Limiting Patient Costs For High-Priced Drugs
Kaiser Health News

As more expensive specialty drugs come on the market to treat some of the most serious chronic diseases, more states are stepping in to cushion the financial pain for patients who need medicine that can cost up to hundreds of thousands of dollars a year.

At least seven states — Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont — limit the out-of-pocket payments of patients in private health plans. Montana, for instance, caps the amount that patients pay at $250 per prescription per month.

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People With Brain Injuries Heal Faster If They Get Up And Get Moving
National Public Radio

When Kate Klein began working as a nurse in the Cleveland Clinic’s Neurointensive Care Unit, one of the first things she noticed was that her patients spent a lot of time in bed. She knew patients with other injuries benefitted from getting up and moving early on, and she wondered why not patients with brain injuries.

“I asked myself that question. I asked my colleagues that question,” Klein says. “Why aren’t these patients getting out of bed? Is there something unique about patients with neurologic injury?

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California tax officials blast Blue Shield in audit
Los Angeles Times

In a scathing audit, state tax officials slammed nonprofit health insurer Blue Shield of California for stockpiling “extraordinarily high surpluses” — more than $4 billion — and for failing to offer more affordable coverage or other public benefits.

The California Franchise Tax Board cited those reasons, among others, for revoking Blue Shield’s state tax exemption last year, according to documents related to the audit that were reviewed by The Times. These details have remained secret until now because the insurer and tax board have refused to make public the audit and related records.

Blue Shield’s operations are indistinguishable from those of its for-profit healthcare competitors, the auditors found, and it should be stripped of the tax break it has enjoyed since its founding in 1939. The insurance giant does not advance social welfare, the key test for preserving its tax exemption, according to the records.

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California tax officials slam Blue Shield in audit
Lodi News-Sentinel

State officials say their decision to strip Blue Shield of California of its tax-exempt status is justified by an audit that outlines the nonprofit health insurer’s stockpiling of $4 billion in surpluses.

The Los Angeles Times reports Sunday that the California Franchise Tax Board report slams Blue Shield for its “extraordinarily high surpluses” and for failing to offer more affordable coverage or other public benefits.

Auditors found Blue Shield’s operations are indistinguishable from those of its for-profit health care competitors. The tax board says the insurance giant does not advance social welfare, the key test for preserving its exemption.

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Aetna’s Humana Deal Pressures Cigna to Agree on Anthem Offer
Yahoo! News

With Aetna Inc. and Humana Inc. pairing off, pressure is mounting on other major health insurers to make their own deals.

Cigna Corp.’s tie-up with Anthem Inc. could be the next one on deck. Cigna rebuffed a bid from Anthem last month, and both were said to have been interested in Humana. But after the acquisition announced Friday, their options just got narrower.

“It paves the way for Cigna and Anthem,” Ana Gupte, an analyst at Leerink Partners in New York, said by phone. “Cigna has fewer choices at this point.”

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Loma Linda University, San Gorgonio Pass hospitals seek alliance
San Bernardino Sun

Loma Linda University Medical Center is forging an alliance with a hospital in the San Gorgonio Pass.

And the Affordable Care Act, signed into law in 2010, is cited as one of the major factors driving such hospital alliances up and down the state.

Loma Linda University Health and Adventist Health are negotiating a long-term contract with San Gorgonio Memorial Hospital to manage and operate the Banning hospital while its real-estate assets continue under the ownership of the San Gorgonio Memorial Hospital District, said Kerry Heinrich, chief executive

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