Beshear says he will create state health insurance exchange if federal health reform law is upheld

Gov. Steve Beshear said today that he will wait on creating a health insurance exchange under federal health reform until the U.S. Supreme Court rules on the constitutionality of the reform law, which is expected to happen in late June. He said in a press release, “The steps we have taken to date, and the planning process we are putting in place helps ensure the state is able and ready to follow the law.”

The exchange, a requirement of the Patient Protection and Affordable Care Act, would be a market for individual health-insurance policies. It would help small employers insure their employees in health plans and "enable individuals to receive premium tax credits and premium subsidies, and qualify small businesses for tax credits," the release said.

"The state has a $57.8 million federal grant to plan and implement of programs and systems required by the law, including "building an end-to-end eligibility and enrollment system to serve both Medicaid and exchange participants," the release said. "Kentucky previously received two federal health insurance exchange planning grants totaling $8.6 million." (Read more)

With time running short, why wait to issue an order? The court's decision "may impact the nature of the executive action," said Jill Midkiff, spokeswoman for the state Cabinet for Health and Family Services. "The timing of issuance of the executive order will not impact the current work or future work that is being completed to establish a state exchange. There is nothing that we need to accomplish at this point that requires an executive order to be in place."

State tells Coventry Cares to keep covering ARH patients; managed-care firm says it will drop Ashland hospital

The state has ordered Medicaid managed-care firm Coventry Cares to keep paying for its members to be treated at Appalachian Regional Healthcare hospitals for at least 30 days, rather than stopping tomorrow -- when a federal judge will hold a hearing in ARH's lawsuit against Coventry, after having ordered negotiations between the parties. For more from ARH, click here.

Meanwhile, the Lexington Herald-Leader reports that Coventry plans to stop paying for services at King's Daughters Memorial Hospital in Ashland, one of the largest health-care facilities in the region. Hospital spokesman Tom Dearing told the newspaper, "Coventry's obvious lack of commitment to the people of Eastern Kentucky, putting profits ahead of lives, will potentially leave thousands of Medicaid recipients without adequate health care options." He said the hospital had 29,000 cases covered by Coventry from Nov. 1 to March 31. (Read more)

Read more here: http://www.kentucky.com/2012/05/02/2172494/judge-orders-hospital-chain-medicaid.html#storylink=cpy

100th Post and April, How Was It?

100th post, that snuck up on me! In all honesty if you had asked me how many posts I had done I would not have a clue. My ASL post is a couple more than that, OK a couple of Hundred but over the last four months this blog gets the lions share of posts. Though the word count is possibly about the same over that time period. So a big thanks to all that have put up with me this far and lets see where it takes us.

But how about April. Well my April Fools just backfired with no one taking the bait. Shame really as I thought it was rather a funny old one. The next two weeks saw me hardly posting, hardly visiting other blogs and over all really doing nothing, painting, reading etc. all replaced by well not a lot! So surprise surprise visits were very low in deed. The surprise then was the last week of April saw so many visits that I ended the month up on March by about 30 visits and the best month to date. I have great hopes for May.

The Elephant I did not paint.

Painting wise it was obviously a fairly poor month. I have failed to finish the Japanese for the Sniper project, finally they are on their bases waiting for me to finish up. This will be done over the next 5-10 days depending on how well the first ones go. They have been hard figures to paint and the basing is a real challenge, though I am looking forward to it. The picture above is the painted Elephant Martin gave me amongst all the Seleucid figures, other figures are also painted. All I needed to do was remove it from it's original base and whilst it still needs some repair work it is almost ready to go. May looks to be much better for the painting as I have so much stuff almost at the point of being done. Ironically April was to end with a friend asking if I wanted to help with work on over 8,000 28mm Naps. Not the full paint job but finishing and basing. I have said yes and that really has got me in the mindset that I need to step up a gear with my stuff, after all with three people working on the figures it's a lot of work. At least it's not in the next few weeks.

I am really happy with the feedback regarding the none figure content. The ECW and the Obscure features are fun to include but only really work if others are interested in it.I already have an idea for C but to do it properly I need to put more work into it so we will see if I can fit it in fully.

Followers. Picked up a few last month which is really nice. I look at the number some of the blogs have and it's amazing but these tend to be older well established blogs and also blogs that put out regular and interesting clobber. An exception to this is Wargaming Girl, no not because she  does not post interesting  and regular posts (don't you start waving those pitchforks my way!) but because it's a fairly new blog (started well after mine) and has over tipple my membership. It gets a post a day just under and Tamsin happens to write well and is funny as well. If you don't follow already here she is. I look forward to hitting 50 followers and at that point will do another Giveaway unless of course I hit 10,000 visits and then I will do the Giveaway then.

Appalachian Regional Healthcare asks federal judge to make managed-care firm keep it under contract

Appalachian Regional Healthcare, a hospital chain in Eastern Kentucky and southern West Virginia, is seeking an emergency injunction by a federal judge ordering Coventry Cares to let its Kentucky members continue receiving services from the hospitals, and to avoid widespread layoffs the chain says will happen if the judge doesn't intervene, reports Bill Estep of the Lexington Herald-Leader. Coventry Cares is one of three state-approved companies to provide managed care services through Medicaid. It said it would cancel its ARH contract after Friday, which would affect about 25,000 Medicaid recipients.

With a few exceptions, Coventry members would lose access to treatment or have to travel long distances to get to other facilities approved by the company, which ARH and officials in affected counties say would be difficult for most because they don't have money or reliable transportation to make the trip. Coventry spokesman Matthew Eyles said the company would continue paying for some services at ARH hospitals, including ob-gyn services to women who are more than 12 weeks pregnant and have a relationship with an ARH doctor.

The state switched to managed-care last year as a way to save money, but as Estep reports, the move has been "rocky." Providers have complained about delayed payments from the companies and their cumbersome pre-approval processes for treatments. ARH sued Coventry and Kentucky Spirit, another provider, claiming the companies owed more than $18 million for services ARH had provided.  Estep notes, "The state allowed another managed care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry, the company said." The company also said the state failed to implement a method to assess risks that would adequately compensate managed-care providers who have more high-risk patients."

ARH and its Coventry patients think the company is trying to get more money out of the state. Many of ARH's patients are covered by Coventry, and ARH spokeswoman said about 300 to 400 jobs would be cut if Coventry cancels its contract. State officials are encouraging continues negotiation between ARH and Coventry. (Read more)

Meanwhile, Bardstown pediatrician and Passport Health Plan board member James Hendrick wrote a letter to the editor of The Courier-Journal offering Passport's services to "help the state get Medicaid back on track." He said he's been very impressed with the nonprofit's "strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality," adding that because Passport is a nonprofit, it's not concerned with appeasing shareholders. Passport has been managing Medicaid in the Louisville region for several years.

It's Not A Flag It's A Bloody Standard!

Just started to re-base my old ECW figures for FoG:R to give them a try and see what they look like. Jury is still out. I can live with how they look as Regiments of foote. It is leaving me with left over figures as I have to alter the composition but this will allow the making up of Commanded Musket. Not that I really feel this is correct but you take these things with Army Lists etc. One thing though is that FoG:R is not ECW, it will not give a true representation of the war, maybe it's fine for TYW but I don't know a great deal about the period outside of the UK.

I have been able with the repainting of a few uniforms and total painting of seven spares been able to generate another Regiment (it will be one of the Whitecoat regiments of Newcastle's) so this will give me 6 Regiments already based for FoG:R and I have another 8 to do as well as all the horse and dragoons. I needed to go digging in the box for a couple of missing pikes and a Standard that had been displaced in storage. I pulled out the pike but found two loose Standards, both have the same error. Can you spot it?

The only Regiments allowed to have a full length Jack are Royal Bodyguard Regiments, such as the Kings Lifeguard and of course the Queens. All other Regiments must halt the progress of the Jack at the halfway point down the Standard. Neither of these two Standards belong to a Royal Lifeguard so will require re-painting. I already have the Kings Lifeguard. Another fault is the lack of any devices to represent company or motto's etc. This will be done in the next few days or weekish depending how the mood takes me. The new Whitecoats will be varnished and based before the weekend and again I need to paint up a Standard for them as well so it's off to do a bit of research.

Meds-for-meth bill drew record lobbying expenses, not even including radio and newspaper ad campaigns

Makers of over-the-counter drugs spent more than any lobbying interest ever had during a single Kentucky legislative session in their effort to defeat a bill requiring prescriptions for the key ingredient in methamphetamine, Bill Estep reports for the Lexington Herald-Leader.

"The Consumer Healthcare Products Association spent $457,053 on lobbying activities in the first three months of this year's legislative session, according to reports filed with the state Legislative Ethics Commission," Estep writes. "The group's lobbying effort was so dominant that it spent more than the next five groups combined in that period, January through March, according to spending reports."

And the figure doesn't even included hundreds of thousands of dollars that the trade group spent on radio and newspaper campaigns, because the lobby-reporting requirements do not apply to messages aimed only at the general public. The group did report spending on "a phone-bank operation to put people in contact with legislators to voice concerns about legislation to require a prescription for medicine containing pseudoephedrine, which is now available over the counter," Estep writes.

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

The efforts, dating back to 2010, were partly successful. The legislature passed a bill "that will require a doctor's prescription for pseudoephedrine, but only after someone has bought 24 grams of the medicine a year," Estep notes. "A 48-count box of the generic medicine with 30-milligram pills contains 1.44 grams of pseudoephedrine. The bill excludes limits on gel caps and liquid pseudoephedrine." (Read more)

The lobbying effort wasn't only about Kentucky. The makers of Sudafed and other pseudoephedrine preparations are trying to stave off similar efforts in other states, and viewed Kentucky as a sort of firewall after seeing prescription-only laws pass in Oregon and Mississippi.

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/04/30/2170495/makers-of-cold-medicines-set-new.html#storylink=cpy

Managed-care firm blames state for problems leading to impending end of contract with ARH hospitals

In the face of a lawsuit that alleges it did not pay claims promptly, Coventry Health and Life Insurance Co. blamed the state for problems that have surfaced since managed care was implemented. Coventry has canceled its contract with Appalachian Regional Healthcare, which has sued the company as well as Kentucky Spirit Health Plan Inc., reports Nola Sizemore for the Harlan Daily Enterprise.

"The current crisis would have never occurred except for the commonwealth's failure to make timely and reasonable decisions on three major issues," Coventry Executive Vice President Timothy Nolan said in a letter to ARH President Jerry W. Haynes. The issues are "a failure to implement a risk adjustment methodology, failure to find a solution to the supplemental hospital payment issue and errors in the original data book and failure to ensure all MCOs meet the same robust standards for network adequacy," Sizemore reports. MCOs are managed-care organizations.

Conventry Health and Kentucky Spirit are two of three MCOs chosen to manage the state's Medicaid program. Since they took over Nov. 1, there have been repeated complaints about delayed payments, as well as burdensome rules requiring doctors to get pre-authorization from the companies before they can provide care.

ARH treats about 25,000 Medicaid patients at its eight hospitals. In the past six months, nearly 11,000 Medicaid visits have been made at the Harlan facility alone, with 7,800 of them covered by Coventry, said Mark Bell, community and patient advocate. This will "present a complex and serious crisis for everyone," he said. (Read more)