Labor Department Scolds 30 Insurers For Not Covering Mental Health Needs

Modern Healthcare: Feds Investigating Violations Of Mental Health Parity Laws
Thirty group health plans have been put on notice by the federal government for not covering behavioral health services and potentially violating mental health parity laws. A report released Tuesday by the Labor Department doesn't name specific companies but gave examples of violations, including a "large service provider" administering claims for hundreds of self-funded plans excluding therapy to treat autism. Some plans failed to cover medication-assisted treatment, viewed by addiction specialists as the "gold-standard" for treating opioid use disorder. (Hellmann, 1/26)

In Medicare and Medicaid news —

Axios: Growth Of Medicare ACOs Stalls Out 
The number of Medicare accountable care organizations — groups of hospitals and doctors who care for specific groups of Medicare patients — has flat-lined since 2018, new data from the federal government shows. The Affordable Care Act created ACOs with the intent of both improving quality of care for patients and cutting costs, and then sharing savings with those care providers. But industry interest stagnated after Medicare cracked down on models that made it too easy for providers to collect money. (Herman, 1/27)

Modern Healthcare: Medicare Shared Savings ACO Participation Grows Slightly For 2022
More Medicare beneficiaries will receive care from providers in Medicare Shared Savings Program Accountable Care Organizations this year, but the number is still lower than it was in 2020, new data show. Nearly one in five Medicare enrollees will be treated by Shared Savings Program ACO providers this year, a slight increase from 2021 but lower than during 2020, the Centers for Medicare and Medicaid Services disclosed in projections published Wednesday. In 2022, these ACOs will cover 11 million people compared to 10.7 million in 2021 and 11.2 million in 2020, according to CMS data. (Goldman, 1/26)

CNBC: A ‘Medicaid Annuity’ May Be Right When Spouse Needs Nursing Home Care
It’s not uncommon for older couples to reach a point when nursing home care is needed for one spouse — and the cost isn’t something they were prepared for. Generally speaking, Medicare doesn’t cover such long-term care. While Medicaid steps in when a person’s financial resources are minimal, some couples face the possibility of depleting their own assets to pay for nursing home care — which is roughly $8,821 monthly, or nearly $106,000 a year — and leaving the healthy spouse in a precarious financial situation. (O'Brien, 1/26)

In other health care industry developments —

AP: Gates Foundation Expands Board Following Bill, Melinda Split 
The Bill and Melinda Gates Foundation announced Wednesday it will add four members to its board of trustees, a first for the Seattle-based philanthropic giant whose decision making has been guided by very few hands since its incorporation in 2000. The foundation, one of the world's largest with its $50 billion endowment, said it would search for new trustees in July after its two co-chairs and trustees — Bill Gates and Melinda French Gates -- announced their divorce. (Hadero, 1/26)

Modern Healthcare: HCA To Build Five New Hospitals In Texas
HCA Healthcare will build five full-service hospitals across Texas to meet a growing demand for healthcare services, the for-profit health system announced Wednesday. The new hospitals will be at different locations including the Dallas Fort-Worth, Houston and San Antonio areas, in partnership with Methodist Healthcare Ministries. Two full-service hospitals will reside in the Austin area, in partnership with St. David's Foundation and Georgetown Health Foundation. (Devereaux, 1/26)

Bangor Daily News: New Medical Center In Dover-Foxcroft Will Bring Specialty Services To Rural Area
Katahdin Valley Health Center is planning to build a new health care facility in Dover-Foxcroft that will expand medical services for low-income and uninsured residents. Construction of the 25,000-square-foot facility on Summer Street is expected to start in May, as long as permitting is on track, according to a notice posted online earlier this month. The project will likely be completed in February 2023. Katahdin Valley Health Center has eight clinics throughout Maine that serve rural areas where people have limited access to primary care and specialty services. The new facility would offer primary care, physical therapy, optometry, pediatrics, dental care, therapeutic massage, chiropractic care and acupuncture, behavioral health, podiatry, walk-in care, a pharmacy and speech-language pathology and therapy. The new clinic means that residents who may be low income, lack insurance or have unreliable transportation will have better access to a broader variety of health care in their own county without having to travel to places such as Bangor. (Royzman, 1/27)

Modern Healthcare: Can Wisconsin Health System Win Lawsuit To Prevent Workers From Leaving?
A Wisconsin health system is unlikely to prevail in its unusual attempt to use the legal system to force a group of employees to keep working at its hospital instead of starting their new jobs with a competitor. Seven employees from ThedaCare, a seven-hospital system based in Neenah, Wisconsin, have accepted jobs with Ascension Northeast Wisconsin, a division of St. Louis-based Ascension. ThedaCare argues in its lawsuit against Ascension Northeast Wisconsin filed last week in Outagamie County Circuit Court that Ascension poached the employees, decimating ThedaCare's ability to provide critical care. (Bannow, 1/26)

Stat: Hospitals Scrap Telehealth Stopgaps For More Streamlined Platforms 
In the early weeks of 2020, thousands of Cleveland Clinic doctors were scrambling to see patients on whatever software and devices they already had at home — and at the time, smartphone apps like FaceTime and Google Duo had to cut it. It was a frenzied, almost overnight transition to virtual care spurred by emergency federal waivers letting doctors use less secure apps designed for consumers to conduct telehealth appointments. But two years into the pandemic, Cleveland Clinic and other large health systems are ditching those stopgap fixes in favor of fewer but more complex, expensive, and customizable tools that can toggle between video visits, lab results and scheduling — and host hundreds of thousands of video and audio visits each year. (Ravindranath, 1/27)

KHN: Resistance To A Boston Hospital’s Expansion Centers On Rising Prices
A boisterous political battle over a proposed expansion by the largest and most expensive hospital system in Massachusetts is spotlighting questions about whether similar expansions by big health systems around the country drive up health care costs. Mass General Brigham, which owns 11 hospitals in the state, has proposed a $2.3 billion expansion including a new 482-bed tower at its flagship Massachusetts General Hospital in Boston and a 78-bed addition to Brigham and Women’s Faulkner Hospital. The most controversial element, however, is a plan to build three comprehensive ambulatory care centers, offering physician services, surgery, and diagnostic imaging, in three suburbs west of Boston. (Meyer, 1/27)

KHN: Watch: ER Charged $1,012 For Almost No Care 
“CBS Mornings” host Tony Dokoupil interviewed KHN Editor-in-Chief Elisabeth Rosenthal about January’s Bill of the Month installment, a collaboration with NPR. The Bhatt family of St. Peters, Missouri, was charged $1,012 for an emergency room visit for son Martand. The toddler had burned his hand on a stove days before, and, after it started blistering, his pediatrician recommended a trip to the emergency room at the nearest children’s hospital. A nurse practitioner examined the child and recommended a surgeon also see the wound. But the surgeon didn’t show after more than an hour, and the family left without the dressing on the wound even being changed. (1/27)