Table of Contents

National Health Financing News

• OMB, CBO Release Updated Budget Projections, Senate Finance Negotiators Hold Teleconference, Agree to Meet
• Senator Edward Kennedy Dies; Special Election Will Fill Seat
• AHA Report Says Hospitals May Profit From Health Care Reform
• Rep. Waxman Seeks Modification to Medicare Part D to Reduce Health Costs
• Rep. Kucinich Asks Health Insurance CEOs to Testify on Health Care Administration
• Vice President Biden Announces $1.2 Billion in Health IT ARRA Funding
• HHS Secretary Announces $25.7 Million in Grants to Expand and Improve Health Centers
• Presidential Panel Warns of Potential Swine Flu Infections this Season
• States Pass Laws Expanding Parents’ Ability to Insure Adult Children
• Navy Adjusts Drug Policy, Increases Drug Testing and DUI Penalties
• Report Says Health Care Costs Will Increase 10 Percent Within One Year
• Polls Reveal Dwindling Faith in Health Care Reform, Confusion About Public Option
• AHRQ Releases Two Health Care Briefs
• Commonwealth Fund Report Examines State Insurance Premium Trends and the Prospects of National Health Care Reform
• AHCA Releases State-Level Estimates Medicare Cuts to Skilled Nursing Homes
• RWJF Releases Case Study of Texas’ Health Insurance Market
• KFF Releases Brief Examining Health Care Subsidies

On May 27, 2009 the Supreme Court of Pennsylvania ruled against the Insurance Federation of Pennsylvania and upheld the certification and referral to addiction treatment by licensed physicians and psychologists under Pennsylvania’s Act 106 of 1989. 

Act 106 requires all group health insurance plans to provide comprehensive treatment for alcohol and other drug addiction with access to treatment provided through certification and referral by a licensed physician or licensed psychologist.  The Supreme Court determined that the issue presented in the case was "whether the statutory mandate precludes the application of utilization review for medical necessity and appropriateness of the mandated treatment" and concluded "that managed care plans may not apply utilization review to abrogate or alter the sole statutory prerequisites to obtaining treatment for alcohol and drug abuse, i.e., certification and referral by a licensed physician or licensed psychologist.”

Download the complete decision here: PA Supreme Court Ruling May2009Act_106.pdf (113.05 kb)

This article assess the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in stages from 1988 to 1990.  The program also participated in federally-mandated random drug tests beginning in 1990.  The study found that the combination of the peer program and drug testing was associated with roughly 33 percent fewer injuries, or a $48 million employer savings in 1999.  The authors estimate that the program avoided $1,850 in per-employee injury costs, corresponding to a 26:1 benefit-cost ratio. 

Miller, T.R., Zaloshnja, E., & Spicer, R.S. (2007). Effectiveness and benefit-cost ratios of peer-based workplace substance abuse prevention coupled with random testing. Accident Analysis and Prevention, 39:3, 565-573. http://cat.inist.fr/?aModele=afficheN&cpsidt=18746296 

Authors: Ted R. Miller, Eduard Zaloshnja, Rebecca S. Spicer.

This study proposes a methodology for estimating the health-related costs of drug abuse and then utilizes the methodology to estimate the value of drug abuse interventions.  The study provides cost estimates for avoiding hepatitis B, HIV/AIDS, TB hypertension, bacterial pneumonia, sexually transmitted diseases for a white male aged 32 years.  The recommended value of loss from symptomatic AIDS is $114,798, for hypertension it is $0 to $74,513 dependent on severity, for severe bacterial pneumonia $161 to $57,528 dependent on severity, and it is $998 to $96,005 for TB dependent on severity. 

French, M. T., Mauskopf, J. A., Teague, J. L., & Roland E. J. (1996). Estimating the dollar value of health outcomes from drug abuse interventions. Medical Care, 34, 890-910. http://www.ncbi.nlm.nih.gov/pubmed/8792779 

This report analyzes West Virginia's Mountain Health Choices Medicaid program which allowed enrollees to elect enhanced coverage if they sign an agreement committing to certain preventative health care measures. 

From the report:

Summary: This report analyzes the West Virginia Medicaid program’s Mountain Health Choices plan, which provides enhanced coverage and benefits to Medicaid enrollees willing to embrace personal responsibility and sign an agreement specifying their rights and responsibilities.  The analysis found that the personal accountability paradigm had little success with the seriously mentally ill because they were either unwilling or unable to enter into the agreement necessary to secure the enhanced coverage.  The study also determined that the medical home model—a key component of the program—was not compatible with the state’s mental health treatment model which focused on acute care.  In addition, the analysis found that these issues resulted in a generally lower level of care for the plan’s mental health clients because the non-enhanced mental health services were less comprehensive than traditional Medicaid.

West Virginia University Institute for Health Policy Research, & Mathematica Policy Research Inc. (2009). Evaluation of mountain health choices: implementation, challenges, and recommendations. 

Full report: http://www.hsc.wvu.edu/wvhealthpolicy/reports/RWJ%20Policy%20Brief%20FINAL%2003.27.09.pdf 

This article assess the relationship between the level of alcohol/substance abuse treatment services received and the employment outcomes in the Alcohol and Drug Addiction Treatment and Support Act (ADATSA) program.  The study found that clients completing their course of treatment earned more than those who did not and that clients who completed vocational services and treatment earned more than those who completed treatment alone. 

Luchansky, B., M. Brown, et al. (2000). Chemical dependency treatment and employment outcomes: results from the 'ADATSA' program in Washington State. Drug Alcohol Depend 60(2), 151-9. DOI: 10.1016/S0376-8716(99)00153-2 http://www.ncbi.nlm.nih.gov/pubmed/10940542 

Authors: Bill Luchansky, Marsha Brown, Dario Longhi, Kenneth Stark, Antoinette Krupski.