20 August 2004

Two new state programs help those with no health insurance

PROVIDENCE -- Insurance regulation wasn't the only health-care topic on lawmakers' plates this year.

They also laid the groundwork for two new programs to help the state's uninsured -- although exactly how each program will take shape remains unclear.

One seeks to help control prescription drug costs by giving people access to a medication discount program. The other envisions a "primary care" program to route more people to doctors' offices, rather than emergency rooms.

The legislation that creates each is deliberately broad, lawmakers said, but it calls on the Department of Human Services to work with the Department of Elderly Affairs on the first program, and with the Department of Health on the second.

The prescription drug program would apply to people between 19 and 65 -- those generally too old for RIteCare or too young for Medicare. Their annual income level would have to be at or below 200 percent of the federal poverty level, set at $18,620 for someone single, or $37,700 for a family of four.

The law allows for an enrollment charge of up to $30 to participate. It calls on the state to set the prescription program up by March 15.

The bill evolved from proposals that called on the state to negotiate with pharmaceutical companies to give an even larger group of uninsured people discount cards for their medications.

But John Young, an associate director of human services, said that it is more likely the state will evaluate, and recommend, the best of a set of already-existing discount cards on the market. Such cards are offered both by pharmaceutical manufacturers and some drug store chains, he said.

Rep. Paul Moura, one of the bill's sponsors, questioned the state's approach , saying lawmakers had wanted the state to take a more active role in setting up and managing the program.

"What he's saying just doesn't make sense," he said of Young's comments. "It certainly wasn't our intent." Moura said he would seek to convene a meeting of state officials and lawmakers to discuss it further.

The pilot primary-care program for the uninsured, on the other hand, has no such activation date, and most of the details -- including who would participate, what coverage they would receive, and what it might cost both the state and the patients -- have yet to be determined.

But the bill, put forward by Lt. Gov. Charles Fogarty, does require the state to return to the legislature with a plan by Jan. 15.

YOUNG SAID about 80,000 people in Rhode Island are uninsured. Many in that group are single adults, he said, but not all are young, healthy singles; the group also includes households that have trouble affording coverage.

He said the department will look at ways to make insurance "less costly" to the group, and will reevaluate options such as allowing people to buy into coverage offered to low-income mothers and children under RIteCare. Another possibility, he said, is finding new ways to use existing community health centers.

It will be up to lawmakers to decide whether to build any proposal into next year's budget, he said.

"Obviously, if you're a policymaker you'd love to do this kind of stuff," Young said. "The question is can you do it for virtually no money."

Lawmakers also took steps this year to reconcile the state's current subsidized prescription drug program for low-income elderly residents with new and upcoming changes in federal Medicare laws.

Seniors who use the Rhode Island Pharmaceutical Assistance for the Elderly (RIPAE) program will have to use already offered Medicare discount programs first before turning to the state for help. But they will not be blocked from turning to RIPAE as a backup if that or other coverage falls short.

At the same time, a special legislative commission will study what the future of RIPAE will be once a new Medicare prescription drug benefit kicks in in 2006. The commission's report is due Feb. 15.

House Finance Committee Chairman Steven Costantino, D-Providence, said a "total redesign" of the existing RIPAE program may be required to mesh it with the coming federal changes.

IN TWO OTHER more publicized prescription drug debates, the Assembly passed legislation that will require the state to begin licensing Canadian pharmacies to sell to Rhode Island customers as of Jan. 15.

While the change may make some state residents more comfortable ordering medications from outside the country, a number of area stores and countless Web sites now offer assistance in making such purchases.

Lawmakers also approved regulations on how insurers set up and manage restricted pharmacy networks that limit customers' choices of where they can fill their prescriptions, with an eye toward ensuring competition in the process.

Senior groups had originally pushed the state to pass a law banning such restricted networks altogether, but backed away from their fierce lobbying after facing uncertainty over whether such a ban would be allowed in Medicare supplement programs.

The final version of the bill says insurers must "offer only nonrestricted pharmacy networks in any Medicare supplement or Medicare+Choice plans" -- but only if that is consistent with federal regulations.

LAWMAKERS APPROVED a series of truth-in-billing measures that will require insurers to count the discounted price they receive for a prescription toward any dollar cap in a customer's plan, rather than the retail cost.

And they passed a bill that will allow the Medicaid program to use non-generic drugs in certain cases where the brand name prescription may be cheaper than the generic one.

Insurers will now be required to cover hearing aids for children under 18, at a rate of $1,000 per ear every three years. They also will have to cover long-term antibiotic treatment for Lyme disease. The mandate was originally introduced for a one-year trial period and was extended permanently this year.

Finally, lawmakers adopted a proposal from the lieutenant governor to set up an advisory committee to work on improving various health-care information-technology systems in the state, such as creating a way for hospitals to share medical records.

The bill sets up an account to pay for that work; it has no money in it right now, but can receive federal financing, grants or state support in the future.

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