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CHLPI Blog

Mississippi Health Care Providers Breaking the Law with Large Medical Bills that Patients Don’t Have to Pay, Report Finds

Originally published by Mississippi Today on March 11, 2019. Written by Anna Wolfe.

Health care providers in Mississippi continue to break the law by sending patients large, out-of-pocket medical bills that they don’t have to pay, concludes a Harvard Law School report released Monday.

The Legislature passed a law in 2013 to prohibit what is known as “balance billing” – when a provider bills a patient for the difference between the initial charges and the amount paid after insurance benefits are assigned.

But the law contains few enforcement measures, so patients must know about the law and challenge balance bills in order to benefit from the legislation, which was enacted under the radar of many officials and health care providers. Feeble efforts to strengthen protections in the law during the 2019 legislative session were unsuccessful.

Michelle Mills received a balance bill in 2018 when her son experienced a sports injury and went to a hospital in her insurance carrier’s network, River Oaks hospital in Flowood, but was treated by an out-of-network emergency physician.

Across the country, 65 percent of hospitals contract with outside agencies for emergency room doctors who are not necessarily included in the same insurance network as the hospital, according to a 2017 report by Yale University.

The independent physician staffing group called Capital Emergency Physicians, which used River Oaks’ address when it incorporated as a business in 2013, charged Mills $1,853, all but $38 it asked her to pay out-of-pocket. Though it was an illegal bill, she challenged it with her insurance carrier, which reversed the first assignment and paid most of the bill.

Mills was successful in disputing the charges, but she said it’s “infuriating” to think about all the people who don’t know they can challenge these bills, who end up paying, or worse, whose debt turns over to collections.

Capital Emergency Physicians did not return calls to Mississippi Today.

“Unfortunately, our collective trust of the provider community is being abused to the detriment of our bank accounts,” Roy Mitchell, director of Mississippi Health Advocacy Program, said in a release announcing the Harvard report. “It is time our policymakers even the playing field for Mississippi’s health consumers.”

In its report, the Center for Health Law and Policy Innovation of Harvard Law School found that Mississippi’s anti-balance billing law, which was one of the first and strongest enacted in the country, needs revising.

“Despite the state’s leadership on this issue, Mississippians like Michelle Mills report that they are still receiving balance bills — in violation of state law. In fact, a January 2019 poll reported that 4 in 10 Mississippians have received or have a family member who received a surprise medical bill,” the report reads.

House Insurance Chairman Rep. Gary Chism, R-Columbus, authored a bill to require the attorney general’s office to enforce the law and establish binding arbitration to resolve any balance billing disputes between providers and patients.

He never brought the bill to a vote in his committee, telling Mississippi Today that several lawmakers who are also medical professionals — nurses and nurse practitioners — voiced opposition to his bill.

“They want to be able to get their money,” Chism said at the time.

According to a Mississippi Today analysis of legislative members, there is one nurse, Rep. Becky Currie, R-Brookhaven, and one nurse practitioner, Rep. Donnie Scoggin, R-Ellisville, in the House. Currie declined to comment on the legislation and Scoggins said he did not discuss the bill with Chism.

Scoggins said he has not been presented with concerns over illegal balance billing from his constituents, but said if it is still happening, he would be in favor of strengthening the enforcement measures.

The lack of knowledge surrounding the law and what exactly constitutes “balance billing” complicates the issue. What might be viewed as a loophole for a few patients who understand the law could receive pushback from the medical community if lawmakers bring it to light and force providers to comply.

Georgia’s state senate passed anti-balance billing legislation last week that would require insurers to pay these surprise, out-of-network bills at an amount determined by a database of paid bills, as opposed to simply prohibiting providers from sending these bills to patients. Mississippi’s law greatly favors insurers in this way.

The Harvard report also suggests large, surprise balance bills could be contributing to Mississippi’s high rate of people with past due medical debt — the highest in the country at 37.4 percent.

The Center for Health Law and Policy Innovation Highlights Policies That Would Strengthen Balance Billing Protections in Mississippi

The Center for Health Law and Policy Innovation of Harvard Law School announces the release ofUnfinished Business: Bolstering Balance Billing Protections in Mississippi.  The report provides an overview of Mississippi’s current law prohibiting “balance billing” and offers policy solutions that would strengthen enforcement mechanisms and protect Mississippi consumers from medical debt.

Mississippi health care providers are prohibited by law from billing patients after accepting payment from their insurance companies.  However, some providers have continued balance billing and have surprised patients with thousands of dollars in unforeseen medical bills.  “Patients don’t expect to get these medical bills,” said Roy Mitchell, Executive Director of Mississippi Health Advocacy Program.  “Providers aren’t allowed to send these bills if they already accepted payment from the insurer, but no one is making sure they comply with the law.  Unfortunately, our collective trust of the provider community is being abused to the detriment of our bank accounts.  It is time our policymakers even the playing field for Mississippi’s health consumers.”

Unfinished Business: Bolstering Balance Billing Protections in Mississippi highlights steps the legislature can take to improve compliance with Mississippi’s existing law and incorporate best practices that have emerged since the state first prohibited balance billing in 2013.  The report includes examples of how states like Texas and Florida have addressed balance billing and saved their residents millions of dollars.

Robert Greenwald, Faculty Director of the Center for Health Law and Policy Innovation of Harvard Law School, said, “Unfinished Business is a tool for state legislators and consumer advocates.  Mississippi’s law needs to be strengthened so state officials can effectively enforce existing law and protect patients from illegal balance billing.”

Mississippi voters overwhelmingly support practical solutions to this issue.  A poll conducted by Mason-Dixon Polling & Strategy in January 2019 found that 85% of interviewed voters supported a state law that would protect patients by requiring health care providers and insurance companies to resolve payment disputes between themselves.  Additionally, 82% supported explicitly giving the state Attorney General authority to investigate complaints and enforce Mississippi’s balance billing law. 

Despite voter support for meaningful policy, Mississippi legislators have failed to pass legislation that would strengthen existing law.  Health care providers, insurers, small businesses, and consumer advocates have worked together in at least 25 states to find solutions that protect patients and families.  Maryanne Tomazic, Clinical Fellow at the Center for Health Law and Policy Innovation, explained, “Other states are using best practices that not only protect consumers, but also ensure that reasonable payments are made between insurers and health care providers.” 

For more information about the report, visit here.

 

RFP: Approaches to Reducing Consumption of Sugar

The Harvard Law School Food Law and Policy Clinic (FLPC), with support from the Laura and John Arnold Foundation, is working with community organizations and government entities to identify locally-supported policies that will reduce sugar consumption and build capacity for policy change. Excess consumption of sugar is linked to obesity, diabetes, and other diet-related chronic diseases that have tremendous social and economic costs. Reducing population-level consumption of sugar is one of the most promising strategies for addressing these pressing public health concerns.

FLPC is offering pro bono technical assistance (TA) to community organizations, food policy councils, and local, state, and tribal government entities across the United States interested in implementing innovative sugar-reduction policies.

A request for proposals (RFP) application will remain open until May 1, 2019. FLPC anticipates making two TA awards as a result of this RFP. TA grantees will be notified by May 31, 2019. Please contact flpc@law.harvard.edu with any questions.

Read the RFP.

FLPC Releases Advocacy and Lobbying Guide for Food Policy Councils

The Harvard Law School Food Law and Policy Clinic and the Johns Hopkins Center for a Livable Future (CLF) released a new resource today for food policy councils and others working to change the food system. Advocacy & Lobbying 101 for Food Policy Councils was created to equip food policy councils in the US with legal information necessary to know how they are allowed to influence policy decisions by local, state, and federal government. 

A recent survey found that the vast majority of food policy councils are actively engaged in advocacy work. Advocacy activities involving interactions with government policymakers to shape specific legislation may require adherence to specific laws and regulations known as “lobbying” laws.

“Creating change in the food system requires educating, organizing, and persuading others that change is necessary and feasible,” said Anne Palmer, program director at CLF. “This guide is intended to assist councils to understand how lobbying laws apply to their work, and how to proceed legally when attempting to influence government policymakers.”

The guide discusses what it means to lobby the government, explains how lobbying differs from general advocacy work, and addresses topics that every food policy council should consider before engaging in advocacy or lobbying. It also examines how the different organizational structures of councils affect what they may do to lobby and provides case studies to illustrate how councils have successfully and legally influenced government policy.

“A food policy council should not shy away from trying to influence government policy simply because these laws exist,” said Emily Broad Leib, director of the Harvard Law School Food Law and Policy Clinic. “We hope this guide empowers councils to confidently navigate applicable state and federal lobbying laws — they will learn that much work on policy issues is not restricted because it is considered advocacy, not lobbying, and may even realize that their opportunities to lobby legally are far greater than previously thought.”

Read Advocacy & Lobbying 101 for Food Policy Councils.

 

Mississippi Delta Fellowship 2019-2021: Applications Being Accepted

Mississippi Delta Fellowship, 2019 – 2021
Full Delta Fellowship Application Description, Details, and Requirements

Applications due by midnight on March 25, 2019

Based in the Mississippi Delta, the Delta Fellowship provides a unique opportunity for law school graduates to inform and catalyze community change through the creation, development, and management of interdisciplinary projects. The Delta Fellow will build on existing projects, launch new projects in partnership with Delta Directions partners (which include programs at University of Mississippi, Mississippi State University, Harvard Law School, and Harvard School of Public Health), and have the opportunity to design one new signature project for completion during their tenure, subject to review and input by members of the Delta Directions Consortium. The Fellowship is hosted by the University of Mississippi Center for Population Studies, and supported by the Winokur Family Foundation and Community Foundation of Northwest Mississippi.

Previous and current project themes of the Delta Directions Consortium include:

  • Food Policy: Delta Fellows’ work has included establishing and supporting the Mississippi Food Policy Council; supporting the launch of farm to school programs throughout the state; assisting small farmers by publishing guides and conducting trainings; and working to increase food access in rural Mississippi.
  • Public Health: Delta Fellows’ projects have included supporting better mental health practices; promoting healthy practices like breastfeeding; providing research and recommendations on improving maternal and infant health; and conducting research on policy opportunities to support better lead testing in small rural water systems.
  • Economic Development: Delta Fellows’ work has included partnering with University of Mississippi to create a small business incubator and launch a transactional legal clinic; publishing guides to support small businesses; and publishing reports in support of economic development.

Principal responsibilities of the Delta Fellow include:

  • Managing existing and developing new projects, based on local needs, research, evidence-based results, interdisciplinary opportunities, and interest from Delta Directions partners;
  • Researching, drafting, and editing policy and research reports, and educating community partners and policymakers on the research;
  • Planning and advising clinical and pro bono projects for Harvard Law students in the HLS Mississippi Delta Project, the Center for Health Law and Policy Innovation, and other Harvard Law School clinics;
  • Identifying opportunities for and mentoring college students from local universities to work in the Delta;
  • Helping to plan and host the annual Delta Regional Forum;
  • Reporting twice annually to Delta Directions Advisory Committee and preparing a public annual report; and
  • Supporting coordination, growth, and development of the Delta Directions Consortium.

For more information, please visit http://www.deltadirections.com (for information about Delta Directions) and http://www.chlpi.org (for information about the Center for Health Law and Policy Innovation). Applications are due midnight on March 25, 2019.

 

CHLPI’s Robert Greenwald Quoted in Bloomberg Law Article on HIV Drug Coverage

A February 22, 2019 article from Bloomberg Law includes an interview with CHLPI’s Faculty Director and HLS Professor Robert Greenwald. The article, Trump’s Call to End HIV at Odds With Silence on Coverage Woes, written by reporter Jacquie Lee explores the tension between the President’s pledge to end HIV in the United States in the next ten years and the administration’s silence on discriminatory drug coverage within Medicaid.  

Excerpt from the article: 

“The Trump administration is promising to end AIDS within 10 years at the same time it’s staying silent on complaints accusing insurers of unfair HIV drug coverage.

Complaints protesting HIV drug coverage in Obamacare plans in counties where the infection rates are growing the most have gone unanswered by the Department of Health and Human Services for years.”

 

Read  Trump’s Call to End HIV at Odds With Silence on Coverage Woes in full. 

Maryland Seeks to Expand Complete Streets Program to Prioritize Food Access

Written by Alex Harding, student in the Food Law & Policy Clinic, Spring 2019.

On February 7th, FLPC provided written testimony to the Maryland Environment & Transportation Committee in support of a bill that would expand the state’s “Complete Streets” grant program to cover projects which improve access to nutritious food to residents living in food deserts.

Throughout 2017, FLPC had the opportunity to work with stakeholders in Maryland who were involved in creating the Maryland Food Charter to develop a complementary policy scan of state policies related to the food system as well as opportunities for change. Following a series of interviews, community meetings, and legal and policy research, FLPC published its findings in “A Review of Food System Policies in Maryland.” This report outlined possible initiatives for the state of Maryland to enhance its food production, safety, and waste prevention policies in order to make the state’s food system stronger and better able to serve the people of Maryland.

Improving access to nutritious food was one of the main concerns raised by the many Maryland community members and experts with whom we engaged. As one of our suggestions to increase food access, we recommended using urban transportation resources to move residents in food deserts—areas of low healthy food availability—to local food markets. Maryland’s House Bill 82 uses the novel approach of incorporating food access into the state’s definition of a Complete Streets program—a grant program that allows local governments to receive funding for infrastructure projects which improve quality of life. This approach allows Maryland to get its food access resources to local governments, who are best suited to understand their local food access barriers and needs and to tailor their solutions efficiently to those specific needs

As a student in FLPC, this was the point where I was invited to write legislative testimony on behalf of FLPC supporting Maryland’s Bill. This project gave me the opportunity on to work on the one hand with the staff of Maryland legislators, and on the other with expert FLPC fellows and advocates who had worked with Maryland and knew its specific legal and political landscape. This has been a rare learning opportunity in policy-making that I would be hard pressed to find elsewhere—it turns out that Harvard Law School does not, in fact, offer as many law-making classes as it does law-abiding ones (judicial activism schemes aside).    

Maryland’s House Bill 82, attached below, addresses food access issues in three key ways. First, the bill would give the term “food deserts” its first official state law definition as “[a] community that does not have easy access to healthy food, including fresh fruits and vegetables, typically in the form of a supermarket, grocery store, or farmer’s market.”

Second, the text of the bill expands the definition of Complete Streets to include food access so as to expand the types of local transportation projects the policy can fund. Third, the bill creates a ranking system for such projects which improve food access specifically for areas already designated as food deserts. The approach of moving infrastructure funding towards food access—especially through a Complete Streets program, is an innovative one. We look forward to seeing more creative solutions like this at the state level from Maryland and across the country.

FLPC’s full testimony to the Maryland Environment & Transportation Committee can be found here.

Maryland’s House Bill 82 can be found here. 

 

Survey: Misunderstanding Food Date Labels Linked With Higher Food Discards

A new survey examining U.S. consumer attitudes and behaviors related to food date labels found widespread confusion, leading to unnecessary discards, increased waste and food safety risks. The survey analysis was led by researchers at the Johns Hopkins Center for a Livable Future (CLF), which is based at the Johns Hopkins Bloomberg School of Public Health.

The study, published online February 13 in the journal Waste Management, comes at a time of heightened awareness of food waste and food safety among both consumers and policymakers. The U.S. Department of Agriculture estimates that 31 percent of food may be wasted at the retail and consumer levels. This study calls attention to the issue that much food may be discarded unnecessarily based on food safety concerns, though relatively few food items are likely to become unsafe before becoming unpalatable. Clear and consistent date label information is designed to help consumers understand when they should and should not worry.

Among survey participants, the research found that 84 percent discarded food near the package date “at least occasionally” and 37 percent reported that they “always” or “usually” discard food near the package date. Notably, participants between the ages of 18 to 34 were particularly likely to rely on label dates to discard food. More than half of participants incorrectly thought that date labeling was federally regulated or reported being unsure. In addition, the study found that those perceiving labels as reflecting safety and those who thought labels were federally regulated were more willing to discard food.

New voluntary industry standards for date labeling were recently adopted. Under this system, “Best if used by” labels denote dates after which quality may decline but the products may still be consumed, while “Use by” labels are restricted to the relatively few foods where safety is a concern and the food should be discarded after the date. Previously, all labels reflected quality and there was no safety label. Neff and colleagues found that among labels assessed, “Best if used by” was most frequently perceived as communicating quality, while “use by” was one of the top two perceived as communicating safety. But many had different interpretations.

“The voluntary standard is an important step forward. Given the diverse interpretations, our study underlines the need for a concerted effort to communicate the meanings of the new labels,” says lead author, Roni Neff, PhD, who directs the Food System Sustainability Program with the CLF and is an assistant professor with the Bloomberg School’s Department of Environmental Health and Engineering. “We are doing further work to understand how best to message about the terms.”

Using an online survey tool, Neff and colleagues from Harvard Law School Food Law and Policy Clinic (FLPC) and the National Consumers League assessed the frequency of discards based on date labels by food type, interpretation of label language and knowledge of whether date labels are regulated by the federal government. The survey was conducted with a national sample of 1,029 adults ages 18 to 65 and older in April of 2016. Recognizing that labels are perceived differently on different foods, the questions covered nine food types including bagged spinach, deli meats and canned foods.

When consumers perceived a date label as an indication of food safety, they were more likely to discard the food by the provided date. In addition, participants were more likely to discard perishable foods based on labels than nonperishables.

Raw chicken was most frequently discarded based on labels, with 69 percent of participants reporting they “always” or “most of the time” discard by the listed date. When it came to prepared foods, 62 percent reported discards by the date label and 61 percent reported discards of deli meats. Soft cheeses were near the bottom of the list with only 49 percent reporting discards by the date label, followed by 47 percent reporting discards of canned goods and breakfast cereals.

Among foods included in the survey, prepared foods, deli meats and soft cheeses are particularly at risk of contamination with listeria which can proliferate in refrigerated conditions. Despite concerns of listeria, soft cheeses were rarely discarded by the labeled date. On the other hand, raw chicken was frequently discarded even though it will be cooked prior to consuming and is not considered as big of a risk. Unopened canned goods and breakfast cereal pose the least concern based on time since packaging, but were still discarded by just under half of respondents.

“Foodborne illness is misery–or worse,” says Neff. “As date labeling becomes standardized, this research underlines the need for a strong communications campaign and highlights a particular need for education among those ages 18 to 34.”

The research was supported by the National Consumers League and the Johns Hopkins Center for a Livable Future.

Misunderstood food date labels and reported food discards: A survey of U.S. consumer attitudes and behaviors” was written by Roni Neff, Marie Spiker, Christina Rice, Ali Schklair, Sally Greenberg and Harvard FLPC’s Emily Broad Leib.

 

FLPC Welcomes Visiting Scholar Cameron Faustman

Cameron Faustman. (Peter Morenus/UConn Photo)

Professor Cameron Faustman has spent his 30 year academic career in the College of Agriculture, Health and Natural Resources, University of Connecticut (UConn).  His teaching and research activities have focused on the fundamental science associated with quality, preservation and safety of food, particularly foods of animal origin. 

He is grateful for the opportunity to spend his Spring 2019 sabbatic leave at the FLPC.  His administrative experiences at UConn have provided him with an appreciation for the impact of sound policy on food, health and the environment.  He was attracted to the FLPC after learning of their efforts with policy activities concerned with food waste.  Cameron seeks to learn how policy is created and implemented as a complement to his understanding of the science of food. 

As an active researcher, he has published more than 120 scholarly manuscripts, books/book chapters, and conference proceedings; his work has been referenced sufficiently to place him in the top 1% of cited authors in all of Agriculture.  He has provided more than 50 invited lectures and visited 9 different countries in that capacity, and served on the editorial boards of 4 different scholarly journals.  He received the UConn Teaching Fellow (1996) and the USDA Northeast Excellence in Teaching (1999) Awards, the highest levels of recognition for teaching excellence at UConn, and regionally in agriculture science, respectively. National recognition of his research accomplishments includes the 1994 American Meat Science Association (AMSA) Achievement Award, 2000 AMSA Research Excellence Award, 2009 Institute of Food Technologists’ (IFT) Food Chemistry Division Lectureship Award, and the IFT Stephen Chang Award for Lipid or Flavor Science Research (2010). 

A faculty member in UConn’s Department of Animal Science since 1989, he served as Head of the Department of Animal Science (2000-04), Associate Dean for Academic Programs and Research (2005-16) and as Interim Dean (2017-19).  He earned his B.S. from the University of Connecticut (1982), and M.S. (1987) and Ph.D. (1989) degrees from the University of Wisconsin-Madison.

Outside of the world of food he enjoys flyfishing, hiking, biking, photography and a seat near a wood-burning stove.

 

Tough Choices Over a Pricey But Effective Drug for Hepatitis C

Originally published by StarTribune on January 28, 2019. Written by Glenn Howatt.

Hepatitis C is one of the most common infectious diseases, with the potential to cause serious liver damage, so patients were thrilled when a set of revolutionary new medications became available five years ago. But at $90,000 per treatment course, the drugs were pricey, and many states, including Minnesota, balked at covering them under their taxpayer-funded Medicaid programs.

Since then, however, the treatment cost has fallen dramatically — in some cases to $24,000 — and is expected to fall further after generics are introduced this year. Now advocates are urging Minnesota to drop its restrictions, which they say prevent patients from getting medications that are highly effective and stop the spread of the virus. “I am frustrated seeing my patients walking around with infections that I could treat with a snap of my finger,” said Dr. Ryan Kelly, a primary care physician at the Community-University Health Care Center in Minneapolis.

Minnesota is one of only 12 states that require patients with an addiction history to maintain a six-month period of sobriety before they can start taking hepatitis C drugs, although some can get the medication with three months’ sobriety if they are in addiction treatment. By comparison, 32 states either have no sobriety restrictions or require basic screening and counseling to weed out patients who are not good candidates for treatment.

Kelly plans to meet soon with officials at the Minnesota Department of Human Services, which runs the Medicaid program, in an effort to change its policy.

Nearly 35,000 infected

The current restrictions, which also require that the drugs be prescribed only by or in consultation with a specialist, such as a gastroenterologist or hepatologist, were introduced when the new treatments came online in 2014. Nearly 35,000 people in Minnesota are infected with hepatitis C, according to the Minnesota Department of Health. On average, 2,200 people in the state are diagnosed with the virus every year, but the state can’t say when they acquired the infection. Disease researchers say that many more are infected but have never been tested.

Hepatitis C, which can lead to liver cirrhosis and cancer, is spread mainly through blood. Many infections are caused when street drug users share needles. “Hepatitis C is on the rise mostly because of the rise in injecting drug users,” said Kelly. “If we treated people who are spreading the infection, more costs would be saved down the road.”

A state official says the sobriety restrictions are necessary to prevent people from becoming reinfected should they relapse after getting hepatitis C treatment. “We want them to be treated in a way that will be successful,” said Dr. Jeff Schiff, medical director for Medicaid and MinnesotaCare. “The cost has come down significantly, but it is still a very significant cost per treatment course.”

Kelly said the decision to prescribe hepatitis C treatment drugs should be left to the doctor who knows the patient best. As with other diseases, doctors weigh many factors before writing a prescription, including the patient’s likelihood to comply with the treatment. “It is a moral restriction that has nothing to do with [patient] health and doesn’t need to be there,” he said.

Schiff said he’s open to a discussion about the future of the state policy. “The landscape is evolving since these [drugs] came on the market,” he said. “Through our internal conversation we have decided that we will take another look at this policy.” 

Sober for his daughter

Gabriel Bliss, 31, has been waiting since April to get the medications that will cure his hepatitis C. He had been a long-term heroin user but quit after his best friend died from a batch that contained fentanyl. He learned of his hepatitis infection while in detox. “I have a 3-year-old daughter, and she is the main reason that I am still alive and the main reason that I am sober,” he said in a recent interview at his Richfield house.

Bliss gets his insurance through one of Minnesota’s Medicaid managed-care plans, which administer benefits to about 850,000 of the 1.1 million residents who are on the program. All of them have similar restrictions to the state policy. After quitting heroin, Bliss saw a specialist but got turned down for hepatitis meds because he had smoked marijuana.

“I figured that if I wasn’t on other hard drugs it would be OK,” he said. “Had I known that, I wouldn’t have smoked, because it is a lot more important for me to get rid of hep C.” Now, he has to wait until March before getting treated. In the meantime, he’s concerned that he might infect others, either through an open wound or even sexual contact, which presents a low risk. “I don’t know why there are restrictions on it,” he said. “You would think that you want people to be healthy because it would cost less in the long run.”

Nationwide, state Medicaid programs are being urged — and sometimes sued — to drop treatment barriers. Led partly by the Center for Health Law and Policy Innovation at Harvard University, 21 states have dropped or reduced requirements that patients must suffer some liver damage before they are treated, a requirement that Minnesota never used.

Nine have relaxed sobriety restrictions, and six have loosened specialist requirements. 

“What we are seeing here are measures that are deliberately put in place to stop people who need medically necessary care versus cost concerns,” said Phil Waters, an attorney with the Harvard center. He said the restrictions are “discriminatory and illegal.”

An ‘early win’

Phil Gyura, a certified nurse practitioner with Minneapolis-based Livio Health, used to practice in New York. He said access to treatment expanded significantly when that state dropped most of its restrictions in 2016. “From a public health standpoint, the more people that we cure, the less likely it is to spread,” said Gyura, director of addiction care and behavioral health integration at Livio.

He said Minnesota has a unique opportunity to expand hepatitis C treatment because so many people get drug or alcohol treatment in centers. “They have the nursing staff and they have the structure,” he said. “It can be an early win in their sobriety.”

Both Gyura and Kelly said most of their patients want to get treatment directly from a primary care doctor rather than a specialist. “I see many people at my clinic who view our clinic as their medical home,” Kelly said. “Being referred to a different clinic to see a specialist, especially to a confusing large hospital system, is a huge barrier.”

Schiff said state policy would allow patients to consult a specialist electronically, without visiting an unfamiliar clinic or hospital. “It would be relatively easy for that provider to get on a telemedicine platform … and do that consultation in real time,” he said.

Nonetheless, critics of the specialist requirement say it hearkens back to the days when the only treatment for hepatitis C involved toxic intravenous drugs, which also weren’t as effective as the newer pills. “It has become much less complicated to treat,” Kelly said.