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California Medicaid tries to recover millions in fees

California's Medicaid agency plans to recoup millions of dollars in fees it paid in the past year for dental, chiropractic and podiatry services, but at least one group of affected health centers has said the move will put its facilities in a precarious financial position. California lawmakers cut these and other optional Medicaid services effective July 1, 2009, but the U.S. District Court for the Eastern District of California issued an injunction against the cuts in October 2010, saying the state did not go through the proper Medicaid plan amendment process. However, the Centers for Medicare & Medicaid Services in May 2011 approved a state plan amendment allowing the California Dept. of Health Care Services -- the state's Medicaid agency -- to reinstate the cuts. On Sept. 30, the state's Medicaid agency notified clinics and health centers that it will recover fees it paid for dental, podiatry and chiropractic services between October 2010 and May 2011, the period covered by th ...

New ADHD guidelines lower age of diagnosis

New guidance from the American Academy of Pediatrics expands the age at which children can be diagnosed with attention-deficit/hyperactivity disorder. The recommendations also encourage physicians to partner with parents, teachers and mental health specialists when creating a treatment plan for these patients. The guidelines, published online Oct. 16 in Pediatrics, recommend that physicians evaluate children age 4 to 18 for ADHD if they have academic or behavioral problems and symptoms of inattention, hyperactivity or impulsivity. That marks a shift from AAP guidance issued in 2000 and 2001, which called for assessments for the neurobehavioral disorder in children age 6 to 12. "Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school," said Mark Wolraich, MD, chair of the subcommittee that wrote the guidelines and professor of pediatrics at the University of Ok ...

Medical liability concerns drive hospital admission decisions

Medical liability is a key reason physicians admit more emergency department patients and discharge them less, say two studies in the October Annals of Emergency Medicine. In one study, a survey of 849 emergency physicians and patients in two inner-city emergency departments found that 11% of physicians reported "medico-legal" concerns as a primary driver for admitting patients with potential acute coronary syndrome. In another study, researchers compared admission rates for congestive heart failure patients in 27 emergency departments in New Jersey and New York between 1996 and 2010. The percentage of such patients discharged from EDs dropped from 24% to 9%. Concerns about medical liability probably were the reason behind the decreased discharges, study authors said. The findings show that doctors consider factors other than patients' health when making admission choices, said co-author of the coronary study David Newman, MD, an emergency physician and director of clinical ...