New child health plan gives PPO role to UMC

Art Nadler

Tuesday, Feb. 3, 1998 | 10:23 a.m.

University Medical Center has officially been recommended to provide health insurance for the state's working poor children.

Following a motion by Assemblywoman Barbara Buckley, D-Las Vegas, the Legislative Committee on Health Care voted Monday to guarantee that:

Chairman Sen. Raymond Rawson, R-Las Vegas, said the committee's recommendations would be forwarded to Gov. Bob Miller, sponsor of the Nevada Check Up plan, and the Interim Finance Committee.

Buckley said she was confident Miller would approve UMC's role as a PPO provider.

"We want to make sure everyone is working together to make this a successful program," Buckley said. "When there are side deals concerning patients (between physicians and hospitals), this is where I have concerns."

Hale said UMC is prohibited from establishing itself as a health maintenance organization (HMO), but it could legally set up a PPO system. An estimated 48,000 children of Nevada's working poor -- numbers could be as high as 69,000 -- would pay a premium dispensed to the hospital through an intermediary. A patient would also pay a fee-for-service to the hospital per treatment.

Nevada is matching $16.4 million in unused Medicaid funds to $30.4 million from the federal government to provide health insurance to poor children. Enrollment is scheduled to begin this month, with coverage starting in June.

Dental, vision and prescription drugs also are being considered.

Nevada dentist Dr. Dwight Meierhenry proposed a dental program that would cost the state approximately $18.50 per child. Additionally, various dental procedures would be paid on a scale similar to Medicaid rates.

Meierhenry said children could go directly to dentists involved in the program, or to participating diagnostic clinics set up in local dentists' offices.

"It's a new proposal," Meierhenry said. "Its emphasis is on prevention. We are trying to give taxpayers the maximum amount of care for their dollars."

Dr. Bernard Feldman of the University of Nevada School of Medicine said children between ages 1-5 are the third biggest reason children go to hospital emergency rooms.

The ERs, Meierhenry said, are not equipped to do dental work. All physicians can do is administer pain killing drugs for temporary relief.

Rawson said the committee would consider Meierhenry's proposal, which is the only one submitted to date.

Davis Vision, the company that provides vision care for Nevada state employees, also submitted a proposal that would fully insure each child for $1.33 a month.