Tuesday, June 24, 2014

Advocates’ comment urging DSS not to erode successful PCMH standards in Medicaid regulations

Eighteen consumer organizations signed onto a letter of comment sent yesterday making the case that DSS should continue using successful national standards for patient-centered medical homes (PCMHs) in new Medicaid regulations. Original versions of draft language included the current practice of adopting NCQA national standards for PCMH recognition and incentives. However, without notice, national standard language was dropped from the latest draft and replaced with CT-specific standards. Advocates have been very concerned about a similar move by SIM to replace proven, successful, well-established national PCMH standards that are working in CT with a yet-to-be developed home grown standard. Since CT’s Medicaid program shifted to a NCQA-based national standard PCMH focused program, quality outcomes are up, non-urgent ER visits are down, per person costs are down, and the program has attracted 32% more participating providers, just as program enrollment grows under the ACA. Based on consumer advocacy, a SIM committee will meet tonight to re-consider the SIM decision to reject NCQA in favor of CT-specific standards.