DSS asks CMS for a HUSKY delay

The administration has asked the federal government for a four month delay for moving HUSKY families into the new HMOs. DSS and the two new HMOs, AmeriChoice (United Health Care) and Aetna Better Health, have been criticized for having inadequate provider networks and for not devoting enough time to building those networks. The third HMO participating in HUSKY, Community Health Network, is based on CT’s community health centers and has served HUSKY clients for over a decade. DSS still expects to be able to meet the deadline of defaulting families into the HMOs on December 1st, but asked for the extension to March 31st just in case. DSS is still fully committed to moving all families into managed care but has promised not to force anyone into an inadequate network. Previously, Anthem, who left the program last fall, agreed to continue serving HUSKY families indefinitely with their larger provider network. HUSKY covers approximately 340,000 CT residents, including one out of five children and one in four births in the state.
Ellen Andrews

Drug company Cephalon will pay CT $6 million fine

CT’s Attorney General announced yesterday that Cephalon, Inc. will pay $425 million nationally and $6.13 million to CT for illegally marketing three drugs causing serious complications in some patients including seizures, respiratory depression, addiction and death. The off-label marketing of the drugs for uses not approved by the FDA caused sales of the drugs to increase by as much as 1,000 percent. The agreement resulted from a four year investigation finding that Cephalon engaged a strategy of buying overlooked drugs with narrow approved uses and aggressively marketing them for non-approved uses to boost profits. The settlement subjects Cephalon to broad corporate integrity and financial transparency standards.
Ellen Andrews

Critical Condition documentary showing tomorrow night

PBS’ POV series tomorrow night at 9pm will be, Critical Condition, describeing the barriers to accessing care for America’s uninsured. A streaming version of the film will be online until Nov. 11th. Directly following at 10:30 pm will be RX for Change, a MacNeil/Lehrer Special, a discussion of Americans’ top health insurance concerns. June 5th CPTV aired a CT version, Critical Condition: Focus on CT.

Legislature and Comptroller announce audit of DSS

Legislative leaders and Comptroller Nancy Wyman announced today that the Comptroller’s office will conduct an audit of DSS to eliminate waste and over-budgeting. Specific concerns include difficulties tracking expenses, over $100 million in DSS carry-forward requests, turmoil in the HUSKY program, start up costs of the Charter Oak Health Plan, and funds appropriated for programs that are not implemented or partially implemented such as delays in securing disease management, PCCM and medical interpreting services. The Appropriations and Finance Committees will hold a joint fiscal accountability meeting on November 18th.
Ellen Andrews

PCCM public hearing and RFA out

The Appropriations and Human Services Committees held a public hearing today on DSS’ proposal for a PCCM pilot for HUSKY. Over thirty legislators came to hear Commissioner Mike Starkowski and Director of Medical Administration David Parrella outline their plans for the program. Legislators universally expressed enthusiasm for the plan and commended DSS for faithfully implementing the program. DSS is planning to hold forums around the state to introduce the program to providers and to collect feedback. They intend to hire a contractor to evaluate the program and a nurse advice line for patients. Legislators expressed concern that the implementation of PCCM be timed to fairly compete for members with the current plans to default HUSKY families into HMOs December 1st. PCCM isn’t slated to start until January 1st. The committees then heard from provider representatives, an IPA, advocates and consumers all in favor of the plan and urged the committees to approve it. Advocates commended DSS for an inclusive process to design the program, including advocates at every step and incorporating most of our input. Improving access to care for families and reducing burdens on providers were the highest priority and every design decision was tested against that standard. The collaboration created not only a strong proposal, but also deepened trust and respect between the agency and stakeholder groups which will continue into the future. While the vote was left open, voting at the meeting was unanimously to approve the plan.
The application and draft agreement for providers interested in PCCM is posted on DSS’ website.
Ellen Andrews

CTHPP is seeking a Program Director

The CT Health Policy Project is hiring a Director of Programs. The position involves coordinating consumer assistance and educational programming for the Project. There are opportunities for policy analysis and advocacy as well. Qualifications include organizational and interpersonal skills, resourcefulness, ability to work independently and take initiative, and most important – enthusiasm and commitment to our mission to improve access to quality, affordable health care for every CT resident. Knowledge of CT’s health care system is not necessary. Bilingual English/Spanish is preferred. Hours and salary are negotiable and based on experience. For more information, click here.

DSS answers Medicaid Managed Care Council on HUSKY and Charter Oak costs

Yesterday’s Medicaid Managed Care Council was standing room only for what is generally a dry actuarial discussion about rate setting. Questions from legislators and advocates were pointed but answers were fuzzy.
First, representatives from Shramm and Raleigh, DSS’ no-bid financial contractors, described how Charter Oak’s costs and benefit package were arrived at. The original bids for the original package promised by the administration from the only three HMOs to apply -- Community Health Network, Aetna Better Health, and AmeriChoice – was $335 per member per month, higher than the $250 premiums the Governor had promised. So they asked the HMOs how they could tweak the package to save 24% and keep the Governor’s promise. They arrived at the $100,000 annual limit on benefits. The auditors acknowledged that this provision will cause a number of very ill patients every year to incur significant medical debt as a planful part of the program’s design – they didn’t know how many, but they will get back to us. They also revealed that the actual premiums for members at lower income levels are higher than the $256 paid by un-subsidized members. While this doesn’t matter to those members, their maximum contributions are set in statute, DSS acknowledged that this increases the state’s financial risk, especially given that so far the large majority of enrolling members are in those subsidized income ranges. Many concerns were raised about the state’s financial risk and the sustainability of Charter Oak. There was no answer to the question posed by Kevin Lembo, the State Health Care Advocate, about when we will know if the costs are in a death spiral and what will be done about it.
Council members also had serious concerns about Mercer’s presentation on how the 24% increases in the HUSKY HMO rates were arrived at. Questions focused on the 8.2% increase to bring provider rates under the HMOs up to the fee-for-service floor. Sen. Harp, Co-Chair of Appropriations, stated that the legislature’s understanding was the HMOs were using the 4 to 4.5% increases they have received every year for over a decade to raise provider rates and last year’s fee-for-service increases were just to catch up. She was very concerned to learn that we were paying the HMOs yet again to raise rates. Members also questioned why price increases were included in the 8.2% item as well as in the 5.6% trend adjustment raising concerns that price increases were being counted twice. Significant concerns were raised about the 5.3% increase (over $30 million) allotted for “Change in MCO financial position.” This appears to be money to cover HMO profits and for “negotiations.” We can only imagine those negotiation sessions, when DSS needed three HMOs to run the program and only got three bids.
When asked about the Governor’s dismissive response to the Council’s unanimous resolution advising DSS to slow implementation of the HUSKY transition and until the HMOs have adequate provider panels (as required under federal law), the Commissioner stated that a handful of members are receiving care now.
The meeting then turned to those inadequate provider networks which continue to grow very slowly. Despite that DSS intends to begin enrollment in New Haven, Tolland and Litchfield counties October 1st and the rest of the state November 1st. Middlesex County began enrollment the first of this month, but thankfully less than 7% of consumers have switched into the skeletal plans. The large majority of those have chosen CHN, the already existing HMO based on the state’s community health centers. All HUSKY families will have to choose one of the three HMOs by November 25th or they will be randomly defaulted into a plan on December 1st.
The next Council meeting will be October 10th at 9:30am and will discuss revenues and expenses for HUSKY during the last year and progress on the dental carve out. Can’t wait.
Ellen Andrews

Behavioral Health Partnership/HUSKY update

At Wednesday’s BHP Oversight Council meeting, DSS reported HUSKY MCO enrollment numbers in Middlesex County, the first to go “on-line” back to managed care plans. Voluntary enrollment in the MCOs started Sept. 1st; at the end of November it will be mandatory. Of Blue Care members, 170 (41%) chose Aetna Better Health, 28 chose AmeriChoice (7%) and 218 (52%) chose CHN. Of traditional Medicaid members, 18 (25%) chose Aetna, 1 (1%) chose AmeriChoice and 54 (74%) chose CHN. It is important to remember these are very early numbers and provider networks are still skeletal.

DSS and DCF also reported on BHP finances ($109 million in FY 08), and access numbers. Access was broken out by children vs. adults, and by outpatient services, intermediate care, home-based services (which have increased significantly) and emergency mobile psychiatric services. We also received detailed information on inpatient care – the numbers of admissions is up but length of stay is down. While we have far to go, inpatient days in discharge delay for children (children ready to leave the hospital, waiting for an appropriate treatment setting) is down from 37% in the last quarter of 2007 to 26% in the second quarter of 08, coming closer to national averages. The Council is reviewing DSS’ plans for using targeted new funding to reduce length of stays in psychiatric residential treatment facilities, with more focused treatment and reducing delay days.

Significant concerns were raised about DSS’ plans for mental health and substance abuse services under Charter Oak. Services are limited and costs to consumers could be substantial. The effect of medical debt on patients’ financial health, serving as a disincentive to needed follow up care, and that Charter Oak could be ineligible for free bed assistance because they have insurance, in some cases, they may be worse off with Charter Oak than uninsured.
Ellen Andrews

PCCM hearing date set

The mandated public hearing on DSS’ Primary Care Case Management proposal has been set. The hearing of the Human Services and Appropriations Committees will be September 25th at 11am at the Legislative Office Building. If you cannot come and would like to submit comments, the Chairs of the Committees are Representative Peter Villano, Senator Jonathan Harris, Senator Toni Harp and Representative Denise Merrill. Mail to any legislator can be addressed simply to the Legislative Office Building, Hartford CT 06106; email addresses can be found at www.cga.ct.gov.

Authorities holding public hearings

The Health First and Primary Care Authorities will hold public hearings on their mandates to develop options for health coverage of all CT residents and to assess the capacity of CT’s primary care system. All are 6:30 to 8:30 pm.
9/17 Putnam Middle School
9/18 Norwalk City Hall
9/23 Torrington City Hall Auditorium
9/24 CHA building, Wallingford
9/25 Norwich Town Hall Chambers
9/29 Danbury Town Hall Chambers
10/1 Waterbury Arts Magnet School
10/2 Legislative Office Building, Hartford
TBA Manchester

The Project turns nine !!!

Yesterday marked the ninth anniversary of the CT Health Policy Project. We took the day off.

To celebrate, we are moving our offices (actually just Ellen’s office). Our address will be not change. As of next week all the staff will be in the same part of the building. Our phones and internet won’t be working on Friday, but hopefully everything will be back up and running again on Saturday. Many thanks to Brian Roccapriore, former Director of Programs, who will be sharing his weekend with us, fixing the inevitable computer glitches.