Nursing homes file suit against state over rates

The CT Association of Health Care Facilities yesterday filed suit in federal court arguing that the rates paid by the state to nursing homes violate federal laws that require consistence with efficiency, economy, quality and equality of access to care and that there is no evidence that rates are set on an objective, reasonable and principled basis. "This lawsuit is a last resort. After years of underfunding, Connecticut's nursing homes are stretched to the limit trying to provide high quality care to 28,000 frail and elderly residents without adequate funding," CAHCF Executive Vice President, Matt Barrett said. The suit names only Governor Rell and alleges that she has established a policy where budget decisions are the main priority in rate setting, excluding the costs of providing care or federal law. The suit cites several state-sponsored studies to back up their claims.
Ellen Andrews

Sen. Frankin stars at Families conference

In describing opponents of health care reform, Minnesota Senator Al Frankin reminded advocates at yesterday’s Families USA conference of a quote by former Speaker Sam Rayburn, “Any jackass can kick down a barn, but it takes a carpenter to build one.” He characterized the opponents as having bumper stickers with only one word – No. Our bumper sticker has way too many words, and ends “continued on next bumper sticker.” He closed by reminding us how close we are to providing relief to struggling consumers with affordable, quality options for coverage. He says we should pass what we have, and not let the perfect be the enemy of the merely very good.
Our CT delegation agrees, in my visits. I spoke with Rep. Chris Murphy’s staff yesterday and they are also determined to see that reform moves forward.
Ellen Andrews

Second wind for health care reform

My second day of visiting Capitol offices found mainly optimism and people really taking a breather. The President’s State of the Union speech last night helped. The Houses and the White House are talking although no one expects this to happen anytime soon. I heard about the seven stages of grieving from more than one staffer, and different people are at different places, but everyone was clear on one point – we can’t not do this. Reform has to happen; the alternative is unacceptable. And everyone stated their willingness, eagerness in some cases, to get back to work (and get it over with). I visited Rosa DeLauro’s, Lieberman’s, and Dodd’s HELP committee staff. The House and Senate were very close before the MA election and most expect much of that agreement to end up in the final agreement. But “it’s a process”.
Ellen Andrews

Capitol Hill visit – What about reform?

I’m spending this week at the Families USA pre-conference meeting of advocates from across the states. We thought we’d be talking about how to implement health care reforms (and we still are talking about that), but politics got in the way. We have also been fanning out across Capitol Hill, reminding our legislators that the need for reform hasn’t changed; our broken health care system wasn’t fixed by MA’s very special election last week. We’ve been hearing a lot about reconciliation, rules, and deep distrust between the House and Senate. We are luckier in CT than advocates from some other states; our delegation knows how important this is. Yesterday we met with Cong. Joe Courtney, who knows more about health care than anyone I know. He is working hard to move this forward and make sure it works and is fair to everyone.
Ellen Andrews

SustiNet workforce and medical home webinars scheduled

Three SustiNet webinars have been scheduled to date; all are available to the public to participate.
The first is February 2nd at 11am. We will be hearing from Mina Harkins, Assistant Vice President at NCQA about their patient centered medical home certification program. To register for that webinar, go to https://www2.gotomeeting.com/register/618793754

The second will be February 8th at 1pm. We will hear from Marcia Proto of the CT League for Nursing, Matt Katz Executive Director of the CT State Medical Society and Scott Selig and Rashad Collins from the Community Health Center Association of CT. Register for this webinar at https://www2.gotomeeting.com/register/649452571

The third will be February 22nd at 3pm. We will hear from Tanya Court of the Fairfield County Business Council, Margaret Flinter from the Primary Care Authority and Alice Pritchard and Mary Ann Hanley of the Allied Health Workforce Policy Board. To register, go to https://www2.gotomeeting.com/register/795515106

Cheshire/ Wallingford LWV health care forum features Congressman Murphy

There were concerns that Saturday’s forum on health care might get ugly, but thankfully everyone stuck to the issues – what should Congress do now about health care reform. Congressman Murphy said that health care is a very personal, hot button issue and it should be. We have to look very hard at what we are spending and what value we get for all of it. Congress needs to “take a breath” and consider how to move forward. Speakers noted that the need for reform hasn’t changed because the political landscape has shifted. In the last ten years, CT families’ premiums rose 7.4 times faster than our incomes. One in ten CT residents is uninsured; three CT residents die every week because they aren’t covered. The US spends far more than any other country on health care but we lag on most measures of quality. All speakers agreed that doing nothing is not a viable option.
Speakers included Cynthia Russo of Midstate Medical Center, Dr. Phil Brewer of Quinnipiac University Student Health Services, Daniel Diaz Del Valle of Innovative Partners and me. Slides are online.
Ellen Andrews

United Health Group profits up 30%

Rising unemployment, and consequent rising uninsurance, reduced United Health Group’s lucrative commercial enrollment by almost a million people compared to last year. Despite that, United posted rising profits for the third straight quarter. Raising premiums and a 12.5% increase in taxpayer-funded Medicare and Medicaid enrollment contributed to the profits. United Health Care (Americhoice) is one of three HMOs in CT’s Medicaid managed care program. An independent audit by the Comptroller’s Office last year found that CT is overpaying the HUSKY HMOs by $50 million annually. Also last year, CT’s insurance dept. approved a controversial, first-of-its-kind proposal by United to purchase HealthNet’s consumer information on CT residents.
Ellen Andrews

I found my blog – finally

Most days I have no trouble figuring out what to write about here, but today I searched and searched. Believe it or not I considered Martha Stewart’s blog on family caregivers (did you know that America has three times as many plastic surgeons as geriatricians).
The blogosphere is full of obituaries for national health care reform – depressing stuff. But then I found Brian Rosman from Health Care For All Massachusetts’ entry for today – “With all due respect Mr. Speaker, it’s not over ‘til I say it’s over”. The video is not to miss; remember that at the end of the movie we learn that John Blutarsky is elected to the US Senate.
Chin up everyone.
Ellen Andrews

Obesity and Tobacco Forum

The CT Public Policy Institute held a forum at the Capitol yesterday on the scope of obesity and tobacco issues in our state and what policymakers can do to improve health and lower costs. 16% of CT adults currently smoke, below the US average of 21%. Smoking kills more people than AIDS plus alcohol plus motor vehicle accidents plus homicide plus drugs plus suicide. Alcoholic smokers are more likely to die of smoking than from alcohol. Effective smoking cessation treatment is more cost effective than statins, front airbags, or annual mammograms. Smoking costs CT’s economy $2 billion every year. The real cost of a pack of cigarettes in CT is $14.30, including medical costs and lost productivity and taxes. Smoking costs CT’s Medicaid program $507 million/year; CT is one of only five states that does not cover smoking cessation treatments. We heard about the remarkable success of MA’s comprehensive treatment program.
The obesity report builds on an Institute forum in May; recommendations centered on menu labeling, taxing soda, and the federal farm bill. The reports were funded by the Universal Health Care Foundation of CT.
Ellen Andrews

If national health reform happens, how will it affect CT?

Passage of a national health reform bill appears uncertain. However under any scenario, if it happens, Medicaid will expand significantly. At least 100,000 more CT residents could become eligible for the program that has struggled in our state. The CT Health Policy Project has drafted a list of policy and design questions that need to be addressed in any Medicaid expansion. As reform progresses, we will be asking questions on other health care issues.
Ellen Andrews

Patient registration open now for Feb. 3rd Hartford Free Clinic; Doctors, nurses and other volunteers needed

Come out Wednesday, February 3, 2010 to the Connecticut Convention Center in Hartford for the NAFC’s (National Association of Free Clinics) C.A.R.E Clinic, which will be providing free medical services to uninsured patients from noon- 7 p.m.
Doctors from many specialties will be present, and patients are recommended to call 877-233-5159 to make an appointment. Walk-in appointments are available but on a limited basis.
Over 700 medical and non-medical volunteers are needed! Medical personnel (MD, DO, DDS, DCs, NP, RNs, BSW, LVN and almost all specialties) and non-medical personnel (for translating, set-up, greeting and other jobs) can register to volunteer at www.regonline.com/ctcare. The deadline for volunteer registration is Feb. 1st. Liability coverage for medical personnel is covered by NAFC.
Nelson Mendoza

SustiNet Board meeting

Yesterday’s SustiNet Board meeting focused on federal health reforms and how SustiNet fits in. The Board heard from Stan Dorn at the Urban Institute and Sarah Dash from Congresswoman Rosa DeLauro’s office. Both gave excellent descriptions of the House and Senate bills, where CT stands in both scenarios, and the major items still being negotiated. Areas still being worked out include financing (excise tax on premiums vs. raising the income tax on high earners), affordability subsidies, how consumer protections will be enforced, and increasing Medicaid primary care payment rates. CT and other states that have been more generous in Medicaid eligibility and where health care is more expensive are disadvantaged under either bill; while there may be some moderation of that inequality, it is unlikely to be completely fixed. On the other hand, either bill provides CT with more resources that were envisioned when SustiNet passed. It was noted that neither the House nor Senate bill is universal; under either, millions of Americans and thousands of CT residents, are likely to remain uninsured. With an individual mandate (which also seems inevitable), it is critical that CT residents have an affordable, comprehensive option such as SustiNet.
The SustiNet Board is charged with developing a set of recommendations for the General Assembly to integrate SustiNet into national reforms within 60 days of passage of a federal bill. The Board set up a small group of voting SustiNet Board members and Deputy Comm. Vogel, the Governor’s point person on federal health care reform, to develop those recommendations that will then be sent to the legislature for review.
Ellen Andrews

Free Clinics coming to Hartford, sign up to volunteer

The National Free Clinic Association is coming to Hartford February 3rd. Care will be provided to anyone who needs it, without payment, from noon to 7pm at the CT Convention Center. The Association has held massive one-day free clinics around the country, bringing desperately needed medical services to the uninsured and great publicity to the issue. The Association also provides on-going support to the many permanent free clinics around the country, including about half a dozen in CT, that do this important work every day. They are currently seeking volunteers; you don’t need a medical background. They need clinicians, but also translators, people to escort and register patients, and help the nights before and after to set up and break down. To register click here.

DSS complies with court decision; legal immigrants can access HUSKY again

Last month, a Hartford Superior Court judge ruled that the state’s action to cut health coverage for adult legal immigrants was unconstitutional. But it took another ruling last Friday for DSS to comply with that ruling, according to Greater Hartford Legal Assistance attorneys who brought the suit. The court found that the denial of health care coverage for low-income state residents who were otherwise eligible violated the equal protection clause of the CT constitution. However, DSS did not re-open the program, only responding to cases brought to them by the attorneys on a case-by-case basis. The cut was the result of an agreement between the Governor and legislature to address the budget deficit. 4,823 CT residents lost coverage; the cut was expected to save $14 million annually.

DSS is again accepting applications from legal immigrant adults and the 4,823 people cut off the program will get notices that they are reinstated and coverage is reinstated retroactively to last month.
Ellen Andrews

Obesity and Tobacco in Connecticut Forum

The CT Public Health Policy Institute will host a forum January 19th on Overweight and Obesity in CT: Precursors, Policies and Possibilities and Smoke and Mirrors: Examining Tobacco Use, Consequences, and Policies in CT. The forum will be from 8 to 11:30am at the Legislative Office Building, Room 2A. Expert speakers will discuss the issues and research papers on the subjects will be released including available data, economic impact and solutions for our state. The research was funded by the Universal Health Care Foundation of CT. Catch up on all you need to know about these issues in one morning. Definitely worth it.

Medicaid Managed Care/PCCM update

Today’s Medicaid Managed Care Council included an update on PCCM given the expansion to New Haven and Hartford January 1st. It was noted that there has been great interest among providers with 122 signed up in New Haven and 47 in Hartford so far and more applications expected. Unfortunately, DSS has refused to remove the unnecessary and intimidating Freedom of Information requirements on providers in PCCM (but not on those enrolled in the HMO panels) or to devote any resources to marketing PCCM. This is in contrast to considerable approved expenditures of taxpayer dollars by HMOs for marketing. But DSS confirmed press reports that they will now be prohibiting the HMOs from spending HUSKY dollars on marketing going forward. They were not specific about how that would be enforced or what the penalties will be. We also reported concerns about the PCCM evaluation planned for this summer, which is premature given the very low enrollment, and using Mercer as the evaluator given their significant business with managed care plans and whether this constitutes a conflict of interest. However, it was noted that many providers are excited about the medical home model encouraged by other payers and are interested in participating in PCCM to support practice transformation.
Enrollment data found, not surprisingly, that the numbers of HUSKY B and Charter Oak members who are not renewing in the programs and Charter Oak members not paying their premiums are up sharply. ACS is surveying those members to find out why. DSS talked about their plans to increase Charter Oak premiums significantly starting February 1st. The rates will increase 72% for people at the lowest income levels compared to 15% for the highest income members because DSS has chosen to rate by income bands. There was a great deal of discussion about opportunities for millions in federal funding that DSS is missing by not applying due to staff shortages. However, it was noted that DPH is partnering with nonprofits and others to ensure that they take advantage of every opportunity and that providers have been doing more with fewer resources for many years.
DSS described their response to the court decision prohibiting coverage denials to legal immigrants. During the meeting, it was announced that the judge denied DSS’ request for a stay of the order. DSS has only been reversing disenrollments on a case-by-case basis and not accepting new applications, possibly in violation of the court order. A Danbury Hospital representative noted that they have a patient currently in chemotherapy who was disenrolled, had to shift to Charter Oak and is struggling with the costs and will very likely hit the annual limit. They were not informed that they could appeal to DSS for a review to restore the patient’s Medicaid coverage.
Ellen Andrews

New in the Book Club: The Healing of America

I usually avoid reading about other countries' health systems; it’s depressing how backward America is about health care. It is odd that the best way to motivate policymakers to do something is to suggest that other states have done the thing and that we are behind, but the worst way to move them is to suggest borrowing a good idea from another country. But the Healing of America by TR Reid is worth reading. For this and other books we’ve liked, visit the CT Health Policy Project Book Club.
Ellen Andrews

January web quiz – national health reform and Connecticut

Test your knowledge of how national health reforms will help Connecticut. Take the January CT Health Policy Web Quiz.

Managed care proposal for seniors and people with disabilities

DSS has issued an RFQ to provide managed care to 26,000 Medicaid only recipients who are Aged, Blind or Disabled. Those people are now covered under the fee-for-service program. No one disputes that this population could use some care management, especially the 26,000 consumers who struggle to access care in a dysfunctional system. However, rather than open the bidding up broadly to get the best entity with the most experience and the best record of success in this challenging work, DSS has chosen to limit the bidding to only the three HMOs that now run the HUSKY program. This is very concerning given the trouble the HUSKY program has encountered; problems that have only grown worse over the last decade. For background on the HUSKY program, click here, here, here and here. The good news is that the new arrangement will not be capitated, however the HMOs’ care management payments will be subject to a 10% withhold released based on meeting “certain performance targets in areas such as quality, utilization and cost.” HMO letters of intent are due next Thursday and full responses by February 8th.
Ellen Andrews

New laws take effect; New Haven anti-tobacco crusader/educator just gets it done

Some new state laws took effect Friday including a few related to health – coverage of autism, prohibiting payment for hospital-acquired conditions and insurers and limits insurers’ use of anti-anxiety drug treatment in underwriting. Nothing revolutionary, but good stuff.

A story in the New Haven Independent last week featured Kenneth Driffin, a social worker who is educating kids in the Hill neighborhood about the dangers of smoking. He doesn’t have a grant and isn’t waiting for one, he’s just doing it. He talks about tobacco and peer pressure, advertising, candy cigarettes, second hand smoke, and pregnancy. In his day job as a counselor at Columbus House he sees the effects of smoking and other addictions on the health and economics of his community. The article contrasts Driffin’s work with Connecticut’s poor record of funding tobacco cessation programs, despite receiving over $800 million this year from the tobacco settlement and cigarette taxes.
Ellen Andrews