SIM
SIM discussion on how to cut the budget
In what was supposed to be a one-hour meeting, the SIM Steering Committee met yesterday to discuss how to cut the original $64m budget in the federal application down to $45m, as requested by CMMI. It was a poorly structured meeting that quickly led to a disorderly grab for money. Staff provided members with a…
Read MoreSIM decision to use national PCMH standards affirmed – again
At last night’s SIM Practice Transformation committee meeting, consumer advocates were able to halt erosion of national standards for patient-centered medical homes (PCMHs). Following research and best practices and resisting misinformation, in June the committee voted to use nationally recognized NCQA standards for PCMHs in SIM. NCQA-recognized PCMHs are the foundation of CT Medicaid’s remarkable…
Read MoreIndependent advocates raise SIM concerns with CMMI
Twenty-two independent consumer advocates signed a letter sent Friday to CMMI voicing concerns about CT’s SIM application. While advocates have many concerns, the letter focuses on the sudden planned shift to shared savings payments in Medicaid. Concerns include the prospect that shared savings incentives could drive inappropriate underservice and that state’s quality and financial monitoring resources…
Read MoreMedicaid, SIM committee update – PCMH success continues, SIM making important Medicaid decisions
The Care Coordination committee of MAPOC has been given responsibility for oversight and advice on SIM’s controversial new plans for Medicaid, especially the shared savings payment model. The committee’s original mission remains as well – to track Medicaid’s successful patient-centered medical home program. In yesterday’s meeting we heard more about continuing PCMH success. The number…
Read MoreNew SIM summary online – consumer concerns remain
The administration’s federal SIM application for $64 million is finished. As the plan and application developed, consumer advocates sent five letters signed by dozens of independent advocates voicing concerns including weak consumer protections, incentives to deny necessary appropriate care, the need for nationally recognized standards, and the lack of independent voices in the process. Some…
Read MoreSIM administrators seeking planning consultants should avoid prior mistakes
State SIM administrators are soliciting bids for a new set of consultants to guide the implementation process. Given the problems with the SIM final plan development process, advocates offer these recommendations. This time: · Use an transparent, objective process that is open to all qualified applicants · Avoid any perceptions of political and other conflicts…
Read MoreNew SIM under service survey — please help protect consumers
The SIM Equity and Access Committee is working to develop a monitoring system for inappropriate underservice as CT’s health system moves toward shared savings payment models. Underservice can be denial of appropriate care, limiting expensive treatment options, limiting access to certain providers, avoidance of consumers that may not generate savings, or cost shifting to consumers.…
Read MoreSIM moving ahead with risky Medicaid plan despite 25 advocates’ objections
At yesterday’s meeting, the SIM steering committee chose to move ahead with plans to radically change the Medicaid program – to include shared savings and an 1115 waiver. The new plan, rushed out in only a few weeks, reverses earlier assurances to advocates that the state would go slowly into shared savings payment incentives, recognizing…
Read MoreMedicaid Council voices concerns about new SIM proposal
In a special meeting yesterday, the majority of Medicaid Council members voiced concerns about the rushed, new SIM proposal for Medicaid. Legislators compared the new proposal to the failed HUSKY HMO proposal 20 years ago and made it clear that they are concerned about “going back down that road”. Concerns included the application’s aggressive pace of…
Read MoreQuestions for SIM about radical new Medicaid proposal
Questions sent yesterday for today’s meeting about SIM’s risky, new Medicaid proposal have been posted. One asks why a dangerous 1115 waiver is necessary? Did SIM planners explore other, less dangerous options? 1115 waivers necessarily include a cap on federal reimbursement (to meet the federal budget neutrality requirement) endangering the state budget and potential future…
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