Charter Oak/HUSKY/PCCM update

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DSS Comm. Mike Starkowski met with the Appropriations and Human Service Committees yesterday delivering a 72 page program update. The big news (from our perspective) is that the PCCM concept paper, drafted by a working group of DSS staff and advocates (including the CT Health Policy Project), will be submitted to the legislature next week. The committees will then hold a public hearing on the draft plan, and approve, reject or modify it. In response to a question from Rep. Villano, the Commissioner also announced that the per-member-per-month payment to Primary Care Providers in PCCM will be $7.50, not $5 as was previously reported. The working group had recommended $7.50 after animated negotiations. The bad news is that PCCM may not start until Jan. 1st. Legislators urged DSS to do everything possible to have it ready as another option at the same time that consumers have to choose between HMOs.

There was a great deal of discussion about the 24% increase in rates to the HUSKY/Charter Oak HMOs that seemed “awfully high” to Sen. Harp, with the committees asking DSS to get back to them with more detail. Sen. Harris and others asked about the lack of providers in the new HMOs’ panels. DSS says the HMOs are actively recruiting providers and the plans will pay the out-of-network costs for care to members through November. Legislators expressed concerns that if out-of-network services are not paid at reasonable levels, consumers may still have difficulty accessing care. The Commissioner emphasized that no consumers will be defaulted into any plan until November 25th and the current ASO arrangement, that by all accounts is working well and possibly saving money, will continue until at least the end of the year.

Overall, the committee members expressed a lot of frustration with DSS – in delays to implementing programs, selectively cutting legislative priorities, and numbers that “change every time we meet”. Rep. Merrill said, “We will keep having hearings until we get answers.”
Ellen Andrews