HUSKY (waiting for news) and PCCM (more bad news) update

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DSS has now changed the date of PCCM’s start from next Thursday to February 1st even in the two small areas they approved, Waterbury and Willimantic. DSS’ plan, approved without revision by the Appropriations and Human Services Committees this summer, called for statewide implementation January 1st. In another sudden change of policy, further limiting the program’s reach, PCCM will only be open to current patients of participating providers in those two areas. In a meeting with providers and legislators last week, DSS stated that they expect to begin offering PCCM in other communities within three or four months. Consumer advocates were dis-invited by DSS from the meeting.

The state still intends to end HUSKY families’ access to Anthem’s more generous list of providers February 1st. Over 130,000 HUSKY members will be forced to find a provider participating in one of the three participating capitated HMOs — Community Health Network, AmeriChoice (United Health Group) or Aetna Better Health. The state is awaiting word from the Centers for Medicare and Medicaid Services (CMS, the federal agency that oversees HUSKY) about whether the HMOs’ provider panels are sufficient to accept members. A December 5th letter from CMS required DSS to halt enrollment into the two new HMOs – AmeriChoice and Aetna – until they have sufficient network capacity. DSS now believes they have that capacity. But a survey of HUSKY HMO providers in New Haven and Hartford by New Haven Legal Assistance found that only one third are accepting new patients. This could make it very difficult for current Anthem members to find a new provider if forced into the HMOs.
Ellen Andrews