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After accounting for the impact of dental and prescription drug carve outs, the capitated rates paid to the three HUSKY HMOs – Aetna, AmeriChoice (United) and CHN – are 24% higher than the capitated rates paid to the plans last year before November. This is according to an analysis done July 17th for DSS by Mercer obtained by the CT Health Policy Project through a Freedom of Information request. The 24% rate increase includes a 13.1% increase due to programmatic changes (coverage for HPV vaccines, routine dental exams by PCPs, eligibility expansions, etc.) that some advocates and analysts take issue with. Along with medical trend and case mix adjustments, the rate hike also includes a 5.3% or $36.7 million increase for “negotiations” with the plans. $36.7 million is significantly more than the increase in physician fee-for-service payment rates last January – the first in twenty years. It is important to note that the budget, agreed to by both the legislature and the administration, allowed for a 2% rate increase to the plans.
Ellen Andrews