The concept paper for the state’s planned PCCM pilot has finally been delivered to the legislature. The Appropriations and Human Services Committees now have 30 days to hold a public hearing and approve, deny or make changes to the plan. PCCM is a way of running HUSKY without HMOs and will serve as another option for consumers and the state to run the program. Under PCCM, consumers will choose a primary care provider (PCP) – a physician, APRN, nurse midwife, or Physician Assistant – who serves as their first contact for health care. Their PCP is responsible for providing routine checkups and health care, arranging for tests, specialists and other needed care and coordinating everything. Consumers will need referrals from their PCP for specialty and other care; PCPs will only need prior authorization from DSS for some hospital services. The state will provide access to an off-hours nurse advice line. PCPs will need to have or get an electronic medical record or electronic disease management data registry within a year. PCPs will be held accountable for the care and coordination they provide.
The goals of the program include improving outcomes, expanding access to primary and preventive care, improving doctor-patient relationships, lowering expenses, and empowering providers and consumers in guiding the HUSKY program. An advisory committee of providers will be convened and charged with developing a proposal for accountability and all other aspects of the program.
DSS plans to implement the program on Jan. 1st and to pay PCPs $7.50 per member per month for care management costs in addition to the usual fee-for-service payments for visits and procedures. Plans for outreach include regional forums for providers and consumers. We will let you know when those and the legislature’s public hearing have been scheduled.
Any providers who are interested in participating can call the CT Health Policy Project at (203) 562-1636.