DSS gets an earful at PCCM subcommittee meeting

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Today’s PCCM subcommittee meeting of the Medicaid Managed Care Council was very heated. Again the room was packed, including four legislators in person and one on the phone. DSS reported that they still have 54 providers in the Waterbury and Willimantic areas participating; no increase from the last meeting two months ago. They are beginning to reach out to New Haven and Hartford providers and have some interest, but no firm commitments. DSS was strongly criticized for a lack of marketing, stating that they consider it the providers’ responsibility. However, language in the contracts severely restricts providers’ ability to talk with their patients about PCCM. In response to action steps from the last meeting, DSS reported that the Commissioner refused to consider either removing the Freedom of Information language from the provider contracts, or alternatively to require the same of providers in the HMO program – in the interest of ensuring equal treatment of PCCM and the HMOs. DSS refused to consider including providers from other areas of the state that have expressed interest in the program to at least one legislator. DSS also reported that the Commissioner refused to allow auto default enrollment into PCCM of new enrollees in those areas who do not choose an HMO, which had been suggested by DSS as an option to more fairly apportion enrollment among the HMOs and PCCM. When the two new HMOs entered the program last year, DSS gave them a similar advantage in default enrollment to help them increase enrollment levels and ensure sustainability. DSS stated that they considered it a “test” of the PCCM option whether consumers would choose the option over the HMOs – if the HMOs aren’t performing, people will leave them to enroll in PCCM. However that led into the next issue – the serious inequality of marketing between the HMOs and PCCM. Pages of DSS-approved marketing activities by the HMOs including an airplane banner, radio advertising, free ice cream, school uniforms, school supplies, and haircuts. Providers have had to bring in volunteers from community groups to explain PCCM to their patients, as they are not allowed to discuss the program with them. Providers are also required to copy the brochure themselves; it is not clear that PCCM brochures are even available in the local DSS office. The program has been in place for over seven months. DSS’ response was that PCCM is a work in progress, but a legislator commented that “pilots can take a year to set up, not a decade.” Another suggested that DSS was “throwing PCCM under a bus” and another characterized the provider contracts as “horrific.” Concerns were raised that DSS was not following through on their stated commitment to implementing PCCM and were intentionally undermining its chances of success. Advocates and legislators were urged to contact the Commissioner to urge him to reconsider his decisions.
Ellen Andrews