Medicaid Managed Care Council meeting update

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Friday’s Council meeting was uneventful. After a year, there are 342 people in PCCM/HUSKY Primary Care; legislation requires at least 1,000. Despite that, DSS is steaming ahead on plans to evaluate the program by July 1st. It is fascinating that they are just now deciding to comply with deadlines in this program – they have blown through every reporting and start date in legislation until now, but they appear to be eager to get an evaluation of the program done as soon as possible. Despite promises to consult with the PCCM Subcommittee, DSS has already negotiated an agreement with Mercer on the scope of the study. They stated that it was a draft agreement, but noted the aggressive time frame for the work and did not commit to making changes in response to the Committee’s input at next week’s meeting. Advocates and legislators raised concerns about a premature evaluation that will not provide a valid assessment of such a small program and could be used to unfairly label the program a “failure” and be used to shut it down before it has had a chance to succeed. Advocates have also raised concerns about hiring Mercer for the evaluation given that Mercer receives much of its revenue from HMOs and Mercer signed off on the 24% rate increase DSS gave the HMOs two years ago, overpaying the HMOs by $50 million/year. Advocates also raised concerns over the $75,000 cost of the evaluation, especially given the growing budget deficit and proposed cuts to essential services for HUSKY families.
Other reports from the Council meeting include good news from the CT Dental Health Partnership – the number of providers and sites continues to grow and prior authorizations are being processed in under 11 business days. Concerns were raised that, while there has been progress, there are still serious problems with access to care. DSS and the Partnership are working hard to address them, reaching out to providers, consumers and advocates to improve the program. The HMOs described their Quality Improvement Projects, required under their contracts, and stated that they will be reporting on their findings, planned interventions to address concerns, and progress toward quality improvement. Concerns were raised about whether patients in the study sample are notified that their records are pulled and subjected to increased scrutiny. The HMOs will check and get back to us at next month’s meeting. INFOLINE reported on the calls and cases they receive on their helpline. Last year they received 66,200 calls for assistance – the three top problem areas were help finding a dental or primary care provider and access to prescriptions. They noted that the carve outs of dental and pharmacy benefits dramatically decreased calls to their office about those services.
Ellen Andrews