SIM ethics concerns intensify with first grants choice

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Monday the Lieutenant Governor’s office announced the award of SIM’s first grants from federal funds; two of the four recipients are represented on theSIM Steering Committee. The members represent Northeast Medical Group (Yale-New Haven affiliate) and St. Vincent’s Health Partners. This would have been prohibited under the state’s Code of Ethics but for a loophole in the law.

Totaling $650,000, the grants are to large provider networks to develop patient-centered medical homes. The standards for the grant were set by a SIM committee and initially rejected by the Steering Committee. With others, both conflicted Steering Committee members then met with the subcommittee arguing to reduce one specific standard to allow at least one to apply for the grant. The committee agreed and the Steering Committee subsequently approved the new, lower standards. 
In May, CT’s state ethics board released an opinion that the SIM Steering Committee (and Consumer Advisory Board) both have substantial roles in setting state policies and funding, but there is a loophole. SIM committee members are not subject to the state’s Code of Ethics for Public Officials because members are appointed by the Lieutenant Governor. The law defining Public Officials subject to the Code only identifies appointees of the Governor and General Assembly; it does not address the very new practice of very significant policy and funding decision-making by appointees of the Lieutenant Governor. Two amendmentswere offered in the last days of the session to include SIM in the Code of Ethics.
This problem allows situations, as happened at the AccessHealthCT Board, where a member argued and voted for weak standards for insurers to join the exchange and opposed active purchasing. He then resigned from the Board, and subsequently went to work for an insurer that intends to participate in the exchange under the weak standards and without facing negotiation with the state to keep rates affordable.
This issue was first raised with SIM’s Consumer Advisory Board in November, with no action taken, and in a February sign on letter from advocates to the Lieutenant Governor, with no response.