Hispanic Health Council unveils new website

Visit the Hispanic Health Council’s re-designed website. The Hispanic Health Council’s mission is to improve the health and social wellbeing of Latinos and other diverse communities. Programs include substance abuse and recovery, nutrition assistance, farm workers health, HIV/AIDS, breastfeeding, diabetes, cancer and parenting support. Join the Hispanic Health Council for their 30th Anniversary on October 21st from 5 to 8 pm at their offices at 175 Main Street in Hartford.

Judge denies parts of nursing home lawsuit

A federal judge has denied an injunction in the CT Association of Health Care Facilities’ lawsuit against the state, but the lawsuit is moving forward. The nursing homes had asked for an injunction to stop $300 million in cuts scheduled over the next two years; the state asked the court to throw out the entire suit. The nursing homes argue that the state’s system of payments underfunds them by $100 million, considers only finances and ignores the quality of care, and violates federal law. About two thirds of nursing home revenues are paid by Medicaid program with payment levels set by the state. In total, nursing homes cost CT $2.5 billion/year; 22 homes have closed since 2002, in part because of low Medicaid reimbursements. The judge also removed Governor Rell as a named defendant in the suit leaving only Commissioner Mike Starkowski. The association contended that the Governor has an important role in setting the state budget and, consequently, for underfunding nursing homes.
A recent study found that CT relies more heavily on nursing home care for fragile seniors and people with disabilities than other states, costing an additional $900 million/year. Other state Medicaid program regulations and administration make accessing care in the community easier. Almost 80% of CT residents would prefer to receive care in the community rather than a nursing home.
Ellen Andrews

Medicaid Managed Care Council update

Friday’s Council meeting focused mainly on plans for the $50 million temporary high risk pool opportunity created by national health reform. DSS joined the CT Insurance Dept. and the Health Reinsurance Association (HRA) to describe their plans. They intend to piggyback on the current high risk pool administered by HRA which was created in 1976 to provide coverage to CT residents with pre-existing conditions denied individual insurance. Insurance coverage will be provided through United Healthcare. After more than three decades HRA enrollment is only 2,529. HRA was criticized at the meeting for very high premiums, high deductibles, and a very confusing website. There will be at least three call centers for the various stakeholders involved in the program, including DSS, CID, ACS, HRA and United Healthcare. Concerns were raised about fragmentation, that consumers would be left with no clear point of contact, and the risk of very high administrative costs, especially given the limited federal resources available. Concerns were also raised about benefits and cost sharing under the plan. DSS admitted that the plan does not comply with state law, but doesn’t have to under federal law. Even more controversial, DSS intends to seek legislative approval to shift any eligible Charter Oak members with pre-existing conditions to this new plan; consumers moving from Charter Oak to the new plan would face significantly higher costs, potentially reaching over $1,000 more per month. DSS refused to outline how they would use the savings in the Charter Oak plan; suggestions from Council members included reducing premiums, lifting benefit caps, raising the pharmacy cap or eliminating the requirement that applicants be uninsured for six months.

In other updates, DSS described the increases in copayments and premiums in Charter Oak and HUSKY Part B. ACS will track cost sharing for families and alert both the HMOs and families when they have reached the federal limits and will no longer be charged copays. DSS is still pursuing the conversion of SAGA into Medicaid with CMS. For the first time since its inception and despite stubbornly high unemployment rates, enrollment in Charter Oak dropped in May when members were notified of the increase in premiums.
Ellen Andrews

Patients asked to leave medical practice after filing complaints for excessive billing

Two Hartford Medical Group patients have been told they are no longer welcome at the practice for complaining about fees charged to them above the payments by their insurers for routine physicals, which are 100% covered. Three complaints have been filed with the Attorney General’s office for excessive and unjustified billing; one patient was told that she could come back to the practice if she withdrew her complaint with the AG. The AG’s office is investigating the allegations which they characterized as “potentially unjustified charges added to consumer bills for services that should have been included in the physical or were never provided.” The practice claims that one patient was belligerent and “nasty” about the extra bill. According to their online policies and procedures, Hartford Medical Group charges $35 to patients who don’t show up for appointments and $45 for “administrative fees” related to nonpayment and collections costs.
There is a small but growing national trend of doctors tacking on extra fees to patients, but for services insurance does not pay for including filling out school and camp forms, no-shows, and flat “non-covered benefits” fees.
Ellen Andrews

Risk adjusting rates webinar slides and video posted

you missed Wednesday’s webinar with Diane Laurent and David Williams of Milliman, the slides and video are now online. Diane and David described the methodologies to adjust rates based on each patient’s utilization history and diagnoses. Some models can predict future utilization and events, such as hospitalizations, for each patient providing an important tool to care managers in patient-centered medical homes.
Ellen Andrews

Immediate impact of national health reform for CT

The White House has developed a list of the benefits of the Affordable Care Act to CT this year. The list includes small business tax credits, closing the Medicare donut hole, funding for early retirees, no lifetime limits on coverage, no rescissions, no pre-existing condition exclusions for children, all children to age 26 can stay on their parents’ policies (and parents don’t have to pay taxes on those benefits), Medicaid coverage (and matching funds) for SAGA, $50 million for a high risk pool, funding for community health centers, and to train more providers. And that’s just part of the list.
Ellen Andrews

CT hospitals left out of Medicare bonuses

No CT hospitals are among hospitals nationally receiving Medicare bonuses under the new national health reform act. The bonuses were designed to equalize payments between high and low cost hospitals – none of CT’s 30 hospitals qualified as lower cost. The provision was prompted by research led by Dartmouth Atlas showing no link between high cost areas of the US and hospitals with quality.In fact Dartmouth researchers have evidence that higher cost areas are associated with lower care. That research is very controversial and other researchers disagree with Dartmouth’s findings.
Ellen Andrews