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

New report outlines long term cost of fully funding state retiree health benefits, Gov. Rell aggressively pursuing funding opportunities in national h

An early estimate to the state’s Post Employment Benefits Commission estimated that fully funding health benefits for the state’s 42,000 retired workers would average $1.9 billion over the next 28 years. The state now pays these bills as they arise; just over $490 million is budgeted for these costs in the fiscal year that starts next month. While full funding would cost more now, it would reduce future costs. The Commission includes representatives from the Comptroller’s and Treasurer’s Offices, the administration, and labor and is charged with analyzing long term funding of the state’s health and pension benefits system. The report was prepared by Milliman.

Governor Rell’s administration is aggressively pursuing federal funding opportunities in the new national health reform act, despite criticizing the reforms. The state will not be pursuing any new opportunities to cover Connecticut’s 343,000 uninsured under the act, but is only considering options to replace current state funding including $53 million to move current SAGA recipients into Medicaid and another $50 million to fund our high risk pool. The Comptroller’s Office has also applied for $100 million over the next four years to support coverage for state employee early retirees not yet eligible for Medicare. As funds for early retiree benefits are limited, the Comptroller’s Office responded to the opportunity quickly to apply early.
Ellen Andrews

Are hospitals more dangerous in July?

Anyone who has worked around hospitals has heard the warning to stay away in July when new residents start. But is it true? The Wall Street Journal examines the evidence, which is mixed. The bottom line is that it’s always wise to be an informed consumer. For tips on making your hospital stay safer and more go to the monthly columns by Carolyn Clancy of AHRQ. And for more on patient safety click here.
Ellen Andrews

CT Health Information Exchange meeting

DPH, DSS, and eHealthCT are hosting a CT Health Information Exchange Leadership Meeting June 10th from 8:30am to 12:30pm at the CT Hospital Assoc. Offices in Wallingford. Anyone interested in health IT and how CT is progressing toward creating a network is welcome. Attendees will hear updates on the DSS Medicaid HIE pilot project, eHealthCT’s Regional Extension Center program and DPH’s strategic and operational planning. Following the updates will be a town-hall style meeting to answer questions and collect input. To register go to http://www.ct.train.org/ for course #1022441 or email lynn.townshend@ct.gov.

Test your knowledge of CT’s individual insurance market

June’s CT Health Policy Webquiz tests your knowledge of CT’s non-group insurance market.

Obesity tools: CT middle of the pack in physical education report; improved home ec classes described

25.7 % of CT children are overweight or obese and policymakers are looking to the quality of physical education as one tool to address it. A new report by the National Association for Sport and Physical Education finds that CT’s state policies are better than some states and worse than others – we require physical education in elementary and high school, but not middle school. CT does not collect height and weight data on students making policy decisions, targeting resources, and evaluation of initiatives more difficult.

The Wall Street Journal Blog reports on what is needed in effective PE classes as well as other pieces of the solution to obesity including healthy eating. The authors argue that schools should require revamped home economics classes as well as physical education. The blog quotes a JAMA commentary describing improved home ec classes as giving students “the basic principles they will need to feed themselves and their families within the current food environment,” including “basic cooking techniques; caloric requirements; sources of food, from farm to table; budget principles; food safety; nutrient information, where to find it and how to use it; and effects of food on well-being and risk for chronic disease.”
Ellen Andrews

Report finds one in five CT residents have pre-existing conditions and risk of insurance denial

A new report by Families USA finds that 593,000 CT residents have been diagnosed with one or more condition that could result in denial of insurance coverage. In September, under the new national health reform act, insurers will be prohibited from denying coverage to the 44,200 CT children with pre-existing conditions, but the other half million adults in our state will have to wait until 2014 for protection. Every income group is affected but low income residents are at higher risk. Whites, African-Americans and Hispanics are about equally likely to be affected. Near elderly residents (ages 55 to 64) are the most likely to be at risk. Pre-existing conditions that often cause coverage denials include any diagnosis of cancer, diabetes, arthritis, obesity, heart disease, or sickle cell disease.
Ellen Andrews

$266 million in Medicaid funding at risk

Congress is considering a bill that extends the badly needed enhanced Medicaid matching rates to states for another six months. Without the legislation, the extra funding is set to expire at the end of this year. CT stands to lose $266 million in federal funds. Along with thirty other states, CT has assumed receipt of those funds in the state budget that passed this spring. The version that passed the House Friday did not include the extra Medicaid funding; an earlier version in the Senate does include the funding. The Council of State Governments/Eastern Region and other groups are urging Congress to continue this vital lifeline to states struggling with declining revenues and surging enrollments in these critical safety net programs.
Ellen Andrews