PA 09-206—sSB 1048

Public Health Committee

Judiciary Committee

Human Services Committee

Government Administration and Elections Committee

Insurance and Real Estate Committee

AN ACT CONCERNING HEALTH CARE COST CONTROL INITIATIVES

SUMMARY: This act requires the Social Services (DSS) and Administrative Services (DAS) commissioners and the comptroller, in consultation with the Public Health (DPH) and Insurance commissioners, to develop a plan concerning the bulk purchasing of pharmaceuticals. Specifically, the plan must implement and maintain a prescription drug purchasing program and procedures to aggregate or negotiate pharmaceutical purchases for HUSKY Part B, State Administered General Assistance, Charter Oak Plan and ConnPACE recipients, Department of Correction inmates, and people eligible for insurance under the state employees and municipal employee health insurance plans. (PA 09-232, 28, eliminates the insurance commissioner's consultative role in developing the plan. )

The plan must include the state joining an existing multistate Medicaid pharmaceutical purchasing pool. It must determine whether it is feasible to subject some or all of the programs listed above to the preferred drug lists adopted by DSS for its various programs.

The act requires DSS to submit the plan to the Public Health and Human Services committees by December 31, 2009. The plan must include (1) an implementation timetable, (2) anticipated costs or savings, (3) a timetable for achieving any savings, and (4) legislative recommendations.

The act also prohibits (1) hospitals and outpatient surgical facilities from seeking payment for costs associated with certain hospital-acquired conditions and (2) specified health care practitioners from charging for certain imaging services.

EFFECTIVE DATE: July 1, 2009 for the bulk purchasing provisions; October 1, 2009 for the imaging service provision; and January 1, 2010 for the provision on hospitals and outpatient surgical facility billing for hospital-acquired conditions.

PAYMENT FOR HOSPITAL-ACQUIRED INFECTIONS

The act prohibits hospitals and outpatient surgical facilities from seeking payment for any increased costs they incur as a direct result of a hospital-acquired condition identified as nonpayable by Medicare according to federal law (see BACKGROUND). This applies regardless of the patient's insurance status or sources of payment (including self-pay), except as otherwise provided by federal law or PA 09-2, 8.

That state law requires the DSS commissioner to amend the Medicaid state plan to indicate that the approved inpatient hospital rates it pays for Medicaid-eligible patients are not applicable to hospital-acquired conditions that the Medicare program identifies as “nonpayable” (also referred to as “never events”) in accordance with a 2005 federal law to ensure that hospitals are not paid for these conditions.

Under this act, “hospital” means an acute care hospital subject to the federal inpatient prospective payment system. An “outpatient surgical facility” is an entity, individual, firm, partnership, corporation, limited liability company, or association, other than a hospital, providing surgical services or diagnostic procedures for human health conditions that include use of moderate or deep sedation, moderate or deep analgesia, or general anesthesia, as these levels are defined by the American Society of Anesthesiologists or by another professional or accrediting entity recognized by DPH.

IMAGING SERVICES

The act prohibits specified health care providers from charging patients, insurers, or other responsible third-party payors for performing the “technical components” of CAT scans, PET scans, and MRIs if they, or someone under their direct supervision, did not actually perform the service. The prohibition applies to physicians, chiropractors, podiatrists, naturopaths, and optometrists.

Under the act, radiological facilities and imaging centers must directly bill the patient or third party payor for their services. They cannot bill the practitioner who requested the service.

BACKGROUND

Hospital-Acquired Conditions

The federal Deficit Reduction Act of 2005 required the federal Medicare agency, beginning October 1, 2008, to limit payments to hospitals for preventable medical errors that result in serious consequences for patients. Since then, the Medicare program has identified selected costly or common conditions that it considers to be reasonably preventable by following evidence-based guidelines. Medicare will not pay a hospital for any increased costs it incurs as a result of one of these events occurring (i. e. , treating a condition that was not present when the patient was admitted to the hospital). Medicare continues to pay for the physician and other covered items or services needed to treat the hospital-acquired condition.

The following conditions have been identified:

1. object inadvertently left in after surgery;

2. air embolism;

3. blood incompatibility;

4. catheter-associated urinary tract infection;

5. pressure ulcer;

6. vascular catheter-associated infection;

7. surgical site infection (chest infection) after coronary artery bypass graft surgery;

8. certain types of falls and traumas;

9. surgical site infections following certain elective procedures, including certain orthopedic surgeries and bariatric surgery for obesity;

10. certain manifestations of poor control of blood sugar levels; and

11. deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.