Human Services Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5297

Title:

AN ACT CONCERNING STATE-WIDE EXPANSION OF THE PRIMARY CARE CASE MANAGEMENT PILOT PROGRAM.

Vote Date:

3/18/2010

Vote Action:

Joint Favorable Substitute

PH Date:

3/2/2010

File No.:

SPONSORS OF BILL:

Human Services Committee

REASONS FOR BILL:

To expand the current primary care case management pilot program available to all HUSKY A clients to a state-wide basis. It is believed that moving to a PCCM model will save the state a significant amount of money.

Substitute language changes this program to a pilot that will first be introduced to the towns of Putnam and Torrington. Every 90 days, the Department of Social Services (DSS) is to expand the pilot to include two additional municipalities and will continue the expansion until the program is operational in each county of the state. DSS may seek a federal waiver to aide with this expansion, and will have to report on the expansion to the committees of cognizance on July 1, 2011.

RESPONSE FROM ADMINISTRATION/AGENCY:

Michael P. Starkowski, Commissioner, Department of Social Services, testified:

“The Department remains committed to developing HUSKY Primary Care, as the primary care case management pilot program is known. HUSKY Primary Care is being introduced gradually in target communities across the state according to the terms contained within the General Assembly's approval of the Department's 1915(b) waiver renewal of March, 2009. The requirement for an independent evaluation to be completed and reported to the committees of cognizance by July, 2010 was also included in the approval of the waiver renewal. The department has begun to have preliminary discussions planning for the evaluation and expects will be completed within the timeframe.”

“The Department of Social Services believes that it is premature to mandate statewide implementation of HUSKY Primary Care until the program is evaluated, the cost-effectiveness of the model in Connecticut is determined, and the additional resources necessary for the pilot's success are both measured and identified.”

Victoria Veltri, General Counsel, Office of the Healthcare Advocate, supports this bill and recommends that, “this bill be revised to include expansion of primary care case management (PCCM) to the HUSKY B and Charter Oak populations.”

NATURE AND SOURCES OF SUPPORT:

Sheldon Toubman, Attorney, New Haven Legal Assistance Association, testified:

“… moving to primary care case management (PCCM) will save more money, put care in the hands of those most able to coordinate it – the treating primary care providers – and provide a stable alternative to the ever-changing set of risk and non-risk corporate contractors which have moved in and out of the HUSKY program over the last three years. Unlike companies which will not hesitate to terminate a contract if it is not in their best interest, individual doctors coordinating care under PCCM are committed to their patients and are not likely to go anywhere. At the very least we need a statewide alternative to compete with the ASO [administrative services only]-administered model.” He stated that Oklahoma went from three Medicaid HMOs to statewide PCCM and saved millions of dollars for the taxpayers right away.

Attorney Toubman proposed the following amendment language:

“To hire an independent entity to administer PCCM…

To remove the onerous FOI requirement on individual PCCM providers…

To expand PCCM as an option to HUSKY Part B children and Charter Oak Health Plan members”

Ellen Andrews, PhD, Executive Director, Connecticut Health Policy Project, testified:

● “Other state Medicaid programs do not experience the same troubles as HUSKY. Very few Connecticut providers participate in the HUSKY program, but 95% of physicians in Maine participate in their Medicaid program. Maine pays their providers even lower rates than Connecticut does, but they administer their program through PCCM, not HMO's. When Oklahoma switched to PCCM in 2004, the state saved $85.5 million in medical costs in the first full fiscal year and the number of participating providers increased by 44%. Outpatient visits went up and emergency room visits went down.

● Connecticut needs an alternative to HMO-based administration for HUSKY. Without a viable alternative, both HUSKY families and taxpayers are held hostage to whatever rate increases, including administrative costs, the HMOs demand.

● DSS has repeatedly refused to remove the inappropriate and unnecessary requirement that PCCM providers agree to Freedom of Information constraints. This requirement is irrelevant and intimidating to providers and has served as a barrier to participation. Notably, providers in the HMO system are not subject to this requirement. When the two new HMOs complained that they needed to build their membership to be financially sustainable, DSS granted them default status until they reached their target. However, DSS has refused to grant a similar policy for PCCM.

● Perhaps our greatest concern is that, despite very low enrollment, DSS intends to go ahead with plans to evaluate PCCM for cost containment among other parameters by July 1st. Any evaluation at such an early stage of a program is unlikely to be valid. A premature evaluation could bias the result and inaccurately label the program a failure before it has a fair chance to reach its potential. We are especially concerned that DSS intends to employ Mercer to conduct the evaluation. Mercer derives a great deal of their business from HMOs across the country and certified the rate setting process that granted the HUSKY HMOs a 24% increase in 2008.

● DSS has had a year to implement this program and has failed. More intervention is needed. I urge you to consider:

1. Hiring an independent entity to administer PCCM.

2. Remove the HMO portion of the program by July 1st and on a regular basis going forward.

3. Require DSS to conduct a secret shopper survey of each HUSKY program annually.

4. Commission regular, independent audits of HUSKY program finances.

5. If DSS is again unwilling or unable to implement this law, create a Special Master for PCCM, appointed by and answering to the General Assembly, to oversee the program by 12/31/10.

Brandon Levan, CTHPP Fellow, Connecticut Health Policy Project, testified: “In the absence of any marketing of PCCM by DSS, community volunteers have been involved in an outreach program to encourage HUSKY providers and HUSKY A enrollees to sign up with the new PCCM program. Funding for these activities was provided by the United Way of Greater New Haven, the Connecticut Health Policy Project, New Haven Legal Assistance, and several generous individuals.”

Sharon D. Langer, Senior Policy Fellow, Connecticut Voices for Children, testified that that the following requirement be added: “PCCM should be supported by an administrative services organization for certain functions that primary care providers may find challenging to implement. Under federal and state Medicaid guarantees of “early and periodic screening, diagnostic and treatment” (EPSDT) services, primary care providers – particularly those in smaller practices – may find it difficult to arrange all of the EPSDT mandated services, such as transportation. An ASO can help facilitate such arrangements, as well as provide other back office functions for PCPs.

Robert Smanik, President and CEO, Day Kimball Hospital, testified: “The PCCM pilot is a model which fits squarely with the patient base and mission of their hospital. Expanding this pilot program will allow other hospitals, such as Day Kimball Hospital, to prove that this model can be very successful. The State's investment in this program can and will produce results if given the right opportunity.”

Also supporting this bill:

Domenique Thornton, Mental Health Association of Connecticut, Inc.

Gary Waterhouse, Executive Director, Connecticut Association of Centers for Independent Living (CACIL)

NATURE AND SOURCES OF OPPOSITION:

None expressed.

Reported by: Barbara DeMaio

Date: 3/25/10