AN ACT IMPLEMENTING THE RECOMMENDATIONS OF THE LEGISLATIVE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE CONCERNING MEDICAID-FUNDED EMERGENCY DEPARTMENT VISITS.

The PRI committee authorized a study of emergency department (ED) use by Medicaid clients and its impact on the state Medicaid budget to determine if reducing ED use and providing care in other settings would achieve cost savings. Concerns had been raised about the frequent use of hospital EDs by Medicaid recipients, and whether there is adequate access to community health care that would prevent and divert clients from the ED.

The study concluded that while overall ED use among Medicaid clients is high, it is extremely varied with more than half of those enrolled in Medicaid in 2012 not visiting an ED at all. Medicaid ED costs for that year totaled about $229 million. There is a small segment of the Medicaid population who frequently visited the ED in 2012 – 4,671 clients had 10 or more visits, and 865 clients had 20 or more visits with 196 of these clients visiting at least five different hospital EDs. The committee approved a final report on February 6, 2014, which included 13 recommendations. This bill implements many of those, with a special focus on preventing and reducing the frequent use of the ED.

Substitute language was developed to clarify that cost-sharing requirements are optional and not mandatory, removed some of the detailed functions for intensive case management, deleted language that would have required DSS to seek a waiver for 12-month continuous Medicaid eligibility, while still mandating DSS seek federal approval for the continuous eligibility. Substitute language also changed follow-up care after an ED visit to occur within 14 days rather than 30 days, and clarified that the Administrative Services Organization responsible for behavioral health connect Medicaid clients with a behavioral health provider and not a primary care provider.

● Department of Social Services -- Kate McEvoy, Director of Health Services for the Medical Assistance Programs and Dr. Robert Zavoski, Medical Director for Medicaid – Appeared with written testimony. DSS supports parts of bill, and objects to others. Specifically, DSS disagrees with putting primary care provider names on clients' Medicaid cards because the department states: a) clients change providers too often, and b) other providers will not treat clients because they may think they will not be reimbursed if they are not named on the card. DSS also disagrees that ASO should attribute clients to primary care provider soon after they are enrolled in Medicaid instead of ASO examining claims history of client and attributing clients to primary care provider as is current practice. DSS was denied an 1115 Medicaid waiver and so DSS cannot apply for waiver regarding 12-month continuous Medicaid coverage for low-income adults, and stated the department is assessing the fiscal impact of providing this continuous eligibility option. (Substitute language removed the requirement to seek a waiver, but kept the requirement to seek federal approval for 12-month continuous eligibility for adults)

● Department of Mental Health and Addiction Services: Commissioner Rehmer - Appeared with written testimony. DMHAS supports most of the bill, but objects to one provision, requiring that intensive case management teams meet weekly. (This provision was deleted in the substitute.)

● State Office of Healthcare Advocate: Victoria Veltri submitted written testimony on behalf of the agency in favor of the bill.

● Connecticut Hospital Association (CHA) submitted written testimony only. CHA supports parts of bill, and objects to others. CHA Disagrees with mandating a cost-sharing requirement in ASO contracts for ED use by Medicaid clients. (Substitute language changed this to keep current statutory language which allowed but did not mandate cost sharing).

CHA also had concerns with one of the intensive case management functions on “follow-up care plans” which might be developed by an ASO versus a “clinical care plan” that would be developed by a licensed physician. (Substitute language removed the words “follow-up” from the bill.)

CHA also had concerns with Section 4(f) regarding implementing policies and procedures in advance of adopting regulation. (This section is technical – PRI did not recommend this and therefore did not change it in substitute language.)

● Laine Taylor: DO of Connecticut Council of Child and Adolescent Psychiatry, appeared with written testimony. The council supports parts of the bill, including 12-month continuous Medicaid eligibility, but would like definition of telemedicine modified to exclude use of telephone or facsimiles, and stated that the rates paid should be equivalent to face-to-face reimbursement.

● Connecticut Oral Health Initiative: submitted written only. The group supports the bill's provision for 12-month continuous Medicaid eligibility.

● Peter Struble, Ex-Fire Chief of Wallingford: Appeared but did not submit any testimony. Would like emergency medical technicians to be part of the discussion in the area of primary and preventative care, and describes a new model, community paramedicine.

● Dr. Karen Jubanyik, Connecticut College of Emergency Physicians (CCEP), appeared with written testimony. CCEP is in favor of bill provisions for intensive case management for Medicaid clients who frequently use the emergency department but believes that primary or behavioral health care follow up should be quicker than 30 days. (Substitute language changed this to 14 days)

CCEP also supports provisions of bill that address intensive case management for Medicaid clients who visit the ED and who have behavioral health and/or substance abuse problems.

While some of the testifiers noted concerns or objections to parts of the bill as noted, there was no testimony received opposing the bill.

Bill No.:	HB-5378
Title:	AN ACT IMPLEMENTING THE RECOMMENDATIONS OF THE LEGISLATIVE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE CONCERNING MEDICAID-FUNDED EMERGENCY DEPARTMENT VISITS.
Vote Date:	3/13/2014
Vote Action:	Joint Favorable Substitute
PH Date:	3/4/2014
File No.: