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Democratic state leaders said Friday that managed-care organizations are flouting the law when they refuse to release information about how they administer the $700 million HUSKY insurance program for poor children.Wednesday Superior Court Judge George Levine said the managed-care organization’s argument that they don’t carry out a “government function” when they get $700 million from the state Department of Social Services’ Medicaid program is “absurd.” Click here to read the New Haven Independent article on Levine’s decision.To add insult to injury, the lack of service the 317,000 residents enrolled in the program receive is abysmal, Majority Leader Christopher Donovan, D-Meriden, said. He said a study commissioned by DSS found only 26 percent of new HUSKY enrollees received calls back from a doctor’s office to set up an appointment, 74 percent did not receive calls back. This means “74 percent were denied services and we’re paying $700 million for this lack of service” Donovan said.
In his decision Levine reasoned that managed care “is simply, insurance” and “No potential insured would purchase a policy without knowing the benefits offered.” He went onto explain that “because the quality of an MCOs participating providers may be affected by the level of its provider fees, a recipient cannot intelligently compare competing MCOs without access to those provider fees.” Donovan said the legislature will look at changing the system back to a state-based model where the state reimburses the doctors for the visit instead of the private contractor. Legal aid lawyers have continued to argue the governor has the power to force the Department of Social Services under its current contract to produce the documents, even without the Freedom of Information Commission lawsuit. Gov. M. Jodi Rell’s spokesman David Dearborn said Friday that the governor’s office continues to press DSS to ask the contractors for the information.In fact Thursday the Department of Social Services reissued its request for information from the three MCOs Anthem Blue Cross Blue Shield, Community Health Network, and Health Net of Connecticut.The context of the letters reads: “In light of the Superior Court’s decision in the above-referenced matters, I am renewing my previous requests for documents responsive to the two Freedom of Information requests that prompted these court cases. Specifically, these were requests submitted by Kari Hartwig (gastroenterology and cardiology provider rates) and Barbara Hunt (drug rejection data). Copies of those requests, along with subsequent clarifications that were provided on behalf of the requesters, are attached hereto. In addition, I am renewing my previous request for documents responsive to a June 26, 2006 Freedom of Information request for all documents, from June 8, 2006 to the present time “referring or relating to the standards or criteria” which your HUSKY A managed care organization or any of its subcontractors use “in deciding requests for prior authorization for any goods or services submitted on behalf of HUSKY A enrollees.” A copy of that request and all subsequent clarifications that were provided are also attached hereto. Finally, since the trial court dismissed your appeal, I am renewing my previous request, in accordance with the order by the Freedom of Information Commission requiring the Department of Social Services to amend its contracts with the managed care organizations to include the language mandated by section 1-218 of the Connecticut General Statutes, that you sign the previously submitted contract amendment.”
