Health Net, one of the three companies that manages the state’s Medicaid program, appealed the trial court’s decision that forces it to disclose provider fees, drugs lists, and prior authorization request information to the state.Health Net also filed a motion Tuesday that asked the court to delay enforcement of the decision while its appeal is pending. Last month, Superior Court Judge George Levine upheld two Freedom of Information Commission decisions that found the HMO’s perform a “governmental function” and therefore are subject to public accountability. The HMO’s argued the information requested contained proprietary business data and didn’t fall under freedom of information law. Majority Leader Christopher Donovan, D-Meriden, called the appeal a “delaying tactic.” He said, “The HMOs are acting like rogue business partners who are hiding the books.” The state pays the HMOs $700 million to administer the program.
He said the Department of Social Services along with Gov. M. Jodi Rell should stand up and actively oppose the HMO’s appeal. But “So far, Governor Rell has not put the weight of her office behind this fight,” Donovan said.New Haven Legal Aid attorneys, who intervened in the lawsuit, have pointed out that the Department of Social Services declined to join the effort to hold the HMOs accountable under FOIA. During the litigation, DSS provided the HMOs with an annual increase nearly twice the amount appropriated by the state legislature, despite their lack of accountability. But to their credit, DSS did send out letters to the three HMO’s the day following Levine’s decision and again requested the information the companies had previously refused to provide, such as standards used in deciding prior authorization requests, drug rejection data, and provider fees. Shortly after the court’s decision, legal services attorney Sheldon Toubman noted that the prescription drug data also is critical to determine the extent of access problems. Toubman stated:We know needed medications not on an HMO’s preferred drug list require prior authorization and are routinely denied to children at the pharmacy for lack of prior authorization. We know, anecdotally, that this often results in emergency room visits and medical complications. What we don’t know is the frequency with which these rejections occur. This ruling will help us get this data, already in the HMOs’ possession.Donovan has 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” he said. “We are currently unable to see if taxpayer money is being spent wisely,” Donovan said. “What kind of stewards would we be if we blindly allowed these HMOs to spend hundreds-of-millions of state dollars?”
