The Human Services Committee received an earful Thursday regarding the state’s Medicaid program which at the moment is outsourced to four managed care organizations. At the moment the state pays more than $700 million to the four MCO’s to run the system that insures over 300,000 low-income families. Three of the four companies refused to disclose information to the state about provider rates and prescription drug lists. Majority Leader Chris Donovan, D-Meriden, has said this type of behavior is unacceptable. “We pay $700 million for this service and we don’t know where it’s going, but we know the services aren’t being delivered,” he said. A superior court judge decided in November that the managed care organizations provide a governmental function and should disclose the information that health care advocates requested. But then earlier this month at the request of the MCO’s the judge delayed enforcement of his decision. Meanwhile, the state through the Department of Social Services will have to decide what to do with the MCO contracts, which expire on June 30, 2007. Newly appointed DSS Commissioner Michael Starkowski said Thursday that he will make compliance with Freedom of Information requests a priority in the upcoming contract negotiations with the MCO’s.
Wellcare, one of the four MCO’s involved in the lawsuit, has agreed to comply with the department’s request for information through an amendment to its contract. Earlier this month in court Judge George Levine upheld the MCO’s motion to stay the decision because the contract provided no legal recourse for the companies. The companies would have been at the mercy of DSS to file a complaint with the Freedom of Information Commission on their behalf. Levine opined that instead of going through endless litigation over the terms of the contract the legislature could mandate the MCO’s to disclose the information without having to negotiated it through a contract. Starkowski said it’s the legislature’s prerogative to do that if they like. He said he met with the four MCO’s last week and told them his number one priority in the upcoming contract negotiations will be compliance with FOIA. He said the MCO’s may request minor modifications or reject the amendment. What happens if they walk? If one MCO terminates their contract with the state the other MCO’s don’t have the ability to carry the load, he said. Starkowski said he was not sold on the idea of a Primary Care Case Management system proposed as a pilot program by health care advocates. What’s a PCCM?A recipient of the PCCM would choose a Primary Care Provider (PCP) who acts as their “medical home”. The PCP is responsible for managing their care including providing preventive health services, coordinating care, and, in some states, acting as a gatekeeper to specialty services. Starkowski said the state has tried the PCCM model in the past and it failed. But just like managed care PCCM has been met with different experiences in different states. He said “I think that we need to acknowledge that in spite of some entirely valid and troubling access concerns, as borne out by the mystery shopper survey, HUSKY has delivered a high volume of services.“HUSKY is another name for the state Medicaid system administered by the four MCO’s. Attorney General Richard Blumenthal said “we have to face the clear fact that the present system is broken.” Blumenthal said the mystery shopper survey that found about 74 percent of calls to doctors in the network were not returned. “Medical care delayed is medical care denied,” Blumenthal said. He said when someone requires medical attention time is crucial. New Haven Legal Aid Attorney Sheldon Toubman said the MCO’s have had 11 years to work out the problems in the system. Toubman said the state should set up a pilot PCCM system. The critical issue is the MCO’s have the unfettered right to set the provider rates, which they don’t have to disclose to the state under Levine’s stay of his decision, Toubman said. The MCO’s have argued the provider rates include trade secrets and thus are not considered public information under the state’s Freedom of Information Act. Senator John Kissel, R-Enfield, asked if the MCO has unilateral control then what negotiating power does the state have?Starkowski said DSS has put together a prospectus to see if the state can’t attract more MCO’s to the program. He said its not always about provider reimbursement. He said sometimes doctors simply refuse to see patients who are notoriously late or frequently miss appointments. But in the end he said he remained open to any new ideas the state or the MCO’s may have to improve the delivery of services.