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Conn. Delegation Presses for Review of Decision for Moratorium on Enrollment in Medicaid Managed Care Organizations

January 30, 2009
Press Release

Contact: Adriana Surfas (DeLauro) 202-225-3661

Bryan DeAngelis (Dodd) 202-224-5372

Erika Masonhall (Lieberman), 202-224-4041

Brian Farber (Courtney), 202-225-2076

Kristen Bossi (Murphy), 202-225-4476

Elizabeth Kerr (Himes), 202-225-5541

Washington, DC – Connecticut’s Congressional delegation, in a letter to Center for Medicare and Medicaid Services (CMS) Chief Operating Officer Charlene Frizzera, expressed concern about the agency’s approval of Connecticut’s plan to enroll Medicaid and State Children’s Health Insurance Program (HUSKY A and B) recipients into two Medicaid Managed Care Organizations (MCOs). These managed care organizations threaten to disrupt and limit access to care for this vulnerable population because of inadequate provider networks. Last November, Connecticut’s Democratic Congressional delegation called on the CMS to issue a moratorium on the enrollment because of these same concerns.

“While we recognize that the state had made progress in enrolling providers and hospitals in the MCO provider networks by that point [the time of CMS's approval], we are disturbed by reports that CMS may have overlooked network adequacy for specialists in approving the contracts. Specifically, at the January 9, 2009 monthly meeting of the Connecticut Medicaid Managed Care Council, a representative from the CMS Boston regional office implied that CMS had not conducted any analysis of whether the specialist networks of the new MCOs were adequate.,” the lawmakers write in the letter.

“At a time of drastically increased pressure on state and federal budgets, it is particularly concerning that CMS has approved a change that could simultaneously reduce access to care and increase state and federal taxpayer expenditures,” the letter continues. “We ask you to take all necessary steps to ensure uninterrupted access to needed care for our constituents. We understand the significant responsibilities facing your office at this time and thank you in advance for your timely attention to this matter.”

Below is the text of the letter.

January 29, 2009

Charlene Frizzera

Chief Operating Officer

Center for Medicare and Medicaid Services

Department of Health and Human Services

Hubert H. Humphrey Building

200 Independence Avenue, S.W.

Washington, D.C. 20201

Dear Ms. Frizzera:

We write to draw your attention to the Centers for Medicare and Medicaid Services’ (CMS) approval under the previous administration of Connecticut’s plans to enroll tens of thousands of Medicaid and SCHIP (“HUSKY A and B”) recipients into two new Medicaid Managed Care Organizations (MCOs). We are concerned that inadequate plan provider networks threaten to disrupt access to care for this vulnerable population.

As you know, Connecticut’s Department of Social Services (“DSS”) recently contracted with three MCOs to cover what is now about 345,000 HUSKY A and B recipients who have been enrolled either in one of two non-risk plans run respectively by Community Health Network of Connecticut (CHNCT) or Anthem (Blue Care Family Plan), or in the non-risk Traditional Medicaid program run directly by DSS. We appreciated the actions that CMS took after our November 17, 2008 letter expressing concern over the enrollments that were taking place, specifically, the notification to DSS that adequate provider network targets must be met as a condition of approving the state’s 1915(b) waiver extension.

On December 30, 2008, CMS approved the new managed care contracts, stating that DSS had verified “compliance with all of the regulations applicable to managed care organizations (MCOs) found in 42 CFR Part 438, including the requirements for adequate network capacity in sections 438.206(b) and 438.207….” While we recognize that the state had made progress in enrolling providers and hospitals in the MCO provider networks by that point, we are disturbed by reports that CMS may have overlooked network adequacy for specialists in approving the contracts. Specifically, at the January 9, 2009 monthly meeting of the Connecticut Medicaid Managed Care Council, a representative from the CMS Boston regional office implied that CMS had not conducted any analysis of whether the specialist networks of the new MCOs were adequate. This was notwithstanding CMS regulations which provide that a state Medicaid agency must ensure a sufficient specialist network, and must demonstrate that such adequate networks exist before “[e]nrollment of a new population in the MCO,” 42 C.F.R. § 438.207(c)(2)(ii).

We recognize that DSS has claimed that access to specialists under the new MCOs will nevertheless be assured through a requirement that the MCOs pay for out-of- network providers. However, we are concerned that this is an inadequate response to the need to have sufficient specialist networks in place, because of the additional burdens it places on patients and out-of-network providers. We understand that DSS tracks complaints about access to specialist services, and we request that your agency pay special attention to this issue.

In addition to our concerns about access to care for these vulnerable beneficiaries, we also note that the fiscal impact of these changes remains unclear, and may in fact cost more than the status quo. At a time of drastically increased pressure on state and federal budgets, it is particularly concerning that CMS approved a change that could simultaneously reduce access to care and increase state and federal taxpayer expenditures.

The December 30, 2008 letter to DSS noted that, “if at any time a plan's network becomes inadequate, the plan must cease enrollment, the State must immediately notify CMS of this occurrence, and provide documentation as to how the matter will be resolved.” In light of this requirement and the above-stated concerns, we ask you to take all necessary steps to ensure uninterrupted access to needed care for our constituents.

We understand the significant responsibilities facing your office at this time and thank you in advance for your timely attention to this matter.

Sincerely,

CHRIS DODD

US SENATOR

JOE LIEBERMAN

US SENATOR

ROSA L. DeLAURO

MEMBER OF CONGRESS

JOE COURTNEY

MEMBER OF CONGRESS

JOHN LARSON

MEMBER OF CONGRESS

CHRIS MURPHY

MEMBER OF CONGRESS

JAMES A. HIMES

MEMBER OF CONGRESS