Connecticut Judge Orders HMOs To Publicly Release Information On Reimbursements For Medicaid Beneficiaries’ Care

December 6, 2006 – 11:45 am | posted in Medical Malpractice, Medicare

Three HMOs that administer managed care plans for Connecticut’s Medicaid program must make public the rates they pay providers and other information, state Superior Court Judge George Levine ruled on Wednesday, the Hartford Courant reports. The HMOs — Anthem Health Plans, Healthnet of Connecticut and Community Health Network of Connecticut — receive nearly $700 million in state money to administer health care coverage for 311,000 beneficiaries in Connecticut’s Husky Medicaid Plan. Some advocacy groups maintain that few physicians will accept Medicaid beneficiaries because reimbursements from the HMOs are too low. Earlier this year, the HMOs appealed an order by the state Freedom of Information Commission to disclose their reimbursement rates and information on how they provide prescription drugs to low-income residents. The HMOs said they should not have to release the information because it involves trade secrets. Levine on Wednesday said HMOs must release the information because the plans in this case act in the place of the state Department of Social Services and, therefore, are subject to the state Freedom of Information Act, which requires public disclosure of government records. Levine wrote in his decision that the department, which has contracted with the plans since 1995, “is obligated to provide quality care under its managed care program.” He added, “Whether quality care is provided depends in significant part on the quality of the medical providers participating in the program. Without question, the level of compensation paid to a provider is a significant factor in the provider’s decision whether to participate in the program. As a result, if providers’ fees are too low to attract quality providers, quality care will not be provided.” According to the Courant, “nobody expects the information to become available soon.” Levine has said he believes the dispute likely will continue for years and ultimately reach the state Supreme Court (Waldman, Hartford Courant, 11/30).

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