Feds Penalize Hospitals For Inflection Rates

The federal government is penalizing more than 700 hospitals across the country for having high rates of hospital acquired infections. In Connecticut, 14 hospitals are facing the penalty and consequently losing millions of dollars. The Patient Protection and Affordable Care Act includes provisions intended not only to improve access to healthcare but also to improve healthcare itself.  According to the law, hospitals that do the worst get penalized and lose one percent of their Medicare payments over the course of the year.

In Connecticut, 45 percent of hospitals in the program were penalized – among the highest rates in the nation. However, some hospitals that were penalized, including Yale-New Haven Hospital, argue that the federal government’s specific data set has problems. Yale’s leaders believe that hospitals like theirs have improved and that the data does not take important factors, such as hospitals with higher rates of less healthy patients, into account. However, unless lawmakers decide to strip the provision in the health law, the penalty will remain and come back again next year.

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Tenet No Longer In Talks To Acquire CT Hospitals

Tenet Healthcare Corporation will no longer be entering into Connecticut to acquire five hospitals, according to a statement released by Tenet and Gov. Malloy. Both sides have failed to come to an agreement and have ended negotiation talks. The news comes after Tenet and the Malloy Administration promised in January to revive the deals. Tenet has spent two years trying to make the acquisitions, which included Waterbury, St. Mary’s, Bristol, Manchester Memorial, and Rockville General hospitals. In a statement, Malloy said “the environment for both providers and state governments is complex and rapidly changing. Unfortunately, the issues that separated us simply could not be overcome.”

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Tenet CEO: Plans To Acquire CT Hospitals Could Be Revived

The CEO of Tenet Healthcare, Trevor Fetter, has sent a letter to Connecticut Governor Dannel P. Malloy saying that he is open to coming back to the negotiating table to acquire five Connecticut hospitals if the state loosens some of its regulatory requirements. Several conditions would have to exist for Tenet to reconsider acquiring Waterbury, St. Mary’s, Bristol, Manchester Memorial, and Rockville General hospitals. Fetter emphasizes that any conditions placed on its deals must apply equally to all hospitals in the state as well as other organizations interested in buying a hospital in Connecticut – whether they are nonprofit or for-profit operators. Malloy sent a letter earlier this month urging Fetter to send a Tenet representative to meet with Mark Ojakian, the governor’s chief of staff, to negotiate a deal. In December, Tenet pulled out of its plan to acquire five Connecticut hospitals after state regulators issued 68 conditions on the purchase that would bar layoffs and price increases for at least five years.

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Tenet Abandons Plans To Acquire Connecticut Hospitals

Tenet Healthcare has officially pulled the plug (for now) on its acquisition of four Connecticut hospitals. Tenet notified government officials that it would not continue its pursuit of buying Waterbury Hospital, St. Mary’s Hospital, Bristol Hospital, and Eastern Connecticut Health Network to convert them from non-profit hospitals to for-profit ones. Tenet cites the extensive list of proposed conditions as reasons for pulling out of the four transactions. Tenet’s decision has widespread impact on Connecticut’s healthcare industry and also creates a political problem for Governor Dannel P. Malloy and his state legislature. Connecticut hospitals were depending on Tenet for capital to remain economically viable long-term and now may need to find other partners or ask the state legislature for funding increases.

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HUSKY Health Primary Care Increased Payments Policy

Under the ACA, Medicaid has increased its payments to equal the 2013 and 2014 Medicare fee for certain primary codes when billed by an eligible primary care provider, who has submitted a valid attestation to the Department of Social Services. However, the ACA requirement ends with dates of service January 1, 2015 and forward. 

The Connecticut General Assembly has appropriated funding within the Medicaid biennial in order to continue increased primary care payments for dates of service beyond December 31, 2014. The Department is establishing a policy for primary care increased payments; this policy will be referred to as the HUSKY Health Primary Care Increased Payments Policy. The Department is also revising the list of codes eligible for an increased payment.

Click here for more information from the Connecticut Department of Social Services regarding the HUSKY Health Primary Care Increased Payments Policy.

30,000 CT Residents Could Lose Coverage Or Subsidies Next Month

Access Health CT’s acting CEO recently said that as many as 30,000 customers of the state’s health insurance exchange could lose coverage or see a drop next month in the subsidies used to discount their premiums due to not submitting the information needed to verify their coverage. The changes taking effect on December 1 could affect more than 10 percent of Connecticut residents who signed up for private insurance or Medicaid through the exchange. The exchange has implemented a process to adjust or cut off coverage for those who have not addressed discrepancies related to their income or citizenship information they provided when applying for coverage. Although the federal health law allows people to receive coverage and financial assistance based on the information they provided, they must provide documentation to support it within 90 days. If verification is not received, the amount of financial assistance the person receives may be reduced or coverage may be cut off. The exchange will check the information of the 30,000 customers over the next week.

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Medicaid and the “Recovery” of the Assets

Starting January 1, thousands of Connecticut residents will become eligible for Medicaid but for some recipients, it will come with a price.  The aptly named “recovery” of the assets of Medicaid recipients means that when those Medicaid beneficiaries die, the state will be able to dock their estates to repay the medical costs it covered.  In Connecticut, a person’s age and the type of services they receive will determine whether they or their estate will be required to repay.  The Medicaid program in Connecticut known as HUSKY has multiple parts and will expand to include HUSKY D because of the ACA. HUSKY D will cover poor adults who don’t have minor children.

For people who enter into HUSKY D, the state can recover assets under three circumstances:

  • “If a person is aged 55 and older, the state can recover the cost of any medical care that was covered by HUSKY D. The state would seek repayment from the estate of the person when he or she dies, but not while the person is alive, according to the state Department of Social Services.
  • If a person is in a nursing home or receives other HUSKY D coverage for long-term care, the state can recover costs from the person’s estate after death, regardless of the person’s age when the costs were incurred, according to DSS.
  • If a person of any age receives Medicaid coverage for injuries sustained in an accident and receives a financial settlement related to the accident, the state can seek reimbursement for the accident-related bills while the person is alive.”

If the Medicaid patient dies or leaves behind a surviving spouse or child under 21, the recovery would be delayed until the spouse dies or the child turns 21.  The rules will apply to people who become eligible for HUSKY D as of January 1 and people who have joined the program since it was established in April 1, 2010.  However, there a separate rules for people who were part of the program formerly known as SAGA medical (state administered general assistance) which was converted into HUSKY D in April 1, 2010. People who received SAGA medical coverage will be subject to more state recovery efforts.

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