1. health and fitness

March 31, 2015
Roderick L. Bremby
Commissioner
Department of Social Services
55 Farmington Avenue
Hartford, CT 06105-3730
Kate McEvoy
Health Services Director
Department of Social Services
55 Farmington Avenue
Hartford, CT 06105-3730
Dear Commissioner Bremby and Director McEvoy:
The Connecticut State Medical Society (“CSMS”), on behalf of its more than 6,000 physicians
and physicians in training, along with the undersigned medical societies, medical groups,
medical institutions and medical professionals, write to you to raise significant concerns
regarding the proposed dramatic cuts in reimbursement for obstetric, facility obstetric, and
related services in the Husky program. These draconian cuts will have an immediate and
irreversible impact on access to care for expectant mothers in the Medicaid program in
Connecticut. Further, these reductions, many of them 20% to 40% cuts in payment for care
delivery, will further erode the already fragile safety net that the undersigned parties have tried
to build up over the last decade.
At the outset, we raise the issue that the majority of the undersigned parties were unaware of
any notice of these proposed cuts until last week when the fee schedule itself was published.
We recognize the existence of a February 2015 bulletin, but there is no record of delivery or
receipt of this bulletin to any of the impacted physicians. Providing a week or less to update
billing and claims processing systems is not sufficient to ensure correct submission of claims
and correct claims payment.
We raise these concerns at a time when more individuals in Connecticut, including expectant
mothers, are covered under Medicaid as both state and federal laws have sought to increase
coverage of care for this vulnerable population. Unfortunately, these cuts will have an
immediate and adverse effect on access to care delivery services for this population. We are at
a crossroads in health care and faced with an emerging population of young mothers that need
greater access to prenatal, perinatal and maternal care services. Reducing reimbursement for
imaging, preventive, and delivery services will provide significantly fewer choices for expectant
Roderick L. Bremby
Kate McEvoy
Page 2
March 31, 2015
women as to where they receive pre- and post- natal care. Patients will be forced to travel 20
or 30 miles or more to seek care in this state, and many patients in this population simply do
not have the means or ability to travel significant distances to receive the frequent care that is
required throughout a pregnancy.
In our initial analysis, it appears that the dramatic reductions in reimbursements for critical care
delivery services will result in significant reductions to those presently providing these services
to this vulnerable population. Many of these practices and institutions can ill afford these cuts
and the financial viability of continuing to participate in the state Medicaid program will be
called into serious question.
In addition, while the February 2015 bulletin indicates that the rates would be tied into the
2007 Medicare rate, the previously mentioned analysis of the proposed cuts seems to suggest
otherwise as many of the rates are significantly less than the Medicare rates that were in effect
in Connecticut in 2007. In fact, many of the rates noted in the revised fee schedule appear to
be almost half as much as the indicated rates for payment in Connecticut. CSMS and the
undersigned parties ask the Connecticut Department of Social Services (DSS) to delay the
implementation of the proposed rate reductions until such time as discussions can take place as
to the impact of these proposed cuts on payment for delivery services. The undersigned parties
believe that these cuts will have a dramatic, profound, and detrimental impact on access to
care for this state’s vulnerable expectant mothers and their children. We ask for an immediate
meeting with you to further discuss these proposed cuts that jeopardize access to care for
expectant mothers who rely on Medicaid as their sole source of coverage. Providing coverage
for medical services is simply not enough when access to care has and continues to be
eviscerated through historic cuts in reimbursement for delivery-related services for expectant
mothers.
[Signature page to follow]
Roderick L. Bremby
Kate McEvoy
Page 3
March 31, 2015
Sincerely,
Connecticut State Medical Society
Connecticut Chapter of the American Congress of Obstetricians and Gynecologists
Connecticut Academy of Family Physicians
Connecticut Medical Group Management Association
Yale Medical Group
Women’s Health Connecticut
Adam F. Borgida, MD, Chair, Obstetrics and Gynecology, Hartford Hospital
William Cusick, MD, Chairperson Department Obstetrics and Gynecology, St. Vincent’s Medical
Center
Daniel Gottschall, MD, FACOG, Chief Medical Officer, Women’s Health Connecticut
Michael E. Ivy, MD, Chief Medical Officer, Bridgeport Hospital
Michael O’Reilly, Chairman, Department of Obstetrics and Gynecology, Griffin Hospital
John F. Rodis, MD, EVP and COO, St. Francis Hospital and Medical Center
cc:
Honorable Dannel Malloy, Governor
Honorable Nancy Wyman, Lieutenant Governor
Senator Terry Gerratana, Co-Chair Public Health
Representative Matthew Ritter, Co-Chair Public Health
Senator Marilyn Moore, Co-Chair Human Service
Representative Catherine Abercrombie, Co-Chair Human Service
Senator Martin M. Looney, President Pro Temp
Senator Len Fasano, Senate Minority Leader
Representative Brendan Sharkey, Speaker of the House
Representative Themis Klarides, House Republican Leader
Senator Beth Bye, Senate Chair Appropriations
Representative Toni Walker, House Chair Appropriations
Members: Council on Medical Assistance Program Oversight (MAPOC)
Robert Russo, MD, CSMS, President
David Emmel, MD, CSMS Legislative Chair
Susan Richman, MD, CT ACOG Chair
Mark DeFrancesco, MD, ACOG President-Elect
Mark Schuman, CAFP and CMGMA, Executive Director
Ronald Vendor, MD, Yale Medical Group, Medical Director
Kenneth Ferrucci, CSMS Senior Vice President