Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”
The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.
Eighteen Connecticut hospitals will lose 1 percent of their Medicare payments in 2016 as a penalty for comparatively high rates of avoidable infections and other complications, such as pressure sores and post-operative blood clots, according to new federal data. The Centers for Medicare & Medicaid Services (CMS) announced this month that 758 of the nation’s hospitals – about 23 percent of all eligible hospitals — would be penalized for patient safety lapses in the second year of the Hospital-Acquired Condition Reduction Program, which was mandated by federal health care reform. The penalties are based on rates of infections and other complications that occurred in hospitals between 2012 and 2014. The 18 hospitals in Connecticut include larger urban institutions, such as Yale-New Haven, Hartford and Bridgeport hospitals, and smaller hospitals, such as Manchester Memorial and Windham. They are among hospitals in the worst performing quartile nationally on patient-safety measures including the frequency of central-line and catheter-related infections, post-operative sepsis and accidental laceration.
In the last 10 years, the average number of serious deficiencies cited in nursing home inspections in Connecticut has dropped by 50 percent, while reported nurse staffing levels have risen, and reports of residents injured by lapses in care have declined, federal data show. But a new report from the U.S. Government Accountability Office (GAO) questions whether those measures – many of them self-reported by nursing homes – accurately reflect improvements in nursing home care, or instead are due to deficiencies in reporting and oversight. The GAO notes that the average number of consumer complaints per nursing home actually has climbed in 30 states since 2005, including a 20 percent increase in Connecticut. The ability of the federal Centers for Medicare & Medicaid Services (CMS) to assess nursing home quality “is complicated by various issues with these data, which make it difficult to determine whether observed trends reflect actual changes in quality, data issues, or both,” the GAO said. The agency said that self-reporting of some of the data is among the problems that could undermine CMS’s much-touted Nursing Home Compare program, which rates nursing homes on a ‘five-star’ scale and is intended to help guide consumers’ decisions.
Federal officials have fined Paradigm Healthcare Center of New Haven $63,700 for several lapses in care that included one case of a resident’s wound deteriorating so badly that 50 maggots crawled out of the person’s toe. The resident had the toe amputated in September, and state records show there was no evidence that the resident’s wound had been monitored weekly – as required – between July 17 and Sept. 3. Helen A. Mulligan, a spokeswoman for the Centers for Medicare and Medicaid Services in the Boston regional office, said Friday that CMS imposed the fine of $4,550 a day – or $63,700 – against Paradigm from Oct. 14 to Oct.
The Centers for Medicare and Medicaid Services has backed off a controversial plan that would have changed the way it determines Medicare coverage for advanced prosthetics – a plan critics said would have affected tens of thousands of veterans nationwide. CMS had issued a draft proposal, known as a Local Coverage Determination for Lower Limb Prostheses, that critics feared would limit access to prosthetics for amputees, including veterans. Following a public comment period that ended in August and a review of those comments, CMS on Monday announced it would not finalize the draft policy. “Both CMS and its contractors have heard concerns about access to prostheses for Medicare beneficiaries,” according to a statement provided by CMS spokeswoman Helen Mulligan. CMS said it would convene a work group in 2016 to examine the lower limb prostheses issue.