http://www.medlaw.com/healthlaw/Medical_Records/8_3/hmo-subject-to-state-free.shtml
HMO Subject To State Freedom Of Information Act In Connecticut
The state Freedom of Information Commission ruled this week that four private health maintenance organizations that run state-funded Medicaid health networks must share some of their documents with the public. On Thursday, state officials sent new contract amendments to that effect to the HMOs.
The ruling could help shed light on HMOs that will receive $625 million in state money this year to serve more than 300,000 clients. However, legal appeals could keep the HMO information under wraps for some time.
The Commission ruled Wednesday to endorse the recommendations of one of its hearing officers in ruling that Anthem Blue Cross and Blue Shield of Connecticut, Community Health Network of Connecticut Inc., Health Net of Connecticut Inc., and WellCare of Connecticut Inc. perform a governmental function in operating the publicly financed networks and that documents related to their performance are subject to the state's Freedom of Information Act.
The case began when Kari Hartwig, an assistant clinical professor at the Yale School of Public Health, sought information from the state Department of Social Services about the rates HMOs pay cardiologists and gastroenterologists. The social services department contends that the private firms did not perform a governmental function and were not subject to the state's Freedom of Information Act.
But the state agency dropped this position in the last week and on Wednesday alerted the Freedom of Information Commission of the change just before the commission began its meeting.
Gov. M. Jodi Rell was apparently behind the sudden turnaround.
David Dearborn, a Rell spokesman, said Rell's chief counsel, Kevin Rasch, met last week with DSS Commissioner Patricia A. Wilson-Coker and both decided to drop the department's position that the HMOs are not performing a government function.
"On one level, the governor's office directed DSS to drop that argument," said Dearborn. "On the other hand, the commissioner is on board with that." He said the department, at Rell's urging, already had made an effort to supply the requested information.
Matthew Barrett, a spokesman for DSS, said "the final decision followed consultation with the governor's legal office." Barrett said a flood of additional freedom of information requests could mean added costs for the state and the HMO contractors.
The Hartwig case was heard with another related request by three legal aid organizations seeking information from the HMOs on their prescription drug programs for Medicaid patients. Hearing officer Victor Perpetua will issue a second recommendation related to that case, although the issues are similar.
Hartford attorney Daniel Klau, Hartwig's lawyer, said the ruling would have little short-term impact because it will probably be appealed by the health insurers.
Attorney Sheldon Toubman of New Haven Legal Assistance Association, called the ruling significant because it would give the public access to information related to the performance of the Medicaid contract, would reveal how HMOs do business in general and could apply to other state contractors.
