Office of Health Care Access
At a Glance
MARY M. HEFFERNAN, Acting Commissioner
Established – 1994
Statutory authority – C.G.S. Chapter 368z
Central office – 410 Capitol Avenue,
Hartford, CT 06134
Recurring operating expenses – $3,028,946
State statutes empower the Office of Health Care Access (OHCA) to gather and analyze significant amounts of health care data, thus positioning the agency as an informed contributor to state health care policy deliberations. OHCA’s role as policy advisor and information resource permits the agency to assess and report on health care access, cost and delivery within the state and to assist policy makers and the industry in crafting and sustaining a superior health care system for all Connecticut residents.
OHCA contributes to the overall financial well-being of the state’s health care delivery system by analyzing acute care hospitals’ financial condition and by assisting the Department of Social Services in administering the Disproportionate Share Payments to Hospitals (DSH) Program. The DSH Program protects access to hospital care for the uninsured and underinsured by providing financial assistance to hospitals that provide a disproportionate amount of such care.
OHCA encourages health system development by overseeing and coordinating statewide health system planning and by administering the Certificate of Need (CON) program for hospitals, other types of health care facilities and for all imaging equipment and linear accelerators costing over $400,000. The CON program encourages health care industry leaders to consider collaborative efforts and multiple perspectives in developing an effective, responsive health care system. The program also provides an opportunity for consumer, provider and payer participation during the application process. The CON process also helps limit excess costs to the evolving health care system by preventing unnecessary duplication of health care technology, services, and programs.
The State continues to be the largest purchaser of health care in connecticut, spending close to $4 billion each year -- nearly one-third of the state’s overall budget. The functions administered by OHCA enable State policy makers to monitor the health care system, identify areas of potential need, coordinate State policy and actions, formulate solutions for meeting identified needs, and fully leverage the State’s significant buying power in a coordinated manner to control cost and increase quality.
OHCA uses numerous vehicles to inform the public, legislators and the health care industry of important health care issues and trends. OHCA’s recently upgraded website now offers current information about the agency and its activities, access to complete OHCA reports and publications, Certificate of Need decisions, and hospital budget and utilization data. The site also includes statutes, regulations, legal notices, relevant forms, and links to relevant national, federal, state, and organizational health care-related websites. The address is: www.ohca.state.ct.us.
In order to address its statutory requirements and fulfill its mission, OHCA needs timely access to accurate information. In recent years material inaccuracies were detected during OHCA’s review of hospitals’ audited financial data. The increasing frequency of revised budget filings from hospitals prompted OHCA to question the sufficiency of procedures that hospitals use in preparing and attesting to their DSH data. OHCA worked to refine the required procedures to be prepared and attested to by each hospital’s independent public accountant (auditor) for its DSH data, beginning with Hospital Fiscal Year 2001 (October 1, 2001 – September 30, 2002). OHCA now requires an Auditor’s Report that is consistent with the accounting standards established by the Financial Standards Accounting Board (FASB) and specific auditing and reporting standards of the American Institute of Certified Public Accountants (AICPA). OHCA requires each Auditor’s Report to:
· Base materiality on the amounts used to calculate that hospital’s portion of future DSH payments;
· Disclose whether the amounts reported are prepared in accordance with generally accepted accounting principles (GAAP);
· Disclose any exceptions to GAAP reporting; and
· Provide specific disclosures as notes to DSH data.
The implementation of these changes should eliminate the need for OHCA to revise incorrect DSH data amounts from data submitted by hospitals. Also in state fiscal year 2001, $85 million in enhanced Medicaid or DSH program payments made to acute care hospitals resulted in over $42.5 million in federal matching funds coming to Connecticut. Further, hospitals benefited from the suspension of the sales tax on hospital bills for the two years ending June 30, 2003. That suspension is saving the hospitals more than $110 million per year in taxes.
Through a grant from the Robert Wood Johnson Foundation, OHCA is leading the ACHIEVE initiative to identify and pursue opportunities for the State to leverage its purchasing power when procuring health care benefits for State employees and retirees, HUSKY members, and individuals receiving fee-for-service Medicaid benefits. The ACHIEVE interagency workgroup is developing a plan to pursue the joint purchase of dental benefits, an effort that is expected to leverage the attractiveness of the State employee health care contracts in exchange for improved dental care access and services provided to HUSKY and Medicaid participants -- without compromising existing benefit programs.
In the fall of 2001, OHCA’s ACHIEVE staff created a Results Management Database to help the agency monitor current health care coverage trends and results, and provide other Agency policy makers with data needed to make key financial decisions related to health care benefits and coverage.
A grant awarded in 2001 by the U.S. Health Resources and Services Administration to OHCA provided the agency with an opportunity to develop a realistic plan to increase health insurance coverage in Connecticut to 100 percent of its citizens. OHCA made significant progress on its objectives in 2001-2002; from August to October 2001, OHCA fielded a household survey to obtain detailed information on Connecticut’s uninsured population. Analysis of this information has been ongoing and will be completed in summer of 2002, along with a comprehensive report on study findings. In early 2002, OHCA further developed models for a premium assistance/employer-based subsidy option for Connecticut’s HUSKY plan and began to frame out recommendations for federal action to support State efforts to provide health insurance for the uninsured.
In 2001, OHCA, in concert with the Office of the Attorney General, embarked upon and concluded a statutorily mandated review of the first proposed sale in Connecticut of a non-profit hospital to a for-profit entity. State law governing the sale of non-profit hospitals mandates that both offices approve the agreement before it can become final. In order to approve the conversion of Sharon Hospital from a not-for-profit hospital to a for-profit hospital, OHCA was required to find that the affected community would be assured of continued access to affordable health care; that the purchaser was committed to providing health care to under/uninsured populations; and that safeguard procedures were in place to avoid a conflict of interest in patient referral. In its review, the Office of the Attorney General was required to determine that the sale price is the equivalent to the fair market value of the hospital; that the process leading up to the agreement was free from any conflicts of interest; and that the charitable assets of the hospital would be preserved. The proposal received approval from both offices in late 2001 and early 2002. Both approvals included conditions on the sale that would serve to protect the public interest, the viability of Sharon Hospital, and maintain an integral piece of Connecticut’s health care delivery system.
The re-engineered Certificate of Need (CON) program continues to protect the health care system and provide savings in system costs while significantly simplifying procedures and reducing time and paperwork for applicants and the agency. During the 01-02 state fiscal year, OHCA performed 98 full CON reviews or modifications and 111 CON determinations, an increase over the prior year of 18 percent and 7.8 percent, respectively. During this period, OHCA also performed more than 75 inquiries and/or reviews to determine whether providers with previously authorized CONs were operating in full compliance with the terms and conditions of those CONs.
Since 2001, OHCA has facilitated the efforts of the Connecticut cardiovascular Consortium (C3), a unique statewide collaboration that includes OHCA and numerous clinical and academic cardiologists who broadly represent Connecticut hospitals’ wide range of cardiac services. The C3 steering committee published an article about the consortium in the November 2001 issue of Connecticut Medicine. A C3 operations committee has prepared a grant proposal for a study of cardiac data. This proposal will be submitted to potential funding organizations in July 2002.
· Published in March 2002, OHCA’s 2001 Annual Report To the Governor and the General Assembly more fully describes agency achievements, objectives, and initiatives.
· In accordance with Section 19a-670, Conn. Gen. Statutes, OHCA’s Annual Report on the Financial Status of Connecticut’s Short-Term Acute Care Hospitals was published in June 2002.
· OHCA continues to prepare its own Affirmative Action Plan, which was submitted in February 2002, and approved in April. This plan complies with Conn. Gen. Statutes’ Secs. 46a-70 through 46a-78.
· OHCA continues to maintain a registry of health care facilities that have sought exemption from CON review in accordance with Sec. 19a-639a, Conn. Gen. Statutes. Eligible facilities that fail to register annually remain subject to CON.
· Due to an extension granted to hospitals by the national Centers for Medicare and Medicaid Services for filing annual provider cost reports, data necessary to complete the Graduate Medical Education report as required under Public Act No. 99-172 were not available as of June 30, 2002. OHCA will publish its report for the 2001 year once this data is fully available.