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Mass. regulators OK joint Caritas-Centene healthcare venture

By Kay Lazar
Globe Staff / March 13, 2009
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After more than a week of controversy, state regulators voted yesterday to accept a bid by a Massachusetts Catholic hospital chain and a secular health organization to provide health insurance to thousands of low-income residents.

The Connector Authority board, which oversees the Commonwealth Care program, voted unanimously in favor of the joint venture proposed by Centene Corp., a St. Louis-based health organization, and Caritas Christi Health Care Network.

The vote followed several closed-door sessions in which officials from Centene and Caritas, the minority partner in the joint venture, assured regulators that women will have "ready access" to family planning and reproductive services, an issue that sparked concerns from abortion foes and reproductive rights activists.

Among the written assurances are a pledge that medical staff operating under the Centene-Caritas insurance plan, known as Commonwealth Family Health Plan, will inform women of their healthcare options, including abortion. The insurers will also provide a toll-free customer service line, available around the clock, to inform women about where they can get contraception, sterilization, and other family planning services not offered in the immediate setting. In an emergency, a service representative will arrange transportation to the nearest appropriate facility, officials said.

The regulators promised to watch closely. "We will certainly monitor their performance," said Jon Kingsdale, the authority's executive director. "We will not allow them to start up or continue if they are not in compliance."

As a measure of the underlying tensions, four board members emphasized the need for oversight.

"I remain somewhat concerned about implementation," said Nonnie Burnes, state commissioner of insurance and a former Planned Parenthood board member. "I am willing to support this as long as we have some way to monitor this" in doctor's offices and other healthcare facilities.

The Connector Authority's vote of approval of the Centene-Caritas joint insurance venture prompted criticism from the Catholic Action League of Massachusetts, which described the deal as "a significant defeat for the prolife movement, inflicted not by secular society, but by the Catholic Church in Boston."

Cardinal Sean P. O'Malley issued a statement last night warning that he might block the venture if he is not persuaded that it conforms with church rules that bar Catholic hospitals from certain forms of cooperation with abortion and other procedures that the church considers immoral.

"While I appreciate the opportunity given to Caritas Christi to serve the poor through this agreement, I wish to reaffirm that this agreement can only be realized if the moral obligations for Catholic hospitals as articulated in the Ethical and Religious Directives of the United States Conference of Catholic Bishops are fulfilled at all times,O'Malley said. "To assure me that this agreement will provide for the integrity of the Catholic identity and practices of Caritas Christi Health Care System, I have asked the National Catholic Bioethics Center to review the agreement and to assure me that it is faithful to Catholic principles."

As the board was voting yesterday, researchers for NARAL Pro-Choice Massachusetts, an abortion rights group, were coincidentally conducting one of its routine phone surveys of hospitals to assure that all provide family planning services. In the survey, a NARAL representative posed as a rape crisis counselor and asked the hospital to provide emergency contraception to a rape victim, as required by 2005 state law.

A nurse at Saint Anne's Hospital in Fall River, a Caritas-owned facility, said, no, it was not required to do so if that violated the religious beliefs of the emergency room physician, NARAL's executive director, Andrea Miller, reported yesterday afternoon.

Six months ago, when NARAL conducted the same survey, two other Caritas-owned hospitals, St. Elizabeth's Medical Center in Brighton and Caritas Holy Family Hospital in Methuen, also said they were not required to provide the emergency contraceptives, according to NARAL. "This is a classic case study of why this access issue matters so much," Miller said.

"I am not saying that the Connector took the wrong vote," Miller added, "I am saying we now have to ensure that people have access to care, especially low-income people for whom these hurdles are especially onerous."

Officials for Caritas did not question yesterday's NARAL survey findings, but issued a statement that said the Catholic system is compliant with state laws.

"When a rape victim comes in, she is given a [Department of Public Health] sexual assault information packet, and after appropriate testing to rule out an existing pregnancy, the appropriate medications would be administered," the statement said. "We have trained our staff on this policy, and in light of this event, will reinforce this training."

In addition to the Centene-Caritas contract, state regulators accepted four other bids yesterday submitted by companies already providing coverage in the Commonwealth Care system, which insures about 165,000 residents.

After approving the new contracts, the board voted to avoid increases in monthly premium costs during the next year for residents in the program because of the severe economic environment. The vote means that many consumers who choose higher-cost plans in Commonwealth Care will pay less.

Officials said they were able to freeze costs to consumers without reducing benefits or shifting the costs, in part, because of a new competitive bidding process that allows bidders to share in the cost-savings they provide the state.

Kay Lazar can be reached at klazar@globe.com.

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