Behavioral Health Oversight Committee

Quality Management & Access Work Group

Meeting Summary: April 4, 2005

(Next 2 meetings at Rushford: 4/11 @ 1-2:30PM & 4/18 @ 3:30-5PM)

Present: Dr. Davis Gammon (Chair), Mark Schaefer (DSS), Arnie Pritchard & Aurele Kamm (DCF), Paula Armbruster (YCSC), Elizabeth Semeraro (Health Net), Susan Niemitz (Hartford BH), Heather Gates (CHR), Linda Pierce (VOI), Linda Russo (Wheeler), Beresford Wilson (HUSKY family representative).

Work Group Process and Timelines

_ Paula Armbruster was designated by consensus chair proxy to facilitate meetings in Dr. Gammon's absence.

_ Recommendations timeline: The DSS/DCF anticipates completing the ASO contract by the end of April. The QA work group recommendations for the 1^st year ASO performance targets need to be submitted to the agencies & BH Oversight Committee by April 21.

_ The Human Services Research Institute (HSRI) Performance Measurement Project: coordination or integration with the work group activities was discussed. Dr. Schaefer thought HRSI could present the project status and criteria to the work group in a month.

_ Data Flow: Dr. Gammon requested that the agencies develop a data flow sheet, identifying what data will be collected by whom, what reports will be generated by whom, where will the reports be reviewed and how will they used. Arnie Pritchard (DCF) will do this with input from Mark Schaefer.

_ A DMHAS representative to the Work Group has not yet been identified.

_ Dr. Gammon requested staff facilitate a phone conference with other Work Group chairs to review each work group's recommendations for the ASO contracts after 4/13/05.

Dr Gammon asked each member provide a list of 10 indicators that could be used to monitor the ASO's performance in the first year. Indicators should be as specific/operational as possible. It's not necessary to propose an actual quantitative target (e.g., 80%). The Departments will figure out what benchmark data are available and how to collect the data going forward. These will be the focus of the work discussions on 4/11 & 4/18.

Discussion Points

¬ Notice of Action for denials, partial denials of services: Aurele Kamm spoke of this from the DCF perspective as she has reviewed these for DCF committed HUSKY members. Ms. Kamm stated while it is useful to know the number of approved VS denied services, the number of appeals filed, number of denials sustained, it is important to get at the number of the initial denials that were ultimately overturned. If the majority of the denials are overturned on appeal, then can look at the "whys" of the denials.

¬ There needs to be transparency for the authorization criteria per level of care and inclusion of an ASO core contract item that addresses provider communication/education on this. Since this is related to the Coordination of Care WG recommendations related to standards for provider information required for Prior Authorization per level of care, staff will send this WG the Coordination of Care meeting summary of 4/4.

¬ A provider & consumer satisfaction survey will be done; the ASO would provide analytical support. The QA work group and BH Oversight Committee could recommend questions/topics be included in both satisfaction surveys in year one that would contribute to ASO performance targets in year 2 and beyond. While there are no standard benchmarks for a provider survey in HUSKY, each MCO is required to do a consumer survey, which may contain common indicators.

¬ How & who would measure infrastructure growth & provider network/capacity: The agencies will have a `mystery shopper' project to assess wait times for appointments in the first year. The agencies will assess reasons for delays for any service (capacity issues), identify regional service gaps and set specific goals for improvement. The ASO would work with local area services, perhaps providing TA, while the state would contract with the local service entities.

o What is the ASO role in ensuring access (i.e. post institutional care)? DSS said an ASO Performance Target could include X% of child/adults connected to post institutional OP services within a specific time period.

o Who is responsible for network development, especially for alternative services? DSS stated DCF, responsible for clinical services, contracts for home based services, therapeutic mentoring, respite, EMPS. DSS will contract with other providers.

¬ There is a need for future discussion of the role of school systems in the BH restructured system, as non-linkage of schools in the BH process may result in longer inpatient stays and/or access barriers to community services.

Revised Sample List of Year One Implementation Targets