BH Oversight Council

Waiver Status

Mark Schaefer stated the waiver amendment and agencies’ response to questions will be sent to the CT General Assembly Committees of Cognizance in the near future. Work on the ASO contract language continues, including defining standard reports, monitoring indicators and post implementation indicator.

Chair Comments

ü Future BH Quality Management & Access WG Role: Dr. Gammon stated the WG could review ASO indicators and state agencies progress as the BH restructuring moves forward. Dr. Schaefer noted that:

o The agencies anticipated that the WG would identify target measures, review the agencies’ operationalization of measures, including quantitative measurements that would be finalized in the negotiated contract by the agencies and VOI.

o The WG could either 1) recommend the target measures, leaving the specific performance target operational issues to the agencies with the WG review after the contract is completed, or 2) specify target parameters as part of the recommendations.

o The WG would contribute to the refinement of the indicator measures (from 200 to 50) that the agencies have contracted to HRSI to develop.

The work group agreed that the Work Group would focus on the ASO, state agencies and the EDS (DSS claims payer) reliability, while the full Committee would receive the monitoring ‘report cards’ and respond to both positive and problematic performance problems in the ASO and the state system.

The first year 7.5% incentive dollars will be tied to the 8 performance indicators, recommended by the WG and finalized in the DSS/DCF/ASO contract. Financial sanctions would be associated with the additional indicators (i.e. authorization time frames). ValueOptions commented that the goals are very positive; however the key is how they are operationalized. For example what baseline data and benchmarks are identified; the size of the provider network will influence how the ASO can fulfill responsibilities for follow up MH services; the methodology applied to the performance measures (i.e. HEDIS, NCQA, federal Medicaid reporting guidelines).

ü Specificity of performance indicators: WG participants wanted to identify some specificity to the recommended performance measures. The following page, the table outlines the discussion points on each of the 8 performance indicators and measurement considerations.

ASO Performance Indicator	Suggested Dimension	Comments
Timeliness in passing authorization data to fiscal agent; Timeliness in correcting authorization info errors; Accuracy in passing authorization data to fiscal agent; Accuracy in importing claims data from fiscal agent.	Timeliness = 24 hours	· The EDS payment cycle is 2 X month · VOI would send daily authorization files to EDS (*DSS to check on VOI frequency)* · VOI would review the provider error messages daily. In the SAGA BH, VOI recollects an average of 50 errors per file that has multiple records.
Provider Satisfaction with ASO performance at greater than “X” percent.	80-90 % In addition, consider these monitoring indicators: · PA match with EDS claims payments · Denied claims would trigger closer scrutiny for reasons for claims denial, using top denial reasons as ongoing ASO/EDS, provider review & interventions.	· Look to national benchmarks, as CT does not have a benchmark reference. · Key domains of survey: clear standards for PA/level of care, user ease and reliability of PA process including adult higher level of care PA, provider access to service PA status, congruency of initial PA & claims payment, ASO PA in accordance with treatment guidelines (i.e. not approving OP care inappropriately).
Member Satisfaction	80-90%	· Look to other states (i.e. Mass) for benchmark %. · Be clear on satisfaction focus: ASO customer services VS BH services satisfaction. · ASO, include factors such as courteous & helpful to member.
The ASO shall assure that appropriate treatment services are provided to a minimum of X percent of persons discharged from inpatient or residential care within seven (7) days of discharge date.		· Expect uniform application of local treatment care guidelines developed by the agencies’ clinical Committee & BH OC. · ID discharges to inappropriate care level (i.e. to OP when a higher CBS is indicated)
At least X percent of persons who are discharged from inpatient care or residential care will be receiving follow-up care at thirty (30) days following discharge.		· Baseline: current HUSKY data on follow up care following discharge. · Monitor ASO intensive case management implementation.
Reduction in Emergency Department utilization 9BH visits).	___ % Reduction of HUSKY baseline data/trend data of ED visits.	Expectation of ASO to impact ED use through: · Intensive CM (ED as a trigger) · PA for Intensive Home-based services (State responsible to have adequate network of IHBS). · Enhanced care clinics: has State qualified adequate # of these clinics.
Reduction in inpatient discharges subsequently readmitted within 30, 60, 90, and 180 days.		Identify national benchmarks (i.e. HEDIS)
Completion of Local Area Development Action Plans by 3/1/06		The ASO is responsible for recruiting providers of various levels of care, assessing service gaps by geographic areas, and develop an action plan to reduce gaps.

ASO Performance Indicator

Suggested Dimension

Comments

Timeliness in passing authorization data to fiscal agent; Timeliness in correcting authorization info errors; Accuracy in passing authorization data to fiscal agent; Accuracy in importing claims data from fiscal agent.

Timeliness = 24 hours

· The EDS payment cycle is 2 X month

· VOI would send daily authorization files to EDS (DSS to check on VOI frequency)

· VOI would review the provider error messages daily. In the SAGA BH, VOI recollects an average of 50 errors per file that has multiple records.

Provider Satisfaction with ASO performance at greater than “X” percent.

80-90 %

In addition, consider these monitoring indicators:

· PA match with EDS claims payments

· Denied claims would trigger closer scrutiny for reasons for claims denial, using top denial reasons as ongoing ASO/EDS, provider review & interventions.

· Look to national benchmarks, as CT does not have a benchmark reference.

· Key domains of survey: clear standards for PA/level of care, user ease and reliability of PA process including adult higher level of care PA, provider access to service PA status, congruency of initial PA & claims payment, ASO PA in accordance with treatment guidelines (i.e. not approving OP care inappropriately).

Member Satisfaction

80-90%

· Look to other states (i.e. Mass) for benchmark %.

· Be clear on satisfaction focus: ASO customer services VS BH services satisfaction.

· ASO, include factors such as courteous & helpful to member.

The ASO shall assure that appropriate treatment services are provided to a minimum of X percent of persons discharged from inpatient or residential care within seven (7) days of discharge date.

· Expect uniform application of local treatment care guidelines developed by the agencies’ clinical Committee & BH OC.

· ID discharges to inappropriate care level (i.e. to OP when a higher CBS is indicated)

At least X percent of persons who are discharged from inpatient care or residential care will be receiving follow-up care at thirty (30) days following discharge.

· Baseline: current HUSKY data on follow up care following discharge.

· Monitor ASO intensive case management implementation.

Reduction in Emergency Department utilization 9BH visits).

___ % Reduction of HUSKY baseline data/trend data of ED visits.

Expectation of ASO to impact ED use through:

· Intensive CM (ED as a trigger)

· PA for Intensive Home-based services (State responsible to have adequate network of IHBS).

· Enhanced care clinics: has State qualified adequate # of these clinics.

Reduction in inpatient discharges subsequently readmitted within 30, 60, 90, and 180 days.

Identify national benchmarks (i.e. HEDIS)

Completion of Local Area Development Action Plans by 3/1/06

The ASO is responsible for recruiting providers of various levels of care, assessing service gaps by geographic areas, and develop an action plan to reduce gaps.

The agencies will respond to the WG recommendations in about 3-4 weeks after submission.

Arnie Pritchard (DCF) had prepared a draft flowchart for the reporting data for the ASO as requested at an earlier meeting. Referred to the next meeting.