Medicaid Managed Care Council
Behavioral Health Oversight Committee
Legislative Office Building
Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-0023
Senator Chris Murphy Jeffrey
Meeting: Wednesday Feb. 16, 2 PM in LOB RM 1D)
Mark Schaefer (DSS) described the current BH delivery system model, contrasting
this with the proposed restructuring of the delivery of BH services.
Currently the DSS administers the HUSKY A (child/parent) and HUSKY B
(child only) programs with four capitated managed care organizations (MCOs) The
MCOs have direct contracts with BH subcontractors for management of BH services
to this population. The State does not have a direct contractual link to the BH
subcontractors and thus limited influence over the scope of their work and
BH restructuring plan will:
Eliminate the BH subcontractors and
the BH dollars will be removed from the MCO capitation rates.
The population served will include
HUSKY A & B as well as DCF voluntary service clients.
· The DSS and DCF will procure an Administrative Service Organization (ASO), which will be responsible for administering clinical management and member and provider service aspects of the BH program. The ASO will receive a fixed administrative fee and will not be “at-risk” for the payment of behavioral health services.
· The involvement of families in the delivery of BH services is a significant change from the current model.
The Role of the ASO includes:
Coordinate behavioral health
services for HUSKY A & B with the current MCOs
Member services, which include
facilitating access to services and provider relations.
Care management, which includes the
service authorization process and intensive care management for members with
complex behavioral health needs, ensuring access to appropriate levels of
services, evaluation of the success of treatment and connection to other
services if current treatment is not effective.
Development of a quality management
plan including member satisfaction assessment and access, service utilization
reports and measurement of key treatment outcomes.
Dillon asked if depression screens for DCF-involved children would be part of
the quality program, using established predictors for at-risk children.
Dr. Schaefer stated that specific quality programs haven’t been
identified but this is doable with the new system in combination with the
current HUSKY MCO system. The ASO will markedly improve management of
information. It will be able to
identify DCF children and youth currently in the system, evaluate
multidisciplinary exams and service follow up. These goals should be attainable
within the existing privacy rules because covered members are currently within
the managed care system.
is not the role of the ASO:
Contract with provider:
the DSS maintains the CT Medical Assistance Program (CMAP) network.
If providers are already enrolled in this, they will need to be
re-credentialed to provide services in the Kid Care model.
Providers do not need to be enrolled in the CMAP if their services are
solely provided through direct DCF grants.
Pay claims: service claims will be
paid through the DSS Medicaid Management Information System (MMIS), which is
currently administered by Electronic Data Systems (EDS).
Residential services will continue to be paid, based on rates set by DCF,
through their LINK system.
key areas that elicited most of the Committee discussion focused on the ASO
selection process, total monetary value of the ASO contract, and funding of the
restructured BH program. The Co-Chairs stated that the questions raised in the
meeting reflect both the Committee’s fulfillment of oversight responsibilities
as well as addressing key pre-requisites that are needed to make this model
work. The basic underlying focus
remains on the families and children.
Dr. Schaefer announced that Value Option, Inc (VOI) was the bidder chosen to negotiate the contract for the ASO with DSS and DCF. The selection process involved review of the responses to the RFP that included the scope of providing services in the KidCare program, organizational references that included any 5 year litigation history, a cost proposal to meet the RFP requirements and justification of those costs, preventing a low bid that could be insufficient to do the work outlined in the RFP.
review had two phases:
Scope of the work in meeting the
RFP objectives, which was a “blind” process so that there was an unbiased
evaluation of responses to this part of the RFP.
Review of the organizational
qualifications, which included the name of the respondent
and an advocate provided input into the RFP development and parents and an
advocate were part of the core review team that evaluated the proposals and made
the award recommendations.
Murphy asked DSS to comment on legislative concerns on the selection of this
bidder, not the fairness of the process. The
Senator stated that considerable information was available on the difficulties
CT and other states have had with this entity.
As a public policy issue, legislators discussed with the Governor the
importance of State review and consideration of any bidder’s business
experience (in-state or outside the state) as part of the selection process.
In response to the Senator’s comments and Committee questions about
external due diligence in the selection process, Dr. Schaefer stated the RFP
review included a review of bidder contracts and references for programs similar
to the CT model. Dr. Schaefer noted
he would have to confer with agency legal staff to determine what level of
detail (i.e. research on VOI CT contracts) could be disclosed. Dr. Schaefer
stated that VOI has had considerable public sector experience with a history of
successes and hard lessons and believes the state will benefit from VOI’s
Schaefer noted that while he could not speak to the discussions of the core
selection committee (he did not participate), the departments believe in the
fairness of the process while at the same time recognizing public trust issues.
The State acknowledges the importance of these issues in this reform.
Schaefer noted that managed care organizations like most business tend not to be
inherently good or bad, and that their performance has much to do with the
scope, structure and oversight of their contracts. Dr. Schaefer stated the State
believes the BH restructuring model, contract parameters and diligent State
oversight will allow this business to perform well.
Gammon noted that the focus on quality is an important step in developing a good
system of care.
ASO will be paid a monthly fixed amount for administrative services only. In
this structure, there would be no financial incentive to withhold services.
In response to Rep. Dillon & Sen. Murphy’s questions, Dr. Schaefer
stated that final ASO payment would be negotiated between the VOI and the DSS
& DCF. It is expected the contract amount will be in the single
digits (million). The contract
amount will include the direct costs of providing the scope of administrative
services plus the potential for a 7.5% profit (7.5% of the administrative
fee) for the vendor. The ASO’s
administrative performance determines the profit amount in that a positive
performance would result in financial reward (profit) while a poor performance
would result in a loss of the profit percentage as well as potential additional
financial sanctions. Sen. Murphy
noted that it is the legislature’s responsibility as policy makers to
understand and evaluate where dollars are spent on administration and services.
Murphy requested information on the amount of dollars that will be available for
the carve-out of BH services. While
recognizing that this is part of the negotiations with the DSS and the MCOs, the
Senator asked if there is a certain threshold that is being considered within
the MCO capitated rates. Sen.
Murphy stated this is a key concept for the restructuring going forward.
It is important to know available program funding upfront before further
defining this complex system of care. Insufficient
dollars could lead to revisiting the whole process.
Dr. Schaefer stated questions
related to the budget for BH under the carve-out might best be considered after
the release of the Governor’s budget, February 9th.
The DSS has information from Mercer, the actuarial consultant, on BH
spending although there are some grey areas.
Mr. Walter asked if the Mercer data could be shared with he Committee.
Dr. Schaefer stated this is the starting point of DSS/MCO negotiations
and cannot be disclosed at this time. Rep. Dillon asked that the method be
Dr. Gammon asked if there are
contingency plans if the system should be under-funded.
Dr. Schaefer stated that if funding were inadequate for the restructured
BH system, the agencies would pursue appropriate funding levels; however
aggressive service management under this system is not an option to deal with
Gedge asked what the timing of the DSS/MCO negotiations are with other
negotiations that involve the overall MCO rates and other service carve-outs.
The DSS and MCOs are currently negotiating the contract extension beyond
Jan. 31, 2005. Dr. Schaefer stated
he could not say when the final MCO rates and BH carve-out negotiations would be
final. The proposed pharmacy
carve-out has been eliminated; the dental carve-out status is still being
discussed (at the Jan. 21, 2005 MMCC meeting it was announced that there will
be no carve-out of dental services).
Rep. Sayers asked about the time
period for the contract; Dr. Schaefer stated the contract is for 3 years with
two, 1-year extensions. He believes that the contract has mechanisms to allow
the State to either assume critical functions or terminate the contract if there
are serious deficiencies in the ASO performance but Dr. Schaefer will check into
this further and share these provisions with the Committee.
What are the savings projected for
the restructuring of BH services? Dr. Schaefer stated that while he cannot speak to the
Governor’s budget, neither DSS/DCF or OPM have suggested there would be any
savings associated with the reform, rather the agencies anticipate an initial
increase in service expenditures. The
system will reduce administrative expenses currently in the MCO/subcontractor
system through timely claims payment, eliminating duplicative provider
credentialing processes and reducing authorization requirements for outpatient
services (i.e. fewer than 25 visits will require registration but are not
expected to require PA). What is
not known is if community-based services will be more costly compared to the
extended hospital and subacute stays currently experienced in the program.
Mr. Wilson asked how the reform
would impact families. Drs.
Schaefer and Andersson outlined key areas that included identification of
clients who remain unstable in the system and through ASO intensive care
management connect children and families to Community wraparound services that
will now be available on a fee-for-services basis to the population served in
the reform. Family involvement in all aspects of the process is prominent.
The implementation period is
anticipated during April-July 2005, pending the ASO contract negotiations. There
may be an initial phase-in of populations in the restructured program. (DSS
stated at the Jan. 21 Medicaid Council meeting that the carve-out would probably
begin implementation in September-October 2005).
Will VOI have a presence in CT?
The ASO has and will be required to continue to have a CT-based
operations and the ASO will be required in contract to establish local
relationships with the systems of care.
Committee Representation on DSS/DCF Clinical Management Committee
Chairs noted the importance of having practitioner representation as well as
family/advocates on the DSS/DCF Clinical Management Committee and requested that
the agencies consider this. Both DSS & DCF commented that providers
participated in the 2002 committees that developed guidelines for the program.
The Committee Provider Advisory Work Group will also give practitioners input
into clinical management guidelines.
Committee Work Groups
Committee members agreed to the following work groups that will include
participants from the Core Committee as well as participants at large:
Provider Advisory WG on clinical
Access to services/quality
Coordination of care that focuses
on the integration of primary care & BH services as well as the MCO/ASO
coordination of services such as transportation and pharmacy, which will remain
the responsibility of the MCOs.
A transitional work group will be
organized later in the process, focusing on issues related to the change of the
service delivery model (i.e. claims run-out and continuity of clinical services
responsibilities of each work group will be briefly defined and sent out to the
broad participant group. Interested participants can email Council staff as to
which work group(s) they are interested in joining.
NAME For the Restructured BH Program
Sen. Murphy noted that the “KidCare” name is confusing, as it was initially applied to the DCF children’s BH reform and now applies to the BH carve-out that includes HUSKY parents/caregivers. There was some support in retaining the “Behavioral Health Partnership” name, which encompasses families and children. Suggestions are welcomed and can be sent them to the Council staff, Committee Co-chairs or DSS/DCF.
BH Oversight Committee February meeting has been rescheduled from February 9th
to February 16, 2 PM at the LOB RM 1D.