Connecticut
Medicaid Managed Care Council 
Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-8307
www.cga.state.ct.us/ph/medicaid

Meeting Summary

March 9, 2001

Present; Sen. Toni Harp (Chair), Rep. Vickie Nardello, Rose Ciarcia & James Gaito (DSS), David Guttchen (OPM), Gary Blau & Dorian Long (DCF), Jeffrey Walter, Barton Bracken, Dr. Wilfred Reguero, Dr. Edward Kamens, Janice Perkins (PHS), Patrick Carolan (BeneCare), Judith Solomon, Lisa Sementilli-Dann.

Also present: William Diamond (Benova), Martha Okafor, David Dearborn, Glendine Henry (DSS), Sylvia Kelly (CHNCT), Tejas Patel, Joan Morgan (FirstChoice/P-1), Dr. Robert Zavoski (CT AAP), Debra Brackett (Qualidigm).

Department of Social Services

Behavioral Health Vendor Status

James Gaito (DSS) reported on the BH vendor changes for PHS and Preferred One:

• ValueOptions is the BH vendor for PHS. The Department has reviewed the risk-based contract and there is a verbal agreement with PHS for the language changes required by DSS. The contract should be signed the week of 3/12/01.
• CompCare (Comprehensive Behavioral Health Care) will be the BH vendor for FirstChoice/Preferred One as of 4/1/01. The risk-based contract should be signed shortly. Currently CompCare is operating as an ASO for the month of March until the final contract is signed.

PHS Payment of Unpaid PROBH Claims

Janice Perkins (PHS) reported that PROBH will continue to pay the run-out claims on a weekly basis until the unpaid claims are resolved. This is based on an administrative agreement between PHS and PROBH. Payment to providers in January was $ 5,103,387 and February was $ 4,101,686. Payment for services ending 2/27/01 will be mailed early next week. ValueOptions has assumed responsibility for payment of services beginning March 1, 2001. An additional 500 providers, including hospital facilities have been added to the BH provider network and 2 SBHCs are applying to be part of the network. The transitional process with the new vendor includes an agreement for continuity of care for 60 days, based on the prior authorization.

The Council had requested a report on the percentage of clean/unclean claims still unpaid by PROBH. Ms. Perkins stated that PROBH is unable to provide this information. PHS will continue to report monthly to DSS on claims aging and payments. Council members requested the following from PHS:

• The process of PHS tracking of claims, the number of `unclean' claims returned to providers.
• Level of PHS assistance to providers with a pattern of difficulty in submitting claims with appropriate information for claims processing.
• PHS will request ValueOptions to provide reports that address the percentage of clean/unclean claims.

Jeffrey Walter requested a report on the money still owed to providers by PROBH. Ms. Perkins reported on the payments made. Ms Perkins stated that PHS takes seriously its responsibility to reconcile unpaid claims and requested providers communicate their concerns with PHS. Mr. Walter stated that it is now important to focus on reporting this information from PHS and the other plans and their vendors from this time forward. Identification of high percentages of `unclean' claims among certain services and provider groups will assist in more targeted, beneficial problem resolution. Dealing with rejected claims is labor intensive and costly for providers and managed care organizations.

Senator Harp thanked Janice Perkins, commenting that while it has not been easy for her to address these issues at the Council over the past months, she has done so with dignity. The changes PHS has made in the MCO/vendor contract is beneficial to the whole system.

Benova Report

William Diamond, Regional Director of Benova, introduced Curtis Pollen, recently appointed Operational Director at Benova. Mr. Diamond reported on the HUSKY A and B enrollment numbers:

• Since July 1998, enrollment in HUSKY A for those <19 years has increased by 18,000, increasing from 158,600 to 176,557.
• The number of adults in HUSKY A increased by 2800 since 1/1/01 when the adult expansion began. As of March there are 59,564 adults enrolled.
• HUSKY B enrollment has steadily increased with 8024 enrolled as of March 2001. The greatest number of applications comes from the mail or through phone application.

• 1053 are eligible but not enrolled because they did not choose a plan, often forgetting to follow through. Benova attempts to F/U by phone or mail. Rose Ciarcia stated there is time lag in the eligibility/enrollment report; a good portion does become enrolled within a month when they choose a plan. In income band 3, they must pre-pay the 1^st month premium before becoming enrolled.
• An additional 428 families are enrolled but not receiving services due to lockout for failure to pay premiums. A small number in Band 1 (no premiums) are in lockout because of delinquent premiums incurred in a higher income band prior to moving to band 1.
• Enrollment ethnicity varies more in HUSKY B than A in that there are more changes among Caucasians (decrease) and Black/Asian (increase) over the past year.

  Council discussion resulted in the following information requests:

• There is no way for families that have delinquent payments while in Band 2 or 3 to receive services when their income places them in band 1.

• The Department was asked to provide longitudinal data on the number of families that lose HUSKY B and enroll in HUSKY A, recognizing that some families will have obtained private insurance.
• The loss of 4000 HUSKY A enrollees in June was related to the timing of the end of the 12- month continuous eligibility period. While this will continue to occur, Rose Ciarcia stated it should not be as significant a drop as June 2000. Rose Ciarcia stated that the CT Community Health Initiative (CCHI), outreach contractors, will assist families with application assistance for initial enrollment and track families through the renewal period, offering assistance.
• Benova was requested to provide HUSKY Plus (physical and behavioral health) enrollment trends at the next meeting.

Presumptive Eligibility(PE)

The Department implemented PE in 10/00, beginning with four school based health centers (SBHC). Since late October:

• 31 SBHC and 23 Community Health Centers have signed on with DSS to participate in PE.
• Twenty-seven additional SBHC in New Haven, New London, Norwich and Groton began participation in PE 3/1/01.
• Eight Head Start sites have shown interest in participating and one has signed an agreement.
• Later in March, a meeting will be held for WIC, and Community Health Initiative contractors to consider participation as a qualified entity permitted to make PE determinations.

Council comments and recommendations regarding PE:

• Of the 747 families that have been granted PE, 247 (33%) have been enrolled in HUSKY. Rose Ciarcia stated DSS was disappointed in the low enrollment numbers but believe there are a number of applications pending.

• DSS noted that most PE qualified entities are doing outreach as well as PE.
• Judith Solomon suggested that every PE site be tied to an outreach site (CCHI) for HUSKY application follow-up. (PE provides 30-day eligibility for HUSKY services, during which time the family submits the full HUSKY application. )
• Martha Okafor (DSS) stated that the Department is exploring how to use the 15 CCHI contractors to connect children to HUSKY through completed application. The Department is looking at linkage of PE with the CCH Initiatives, based on locality and feasibility of this linkage.
• There is a bill before Human Services that allows DSS to eliminate the income verification associated with the HUSKY application. This self-declaration of income, which 13 states have adopted, would reduce one of the barriers in completing an application.
• Dr. Reguero commented that the WIC reorganization plan might result in a reduction of WIC centers. It is important that the State ensure that WIC services not be diminished. (No comment from DSS).

School System Integration in HUSKY Outreach Initiatives

David Dearborn (DSS Director of Marketing) reviewed the many faceted DSS HUSKY outreach initiatives (a copy of the report can be obtained from Glendine. Henry@po.state.ct.us). HUSKY is grounded at the community level with the Ct Community Health Initiative, a merger of prenatal care and Healthy Start with outreach, as the foundation. The adult HUSKY expansion, begun 1/1/01, has elicited a 53% increase in calls to INFOline and Benova. The Department has a web site for enrollment questions and a consumer fact sheet clarifying the adult coverage, complicated by the differences in the adult (150%FPL) and child (185%FPL) income eligibility guidelines.

Among the ongoing school based initiatives, two new efforts have been added:

• Include the 52 school system special education programs for HUSKY outreach
• Pilot of a health assessment record insurance information:

Glendine Henry (DSS) reported on this pilot with 14 of the 174 school districts. The goal of the pilot is to identify the families' insurance and provide an additional resource to school nurses and medical personnel to encourage families to apply for HUSKY. The Health Assessment record information is required for children in Kindergarten, 6, 7, 10 and 11^th grades. DSS will continue to work with school nurses to expand the addition of this question on the form to all 174 school districts.

Council members comments on the project:

• Judith Solomon observed that the wording of the items -"Medicaid Number" and "Health Insurance company/number" may be confusing to families as many families identify with their HUSKY insurance company rather than the Medicaid program. Ms Solomon suggested replacing "Medicaid #" with HUSKY. It is also important to link school nurses with CB outreach as the schools have limited resources for follow-up with the families.
• Rep. Nardello thanked DSS for persisting in what ended up being a time-intensive process. Rep. Nardello stressed that it is important to:

• Have the school nurses obtain insurance information from the parent, who is usually present when the form is returned to the school.
• Distinguish Medicaid (HUSKY) from other insurance on the form.
• Link school efforts with other outreach.
• Resolve the confidentiality issues with the schools, otherwise information collected cannot be used. Re. Nardello stated that in her experience, parents are often receptive to signing permission for information use when they understand how the information will be used.
• Rep. Nardello requested DSS report on the follow-up data on the 3000 school lunch application requests for HUSKY information at the next meeting.

Senator Harp thanked DSS for their work and stated that Ms. Solomon's suggestion is an excellent one, that of developing linkage with HUSKY outreach sites such as schools and the community outreach efforts.

Behavioral Health Outcomes Study Report

James Gaito provided an overview of the BH study that seeks to identify `what works' in the delivery of children's outpatient BH services. The study, begun in July 2001, is a collaborative study involving the Medicaid Council BH subcommittee, DSS, DCF, the BH provider community and advocacy representatives. A contract has been signed with Yale University. The study involves the collection of 4000 completed pre treatment (OTR) and discharge forms that include information about the changes in social and psychological functioning measured by the GAF score and other variable. Providers will be paid for the extra administrative work required by the study. The impact of variables such as family demographics, participation in treatment, type of facility providing the service and managed care policy on treatment outcomes will be measured.

Eight months into the study approximately 700 OTR forms have been submitted and 16 discharge forms, of whom half are unusable because of the inability to match the subject identifying number. Two issues appear to have slowed the project: provider concerns about client confidentiality and consent for release of information. Data will be reported in aggregate, without individual identifiers. (The Attorney General's office has reviewed the study with Yale and the Yale HIC did not require individual client consent). Commissioner Ragaglia has agreed to provide departmental blanket permission for release of information on DCF children.

Mr. Gaito stated that providers and MCOs have been working hard on a voluntary basis to implement the study. The response from some of the provider community has been disappointing. While providers in the urban areas list barriers to completion of the discharge form that include longer time spent in treatment and dropout clients that return after a month or more, the low OTR number speak to the low participation in the study. The study time line of 9 months was based on the data from MCOs and a large clinic on the average number of sessions (15-17). It was recognized that a smaller percentage of clients would be in treatment for longer and their data would not be included.

Jeffrey Walter, BH subcommittee co-chair, was appreciative of DCF's effort to reduce the consent barrier. The concern is that the extended study time because of low participation will render the study invalid. Mr. Walter requested the Council's help in determining what it will take to have the BH provider community participate in the study. Mr. Gaito noted that the agencies (DSS and DCF) are committed to the study, as it will provide valuable data toward the design of the new system.

Senator Harp expressed her concern and displeasure regarding the problems in completing the study, commenting that the constraints of the spending cap requires program funding decisions based on information about the efficacy of existing programs. Basic information about the current BH program is needed to support the funding decisions related to the new program. The Senator stated; "It is up to the BH community, health plans, DSS and DCF to move this study forward. If we cannot even complete this study, how can we institute a new BH system? To have only 700 (pretreatment) forms and only 16 completed data sets at this point in the study is unacceptable".

Rep. Vickie Nardello stated she agreed with Senator Harp: "We need cooperation for this study in order to have data that will guide policy decisions for the appropriate allocation of money toward programs. All providers and the two agencies need to work together to make this happen".

Subcommittees

The Behavioral Health subcommittee met in January, with the working group meeting monthly. The subcommittee has addressed the PHS/PRO payment issues, the BH Outcomes study and the DSS/DCF plans for KidCare including the impact of the moratorium of out-of-state residential placements.

The Council will meet Friday April 20^th at 9:30 in LOB RM 1D.