Meeting Summary: April 21, 2006
Next Council meeting: Friday May 12 @ 9:30 AM in LOB RM 1D

Present: Sen. Toni Harp (Chair), Sen. Edith Prague (Vice-Chair), Rep. David McCluskey, David Parrella & Rose Ciarcia (DSS), Auralee Kamm (DCF), Dorothy Lucas (Heath net), Thomas Deasey (Comptroller Office), Rev. Bonita Grubbs, Ellen Andrews, Drs Leonard Banco & Edward Kamens, Mary Alice Lee.
Also present: William Diamond (ACS), Robert Diaz (WellCare/PONE), Gail Digioia (Anthem), Lynn Childs (CHNCT), Nan Jeannero & Margaret Dickinson (Mercer Government HS Consulting), M.McCourt (Leg. Staff).

2005 HUSKY External Quality Review Audit: Nan Jeannero & Margaret Dickinson (Mercer)
(Click on icon to review report summary)

This report, the second year of a three-year reporting cycle, evaluates processes and outcomes within the HUSKY managed care organizations. This second year review focus included:

• Timeliness & access to services: breadth & depth of provider network, timeliness of services & entry into care and coordination of EPSDT (pg 12).
• 4 Performance Improvement projects (PIPS) (pg 20)
• 6 Performance measures: NICU admits/100 members, ED use/1000M, ED use by asthmatics, Inpatient readmission rates, Breast cancer screens, diabetic retinal exam (pg 29).
• Compliance with selected HUSKY B contract amendments (pg 17)
• Interventions to correct areas of non-compliance in the 2004 EQR report (pg 8).

Discussion:

ü The timeliness and access to services graph (pg 12) is a process measure reflecting MCO documentation of planning and assessment of provider network, considering special needs and utilization of population, not the adequacy of networks.
ü Overall plans had high rates for the 5 measures, with overall lowest percentage scores seen in “monitoring & results of appointment availability” processes.

o Anthem had high scores equal to other plans except in “monitoring appointment availability” (25% compared to 3 other plans @ 50%)
o CHNCT scores were comparable to other plans with the exception of “adequacy of provider network development plan” (50%),
o Health Net scored lowest of the 4 plans in 4 of the 5 categories with the exception of “monitoring appointment availability”. Their “network development plans”, based on contract, was < 5%; Anthem and PONE was 100%, CHNCT 50%.

ü In the performance measures, most of the recommendations from the 1^st audit were met; the monitoring issues are relatively easy to fix. Council asked that in future presentations national or other comparable Medicaid performance rates be included in order to interpret CT rates.

o Average NICU admits are over 10%, with a slight decline in 2004 from 2003 rates. CHNT has rates over 12%, a reduction from 2003 while WellCare/PONE increased over 12% in 2004.
o ED use decreased in 2004; Anthem and CHNCT have the higher rates. DSS was asked to choose a common reporting measure (i.e. per 1000 MM or per 1000 members) for the audits and the 6 month HUSKY data reports to allow comparisons across reports.
o Readmission rates slightly declined in 2004. In 2004 CHNCT had highest rate (1.2% compared to 0.8% average) and WellCare showed the greatest decrease (0.4%).
o MCOs need to look at improving diabetic retinal exams.

ü A communication process between the MCOs and the HUSKY B plus programs is present.
ü Performance Improvement Projects (pg 20) were reviewed; Health Net PIP reports were not available; the MCO expected to finalize the reports at the end CY 2005, beyond the audit deadline.

Mercer outlined the MCOs strengths in the quality improvement processes and outlined key recommendations for each health plan (pg 38). Mercer has received each MCO's Corrective Action Plans (CAP) and the 3^rd year of the cycle has begun. Rep. McCluskey thanked Mercer for this extensive and informative report.

State Administered General Assistance (SAGA) Program Report

The Chair of the Council had requested a report on Saga enrollment, revenues by service provider and service utilization patterns pre and post budgetary capped program funding in SFY 04. CHNCT assumed responsibility for non-hospital ambulatory services, pharmacy use, service access & network development, member outreach and care management while DSS retained financial responsibility for hospital inpatient, ED and clinic services. Since July 1, 2003 SAGA enrollment has increased by 5,347 enrollees (15%).

Summary of changes of services by visit/unit of service and revenue changes:

Department comments:

ü The decrease in Community PC and hospital clinic services was anticipated with the implementation of a managed care model under which primary care would be primarily delivered in federally qualified health centers (FQHCs).

ü Hospital ED/urgent care visits increased both in number of visits and number of individuals using the ED. Members with more frequent ED visits/FY increased in FY04/05. Summary of frequency of ED visits/enrollees:

Council discussion:

ü The SAGA population has proportionately more “high risk” clients with chronic health problems compared to the Medicaid HUSKY managed care clients; however ED use has been increasing in both programs. An important difference in the two “managed care programs” is non-integration of SAGA hospital-based services and CHNCT ambulatory services. Currently the ED/hospital related services are outside CHNCT's management; in fact CHNCT does not receive hospital-based service data for the SAGA clients. The DSS data warehouse will soon be able to provide CHNCT with client hospital-based services, which, if the data is timely, would allow CHNCT to provide comprehensive care management to SAGA clients.

ü ED use may reflect some capacity issues in geographic areas where there are no FQHCs, although the SAGA population is concentrated in the 5 largest cities with FQHCs. CHNCT will be updating SAGA geo-access analysis and assess distribution of the enrollees across FQHCs and individual clinic capacity.

ü The SAGA enrolment has increased by about 15% since 7/03, despite overall improvement in the State's economy. The reasons are unclear and therefore it is hard to predict future trends; however DSS noted they receive numerous calls from uninsured single adults regarding eligibility for Medicaid coverage. Over the next several months, DSS plans to assess causes for enrollment increases and will provide that information when available. Sen. Harp suggested DSS also consult with DMHAS, as the SAGA population has a higher rate of behavioral health service use than other Medicaid populations.

ü Sen. Harp noted a $5.5M savings in SAGA due to pharmacy programs in FQHCs; did the legislature give DSS the authority to carry over the dollars, since there are unfilled needs in the program? DSS did not think so and added that it would be difficult to move pharmacy dollars into the program that has separate pools of dollars.

ü CHNCT analyzed the SAGA medical primary care service utilization and established a $80 rate with an $8 withhold for FQHCs. The withholds have been paid and CHNCT is planning to bring the FQHCs backup to the full payment of $105/visit.

ü The department was asked to provide the Council with information on the primary diagnosis for hospital/ED use; DSS will provide that information.

Sen. Harp thanked DSS for the report and looks forward to follow up discussions about SAGA.

HUSKY A Data Reports

Hilary Silver (DSS) provided the Council with an EPSDT revised form example (click on 2^nd icon to view). A work group led by Ms. Silver that included HUSKY health plans, practitioners and Quality Assurance SC members worked diligently to revise the forms. Major revisions included adding the service billing code on each form, adding a behavioral health screen for ages 9 years and over and developing a more comprehensive list of age-appropriate anticipatory guidance items, as recommended by the QA SC and the Council. The Council applauded Ms. Silver's leadership in completion of this initiative and the work of the group participants. The Subcommittee will continue to work with DSS to encourage practitioners to voluntarily use this form if they do not use a similar form for well visits.

HUSKY Utilization data (click on 1^st icon above to view reports):
Observations of data reports:

ü The 6-month average length of stays (3.3 to 3.5 days) and ED visits (58 visits to 62/1000 MM) both increased slightly from comparable 03-04 time periods.
ü Maternal care: DSS had reported to the Council in the past that 6-month DSS/DPH birth data match would be available through the DSS/DPH data sharing agreement. This match that will provide timelier, complete, less administratively costly picture of maternal care in HUSKY may not be available. While CTVoices will continue with a yearly data match that provides information on the HUSKY births, DSS needs to determine the best approach to more timely MCO reports that take into consideration the above factors.

o Percent of pregnant women enrolled in HUSKY in the first trimester (2004 & 1^st half 2005) has decreased over that period from about 65% to 55%. Health Net reports the highest numbers and WellCare the lowest, although showing an increase to about 48% in 2005. Anthem noted missing client information.
o Average percent of women with at least 80% of expected prenatal visit increased several points to about 78%, with missing data reported by Anthem. Both Anthem & Health Net report higher percentages compared to the two smaller plans.
o Timely postpartum visits increased 15 percentage points on average in the 1^st half 2005 to 70%. Missing information and women receiving visits outside the measure's parameter (about 400 women) were noted. MCOs rely on provider reports for prenatal and postpartum data.

HUSKY Enrollment
Expedited Eligibility (EE) for pregnant women totaled 2,245 from 11/30/05 to 4/14/06 (about 125/week). Approximately two-thirds (1486) applications were granted within the new policy timeline of 1-5 days, 10% (231) were granted after the 5 days, while 16% (366) were pending at the end of the period and 7% (162) applications were denied. DSS agreed to report on he denial reasons.

Children's Presumptive Eligibility (PE): there are now 100 qualified entities sites that send the PE/HUSKY application to one of three Regional Processing Units (RPUs). A total of 782 children were granted PE between 11/30/05 through 4/19/06 (about 39/week over the 20 weeks). This number seems small considering the number of children that lose HUSKY coverage monthly.

HUSKY enrollment 4/1/06
Summary:

HUSKY A has been steadily losing children since August 2005; HUSKY B has had overall losses while adult enrollment has increased monthly.

DSS was asked about the State's implementation of the federal requirements for Medicaid proof of citizenship/identity that is mandated to start July 1, 2006. The department said that states are still trying to understand the provisions for implementing the mandate. DSS will look to matching birth records with DPH, obtain hospital new birth data. The burden for the general Medicaid population will fall on local health departments/municipal offices as Medicaid recipients request birth certificates. Currently DSS requires identification from applicants that could be a birth certificate. The eligibility system does capture the type of identification verification used (i.e. birth certificate) through a verification code. Council comments:

ü DSS does collect digital imaging for some programs; however this may not include citizenship verification. While CMS will reportedly allow various forms of citizenship proof & identity; doubts CMS would waive current identification used by states that do not meet proof of citizenship requirements.
ü Sen. Harp suggested DSS consider in the future developing a common identification card with specific identifies for all Medicaid clients, similar to the DMV card.
ü It was suggested that the Council sponsor a forum on this federal change to inform the public. Applicants' failure to provide the required documentation with their new/renewed applications would delay or discontinue applications for incomplete documentation, similar to what has occurred with the elimination of self declaration of income in HUSKY.

Next Council meeting: Friday May 12 @ 9:30 AM in LOB RM 1D