Anthem	CHNCT	FirstChoice/P1	Health Net	Total all Plans
Member months	1,246,868	492,200	235,198	1,044,802	3,019,068
Revenue	195,787,457	$79,800,464	$$39,030,444	$173,081,179	$487,699,544
Medical Expense	181,859,073	69,050,763	36,144,430	160,599,274	447,653,540
Administrative Expense	14,662,500	8,738,301	5,048,411	13,882,233	42,311,445
Total Expense	196,521,573	77,885,498	41,192,841	174,481,507	490,081,419
Net Income	(477,176)	1,914,966	(2,623,928)	(1,008,236)	(2,194,374)
Medical Loss Ratio	93%	87%	93%	93%	92%
Administrative Loss Ratio	7%	11%	13%	8%	9%
Margin	0%	2%	-7%	-1%	0%

All Plans	1997**	1998***	1999	2000	2001
Member Months	NA	2,594,181	2,726,260 (A&B)	NA	3,019,068
Revenue	$355,891,806	$371,857,435	$391,718,968	$438,048,971	$487,699,544
Medical Expense	$321,211,261	$318,870,962	$357,912,361	$381,003,060	$447,653,540
Administrative Expense	$5,483,081	$45,806,348	$37,459,038	$43,869,414	$42,331,445
Total Expense	$326,694,342	$364,677,310	$395,371,399	$424,872,474	$490,081,419
Medical Loss Ratio	90%	86%	91%	88%	92%
Administrative Loss Ratio	16%	12%	10%	10%	9%
Margin	Range of 4% to -25%	1%	-1%	2%	0%

· Break out of administrative costs, especially among subcontractors, unclear in the reports. According to the MCOs, the inclusion of administrative costs varies by MCO. Administrative costs may be reported separately or put in with medical expenses depending upon the type of contract the MCO has with the vendor:

o In a contractual ASO capitation arrangement such as Anthem BCFP has with ValueOptions, the vendor fee is in the administration expense category.

o Risk based capitated payments to vendors (i.e. dental) would be reported under medical expenses.

o Rep. Nardello commented that the current financial reports never get at the vendor's administrative cost in any consistent manner. Legislation passed in 2002 (PA No 02-3) {requires "on or after July 1, 2002, each managed care subcontractor paying claims for mental health or dental,.paid by a Medicaid managed care plan shall submit a report on a quarterly basis to DSS on the proportion and amount of its monthly payment received from the plan for that which has been 1) paid directly to providers of health services and 2) used by the subcontractor for its own administrative costs and profit".} may provide the information requested by the Council.

· Senator Harp asked DSS to comment on how this financial report is used by DSS in the administration of the program. David Parrella stated that the data suggests that while the program is not now financially robust, it is not headed toward disaster. There has been significant program growth in 2001-02. The main area of concern in maintaining capacity to enroll members is dental. The Department hopes that by moving dental and mental health out of the program, as a carve-out, the program will be more viable and current MCOs as well as those attracted by the marketing material distributed throughout the country will be willing to participate in the HUSKY program. The dental carve out time line: complete the RFP, issue it in September, select ASO vendor by April 2003, implement July 1 2003. The BH process will be similar, with an RFP released in the Fall and a July 2003 start date.

	Enrollment #'s	Case Management Fee
New Haven 9/01-5/02	71	$1670
Newington 9/01-5/02	1092	$26,590
Pilot Totals	1163	$28,260
Projections for FY2003	3700	$127,500

· A total amount of $500,000 was allocated to DPH in the 2000 legislative session, of which $250,000 would be used by DPH for provider oral health education and $250,000 to develop the dental pilot infrastructure.

· These expensive pilots needed established evaluation measures prior to releasing the funds.

· Unclear what the case management services are, request UCHC to attend the next Council meeting to define this service within the pilot program.

· The case management fees appeared to be an indirect way to increase overall dental fees.

· Applied for a Robert Wood Johnson $1M grant for innovative programs to improve access for Medicaid and SCHIP populations across urban, suburban and rural areas. Five communities have been targeted: Manchester, New Haven, Stamford, Torrington and Willimantic. The Governor has designated DSS as the lead agency for the grant, with collaboration by DPH, UCONN Dental School, Dept. of Education and community groups. The grant will target school children, using portable hygiene equipment for preventive services; a UCHC dental fellow will provide restorative care at safety net sites with cost-based reimbursement. The Department is working with community groups to further define the program and interface with existing services over the next 9 months, if CT receives the grant.

· Developed a Dental Policy Guide that will be mailed to dental providers, which describe the services covered under HUSKY and prior authorization.

· Worked on a state loan forgiveness program for dentists, dental hygienists that require work in the public sector part time (federal programs require full time work). This program has been allocated $350,000 through DPH beginning July 2003.

· Worked with the Dental Hygienist Association to disseminate and clarify the Medicaid regulations that allow the hygienists to work unsupervised in public health settings.

· Continued work on the HUSKY dental carve-out and the RWJ grant application.

· Build provider collaboration through DBP monthly office visits/calls, information in the provider newsletter about cultural diversity, language interpreter access, and transportation access.

· Dedicated outreach staff for provider (dentists & dental hygienists) in Hartford, Tolland, New Haven counties.

· Send members appointment reminder postcards, phone reminders and appointment assistance.

· Anthem donated $20,000 to the Hartford school clinics for additional sealants.

· Provide oral screens, dental caries check at summer camps, send restorative recommendations to the parents; HealthReach staff track these children for access to the recommended services.

· Studying the no-show rates in New Haven, Hartford & Fairfield counties, provide this information to HealthReach staff for connecting child to dental care. No-show rates vary by areas: Torrington 4%, Newington 30-45%. Anthem has recorded an overall 60% no show rate.

· 1200 students in 5 schools received dental screens.

· Of the 272 BeneCare children requiring restorative care, BeneCare made dental appointments, and 212 children received complete care. There was a 90% appointment `show' rate, credited to strong case management by the Benecare, CHNCT and Preferred One outreach staff. The school nurses referred children enrolled in other health plans that were screened and required further dental services to these other health plans for appointments. The cost for the pilot, excluding dental service costs, is approximately $60-70,000.

· BeneCare and ACS (formerly Benova) attended WIC programs, kindergarten sign-up days, and summer camp programs to provide information on dental care and HUSKY enrollment to parents.

· Expand the program (begun in West Haven) with the collaboration of the newly created New Haven Oral Health Coalition, targeting specific sites, use screening forms to identify children who have had recent services under BeneCare, and follow up treatment as appropriate.

o Case management, screens, education and follow up treatment services will be the focus of the expansion.

o Work with 8 dental offices that do not presently take Medicaid members, who have agreed to do follow up dental treatment and become the pilot member's `dental home'.

· Identify members with no oral health care, link oral health with EPSDT pediatric services/PCP.

· BeneCare has developed a central call center for available dental appointments within their provider network in the community, notifies members of new available dental providers.

· Both CHNCT and Preferred One have targeted prenatal dental care, as studies suggest a correlation of maternal poor oral health and a higher incidence of low birth weight babies. Pregnant women are also given information on the importance of infant oral health.

	Enrollment # Change 00-02	Enrollment % Change 00-02	Enrollment # Change 01-02	Enrollment % Change 01-02
HUSKY A & B	50,105	> 17%	39,953	> 14%
Total HUSKY A	42,780	> 15%	35,440	> 13%
HUSKY A Adults**	22,793	> 28%	17,393	> 22%
HUSKY A <19	19,987	> 10%	18,047	> 9%
HUSKY B			4591	> 35%
HUSKY Applications(May)	1144	> 47%	181	>7%*

· Total application processing time is 45 days for applications received either through ACS or DSS.

· If the application received is complete, disposition is completed within 7 days with approved, referred, denied, withdrawn or canceled letter sent to the applicant.

· If there is missing information on the application, ACS works within a 30-day time frame to obtain the information. According to ACS, many applications aren't complete. ACS follows up with the applicant in obtaining the information required for a completed HUSKY B application; DSS follows up with incomplete HUSKY A applications. Some incomplete applications are referred to the regional DSS offices (i.e to clarify self-reported income versus income information from linkage to other income systems).

· Completed HUSKY A applications are screened for other related program eligibility. Those that may be eligible for other programs are sent to the regional DSS office and the decision letter is sent to the applicant. If the applicant is not eligible for related programs, the DSS presumptive eligibility unit reviews the presumptive eligibility forms and the decision letter is sent to the applicant and forwarded to the regional DSS office for maintenance.

· The Senator requested the Department discuss current initiatives to better inform clients of maintaining continuous health coverage and changes in coverage for those transitioning from welfare.

· Can the HUSKY MCOs alert their members of approaching renewal times? Rose Ciarcia stated that a MMIS system request had been made to include providing MCOs with the 12 month expiration/renewal dates for their members. The work cues for the MMIS department are long; moving this up to the front of the work cue without additional resources is difficult.

· Study set included 123 children, with a 48% match (59 children) between the database and the medical record. Of those matched sets, 91.5% of the children had a documented rational for the medication use.

· The most frequently documented diagnoses among the 59 children were attention-deficit or disruptive behavior disorder (64.6%) and seizure disorder or treatment of spasms (25%).

· The drugs most frequently prescribed were stimulants (52.1%) and alpha-2 agonists (12.8%) for ADDH and mood stabilizers (20.8%) for seizure disorder/spasms.

· Of the 500 children less than age 5 identified in Phase I as having been prescribed psychotropic medications, 123 were included in the study, but matched data (pharmacy database & chart match, documentation of medication reason) brought the number down to 59. The small study numbers represent lack of concordance with the study criteria for the majority of identified subjects. Whether there are similarities among the actual study subjects to the larger group could not be determined.

· Identification of the prescribing provider was not possible because of incomplete data: pharmacy database has drug, DEA institution name rather than individual provider. Similar problems arise in identifying the providers when the Tax ID is used: this usually references the institution, not the individual provider, in clinic practices.

· There is evidence that some of the psychotropics are prescribed for medical diagnoses rather than behavioral/mental health problems.