Meeting
Summary: June 10, 2005
(Next
meeting: Friday, July 15 at 9:30
AM in LOB RM 1D)
Present: Sen. Toni Harp (Chair), Rep. David McCluskey, David Parrella
& Rose Ciarcia (DSS), Dr. Victoria Niman (DCF), Thomas Deasy
(Comptroller’s Office), Janice Perkins (Health Net), Linda Pierce (VOI),
Jeffrey Walter, Ellen Andrews, Dr. Alex Geertsma, Dr. Edward Kamens, Mary Alice
Lee, Robin Hoffmann.
Also
Present:
Hillary Silver (DSS), William Diamond (ACS), Paula Smyth (Anthem BCFP),
Sylvia Kelly (CHNCT), David Smith (Preferred One), Auralee Kamm (DCF), Jody
Rowell (Child Guidance), Dr. Larry Loeb (DSS Dental Advisory Committee), M.
McCourt (Council Staff).
Prior to discussing the legislative changes in the HUSKY
program, Mr. Parrella highlighted an important milestone in the Medicaid Managed
Care program with regard to EPSDT preventive screens.
In 1994 the preventive screen ratio was 49% in the annual HCFA (now CMS)
416 report. For the first time
(last half of 2004) each MCO achieved an 80% EPSDT screening ratio and
cumulative ratio of 84% in the utilization reports, consistent with the federal
goal.
Legislative HUSKY changes that were passed on June 8th, the last day of the 2005 session, were discussed. The department is still reviewing the implementing bill and will provide timelines for implementation of the changes in July. Highlights of the legislation include:
ü Expansion of HUSKY A parent/caregiver eligibility from 100% federal poverty level (FPL) up to 150% FPL. What this means to HUSKY A families:
o As of now, new adult application eligibility will be based on the 150% FPL family income level.
o Eligibility for renewals will be now based on 150% FPL. Those enrollees that do not return their renewals will lose eligibility at the end of their current eligibility period.
ü Implementation of premiums associated with adults in HUSKY A will require DSS to obtain a waiver from CMS, either as an amendment to the 1915(b) waiver or as a SCHIP waiver. DSS will be discussing state options with CMS and report the waiver process at a future Council meeting. There will be a tracking process for adults that lose coverage because of non-payment of premiums.
ü Transitional Medical Assistance (TMA) coverage period for clients with earned income coming off cash assistance is reduced to 12 months from 24 months. Client notices will be mailed.
ü Some recommendations from the legislative study on Medicaid eligibility were implemented:
o Children’s Presumptive Eligibility (PE) has been reinstated, although a target date has not been determined as the central DSS unit that had previously managed PE was disbanded prior to the elimination of PE.
o HUSKY A plan lock-in (currently in HUSKY B) will be applied following Medicaid guidelines. A 60-day plan choice period will be followed by a 90-day “free-look” period, during which the member can decide to stay in the new plan or change back. After that period, the member will remain in the plan for the remainder of the 12 months, although there will be defined exceptions to the lock-in. DSS will discuss the process internally (and with DCF) and obtain feedback from the MMCC Consumer Access Subcommittee on criteria for exception/appeal process.
In response to Council questions about the plan lock-in,
DSS outlined the benefits of the policy:
·
Reduction
in MCO &ACS administration costs, improved continuity of care with PCP.
·
DSS
will develop more robust contract standards for MCO provider networks,
especially for specialty services.
o The DSS will revive the 2004 state plan amendment and send to CMS to implement HUSKY B premiums for band 1 ($30/per child/month, $50/family/month) and increase Band 2 premiums to $50/child/month and $75/family/month. There will be a lock –out period for non-payment of premiums.
ü
Legislation allows the BH “carve-out” to go forward
(includes BH services for HUSKY A child/adult, HUSKY B and some families in DCF
voluntary services). The target
date for the ‘Behavioral Health Partnership” (DSS & DCF) is January1,
2006.
·
The
current DSS/MCO contracts extend to the end of December 31, 2005. DSS and MCOs
are negotiating MCO rate adjustments effective July 1, 2005.
Going forward DSS expects to have annual contracts based on the State
fiscal year (7/1-6/30). Contract amendments for the BH “carve-out” at the end of
the 2005 will have significant changes, the most sensitive being related to plan
lock-in and specialty benchmark network adequacy.
DSS Dental Advisory Committee
Update
Dr. Larry Loeb, Chair of the
DSS Dental Advisory Committee summarized the Committee activities to date, which
have focused on reduction of barriers to dental provider participation in
Medicaid:
·
Consistent
policy for prior authorization. DSS
has been helpful in issuing information to providers.
·
The
current claim form is different for each MCO.
A standard form is currently being discussed with the DSS claims
contractor EDS.
·
Under
review is development of a common provider credentialing form that would
streamline the process and reduce paper work for MCOs & providers.
Sen. Harp thanked Dr. Loeb for the update and the
Committee’s work.
Sen. Harp’s questions for DSS:
·
What
is the status of the dental legal action? The
department said there has been no activity in the Court for months.
·
The
Senator requested DSS provide a brief update on other Medicaid legislation in
July, including General Assistance program changes, pharmacy legislation and the
SAGA pilot.
·
Are there withholds for HUSKY
MCOs that could be applied to performance incentives?
DSS said no, commenting that past performance incentives have been
unsuccessful (previously $4M dollars were removed from performance incentives
and added to the MCO capitation rates).
Hillary Silver reviewed the EPSDT, dental and maternal/child data. (Click on report below).
ü The cumulative MCO EPSDT Screening ratio for the 2nd half 2004 reached over 80% for the first time since Medicaid managed care began. Of note, older HUSKY A children’s screening rates are also higher as well, with the 15-18 year group above 60%.
ü The cumulative participation ratio, while not yet 80%, is higher (72%) compared to the 2nd half 2003.
ü Dental service access (any dental service for members ages 3-20 years) remains stagnant at just over 30%. Preventive dental services are only 25% for the 2nd half 2004.
ü The percentage of women enrolled in the 1st trimester is steadily increasing to just under 60%, with Preferred One having almost 80% of women enrolled in the 1st trimester during this reporting period.
Council questions/comments:
·
Who
are the 19-20 year olds in HUSKY A? DSS they
are pregnant women that do no meet other eligibility criteria, DCF transitional
children, 18-21 years SSI recipients. One of the issues for transitioning youth
with special health needs is ensuring they are connected to an adult provider
before they leave the system. Many
do not follow up when they lose their eligibility.
·
At
the May Medicaid meeting DSS noted that the CMS 416 report showed an increase in
dental services, (from 38% to 43%). DSS
was asked to identify the differences in that report and the
6-month
dental utilization reports.
·
The
DPH/DSS memorandum of understanding (MOU) on matching DPH/Medicaid birth data is
delayed a bit while waiting for a software upgrade to handle the large data
files. The initial plan is to
provide MCOs with regular 6-month DSS/DPH data matches on pregnancies/prenatal
care. MCOs will still need to go
directly to providers for post partum data.
Mary Alice Lee, CT Voices, reviewed the ED and hospitalization rates and top diagnoses for 163,615 children continuously enrolled (represents about 65% of all enrolled children) in HUSKY A in CY 2003.
(click on report below)
Highlights of the report:
ü 2003 enrollment represents a 17% increase from 2002; therefore the number of ED visits increased from 86,650 in 2002 to 95, 091 visits in 2003.
o ED rates were unchanged from 2002: 33% of HUSKY A children had at least one ED visit in 2003, whereas 38% of children that changed health plans had an ED visit. There were 48.4 ED visits/1000 member months (MM) in HUSKY A compared to 35.9 ED visits /MM in another state Medicaid program.
o
Hospital admission rates were unchanged from 2002: 4% of
children were hospitalized at least once, whereas children with special
needs had twice that rate (8%), unchanged from 2002. The 2003 average length of
stay (ALOS) increased to 5.6 days compared to 4.1 days in 2002. The ALOS for MH
disorders was 7.1 days. MH represented 71% of all children/youth inpatient days.
ü The leading reasons for ED visits were 1) injuries (26%), with the highest rates in children ages 6-14 & 15-20 and 2) respiratory conditions (21%), with the highest rates in the <1 & 1-5 year age group. ED BH visits are in the “other diagnosis” (10% of all ED visits). ED visits that result in hospital admissions are not billed as separate ED visits, therefore not included in the ED visit rates.
ü The leading reason for hospital admissions were 1) mental disorders (56%), with the highest rate at 78% for the 6-14 age group & 50% for 15-20 age group.
Highlights of Council comments/questions:
· MH hospital days are 71% of all hospital days in HUSKY A. Do we know the percentage of DCF involved children in the hospitalization rates? DSS stated that as of October 1, 2005 new DCF coverage groups will be used and will capture all DCF children in HUSKY. All DCF children cannot currently be accounted for in reports.
· There is outpatient MH “grid-lock” making it difficult to connect children hospitalized for MH disorders to community-based care at discharge.
· The ALOS for MH hospitalization-7.1 days- seems low, given the growing reinsurance dollars expenditures for non-medically necessary hospital stays. Dr. Lee will look at the report to identify the percentage of children that fall within the reinsurance groups.
· We don’t know the number of urgent versus non-urgent ED visits.
o Primary care providers generally do not know when their patient has been seen in the ED in order to schedule a follow-up PCP visit or educate families, especially inexperienced parents, who seek ED care for “normal” events during the 1st year of life.
o ED visits, which are not part of the PCP record, contribute to discontinuity of care within the ‘medical home’ primary care practice.
o It was suggested that the national electronic medial record (EMR) initiatives will eventually coordinated health data from disparate sources into one record.
· Dr. Wilcox, an ED physician and PONE Medical Director commented that his clinical experience in various EDs is that ED overcrowding is not related to ED inflow, rather an outflow problem, with hospital bed capacity.
Jeffrey Walter, Co-Chair of the BH Oversight Committee commented that the ED/hospitalization reports illustrate the rationale for the BH “carve-out” that is improve and expand community-based services and reduce institutional care. The Behavioral Health Partnership between DSS and DCF is moving forward subsequent to the 2005 legislation (PA 05-280). The Committee work groups have been meeting regularly, developing recommendations to the two agencies that will be reviewed and approved at the June 29 BH Oversight Committee meeting. A fifth work group will begin to address consumer and provider transition issues to the new system.
The Medicaid Council will meet
Friday July 15 at 9:30 AM in LOB RM 1D. Agenda items will include the HUSKY A/B MCO revenue &
expense report, including a separate report on BH and dental expenditures, an
update on the timeframes for implementing the HUSKY program changes, information
about the DSS data warehouse (deferred until September meeting) and a
brief overview of other Medicaid legislation.