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

JULY 14, 2000

Present: Sen. Toni Harp (Chair), Rep. Vickie Nardello, Barbara Parks Wolfe (OPM), David Parrella & James Gaito (DSS), Marie Roberto (DPH), Karen Dubois Walten for Paul DeLio (DMHAS), Dorian Long for Gary Blau (DCF), Cynthia Matthews (Comm. On Aging), Janice Perkins and Patrick Carolan (HMO industry), Dr. Wilfred Reguero, Dr. Edward Kamens, Dr. Leonard Banco (AAP), Jeffrey Walter.

Also present: Martha Okofor, Kathy Brennan (DSS), Sheila Allen Bell (Benova), Debra Bracket (Qualidigm), Sylvia Kelly (CHNCT), Linda Scofield (Preferred One), Deborah Hine (Anthem Blue Care Family Plan), Catherine Jackson (PHS), Mariette McCourt (Council staff).

Department of Social Services Report

July Rate Adjustment

James Gaito stated that the department was committed to a July 2000 MCO rate adjustment in the 1999 contract. Effective July 1, 2000 a 3% rate increase was implemented, which will formally be communicated to the health plans via a contract amendment.

The capitation rates are a function of age, sex and county, distributed across 48 cells. The FY01 capitation rates are weighted by June 2000 membership. The following show the total county rates, statewide rates for FY01 and FY00 and the percentage of the county rate/statewide rate FY01:

The department was asked why Fairfield has such low rates. Mr. Gaito stated that the legislature required all counties be paid at least 90% of the statewide average that is based on the Medicaid fee-for-service (FFS) cost experience. Rates are based on the FFS history of 1995-96 costs and utilization experience trended forward for the FY01 rates. The department is moving toward of system in which the base rate is configured from encounter data rather than the FFS history. Implementation of this will depend upon HCFA's stance regarding the upper payment limit configuration. The UPL is currently based on the last FSS year cost experience, which was the basis for the waiver renewal financial data.

Contract Amendments

A separate amendment will be issued the week of July 17th that will reflect the rate adjustment. Other contract amendments are expected to be implemented in September. The Council raised these issues:

• Rep. Nardello noted that the DSS/MCO contract had financial quality incentive and sanctions; $ 7. 6M of the quality incentive money was reallocated to the base rates. In addition there has been a 3% rate adjustment and a $ 10. 5 tax credit for commercial/Medicaid plans. In light of this infusion of money into the program, what will the performance standards include? Mr. Parrella stated that there are performance standards and financial sanctions in place now. Additional standards will be included; however the department cannot discuss these in any detail with the Council until they are first shared with the MCOs. The content areas of the amendments will reflect both HCFA standards and State concerns related to performance standards. These include clarification of third party liability and the notice of action policy, dental performance standards, the behavioral health State agencies collaborative program interventions and funding and the behavioral health outcomes study MCO and provider roles.
• Sen. Harp requested the department work with the MCOs to establish goals for incremental increases in utilization rates for services that currently have low or unchanged utilization rates. The department was requested to determine the collection of meaningful data and the establishment of performance standards related to women's health. Areas of low performance related to women's health include the percentage of women that are enrolled in managed care in the first trimester of pregnancy (42%), the percentage of women accessing postpartum care (<60%) and women's access to primary care visits (<50%). The Senator suggested that incentives could be designed to improve performance, especially in earlier enrollment of pregnant women in the program Mr. Parrella stated that there are performance areas that the department is not satisfied with. Clearly behavioral health inpatient readmission rates, dental access and EPSDT ratios require attention. There is a need for different approaches to improve utilization in these areas. Mr. Parrella stated that the issue of pregnant women's timely enrollment in managed care is a public health issue and focus is needed on adolescents and minority women. The department would be happy to have a dialogue with the MCOs to establish benchmarks and realistic performance standards related to women's health. The department needs to assess the future of the program before deciding whether standards will be included in the amendments for this contract, which continue for 11 months to June 30, 2001 or in the new contract beginning July1, 2001. The department expects to exercise the option to extend the current contract for another year, into 2002.

Notice of Action Policy (NOA)

The April 18th letter to the MCOs outlined the requirement of a NOA for partial denial of services as well as reinforcing existing due process provisions. A formal policy transmittal, based on the content of the letter, was issued to the MCOs in June. The policy is effective July 1, 2000. In response to Sen. Harp's question regarding the legal status of the due process litigation, Mr. Parrella reported that there has been no negotiated settlement. It will be heard in federal court later in July. Barring unforseen circumstances, the department expects to be going forward with the litigation.

Psychiatric Inpatient Reimbursement Process

Children in inpatient psychiatric settings, many of whom are DCF children, remain inpatient beyond the time they are clinically ready for discharge because no alternative outpatient setting is available. Beginning September 1998 the Department of Social Services assumed an incremental percentage of the costs over time for these prolonged inpatient stays. The department assumes 100% of the cost for stays 60 days and beyond. As noted in previous Council meetings, the intended consequence of reinsurance was to reduce premature discharges of hard-to-place children. The unintended consequence of this process was extended stays that resulted in `gridlock' in the inpatient system as few, if any, community-based programs were implemented for alternative discharge settings. The reimbursement payments to the MCOs were delayed at times as the department worked to develop a cyclical claims submission/payment process. In February 2000 this became a problem for PRO BH, as PHS's contract with the subcontractor did not provide for up-front payments to PROBH. The plan reported, at the February BH subcommittee meeting, that they would begin having difficulty paying providers for inpatient stays because of delayed reinsurance payments from the State.

The Behavioral Health Subcommittee and the Medicaid Council requested the department to report on the establishment of a reimbursement payment cycle and time frame for implementation. Mr. Parrella reported that the timely disbursement of payments to MCOs and providers has been of grave concern to DSS and others. Approximately $ 19. 9 million has been paid to MCOS since the onset of the process 9/1/98 through 5/31/2000. Two interim payments were made in FY00: August 99, reconciled January 1, 2000 and April 2000, reconciled May 31, 2000. The reinsurance payments are up to date as of May 31, 2000. Beginning in August 2000 a monthly payment cycle will be implemented. A memo from DSS Deputy Commissioner Starkowski will be sent to the MCOs detailing the process. Jeffrey Walter, Co-Chair of the BH subcommittee and Sen. Harp thanked the department for their prompt response to the Council request for an established payment cycle.

MCO/Council Review of Quarterly Data.

James Linnane had presented the HCFA 416 report on EPSDT at the June council meeting. A full report of the fourth quarter 1999 utilization in the HUSKY A program was mailed to Council members. The four MCOs were asked to respond to questions the Council had about the report. The discussion focused on three areas of concern to the Council: dental access, 1st trimester enrollment of pregnant women in HUSKY and postpartum visit rates.

Dental Access

Dental Services 4^th Quarter 1999: Total Ages 3-20*

*Compare percentages to the optimum of 50%, assuming two preventive visits/year.

Rep. Nardello observed that dental access rates for preventive care, treatment and overall dental access remains low and unchanged over the past year. This is of concern to the Council, DSS and the MCOs and has been discussed at previous Council meetings. The health plans were asked to describe any new innovation that have been implemented or planned for the future to improve access.

PHS: Catherine Jackson reported on the collaborative dental enhancement plan by Anthem Family Plan, PHS and DBP, the subcontractor for both plans, that has been submitted to DSS:

• Beginning with the new DSS/MCO contract, new member welcome calls include identification of the family's primary care dentist (PCD) and members are assisted in finding a PCD. The new handbook informs members that twice-yearly dental check-ups are covered services for children aged two years and older.
• Recruitment of dentists and dental hygienists continues, with DBP establishing new offices in membership areas. Twenty-seven hygienists have been recruited since the 1999 legislation enabled experienced hygienists in community-based settings to obtain Medicaid reimbursement and work without direct dental supervision. DBP has assessed the appointment wait times for dental services and has found that there appears to be access to services. This is reported monthly to PHS.
• Two pilots in Meriden and Stamford at SBHC will target 1st grade children for dental education (importance of dental hygiene), dental screens performed by dental hygienists and referral to dental treatment. Rep. Nardello stressed the importance of follow-up of children requiring treatment beyond a letter to the family. DBP is working on an electronic follow-up component. The permission form to participate in the pilot will include information of insurance and the health plans will collaborate with the Children's Health Council in HUSKY outreach for the uninsured.

Preferred One/Benecare

Patrick Carolan (Benecare) described:

• A New Haven initiative that partners Primary Care visits with dental screens. While Preferred One EPSDT rates have increased, the dental rates remain low. Children screened that require treatment receive an appointment, either for the clinic or private practitioner, before leaving the clinic. Dentists are reportedly willing to accept Medicaid patients because of the strong follow-up by Benecare. About 500-700 children who had previously not received services received dental services in this initiative. The missed appointment rate for Primary Care still remains high (only 45% of families keep appointments). Of these, 85% received dental services.
• A project in which BeneCare is working with the University of New Haven to recruit dentists to work in the community health clinic one day a week. Dentists seem to be more willing to work at the clinic than make appointments in their own offices. The high percentage of missed appointments reportedly discourages dentists from seeing Medicaid clients in their offices. Preferred One plans to survey clients to identify the barriers to keeping appointments.

CHNCT

Senator Harp commended CHNCT for their consistently high dental access utilization rates as compared to the other health plans. Unlike the other three plans, dental services are not `carved-out', rather are managed within CHNCT.

Dr. Beth Smith, Medical Director, outlined the CHNCT dental access plan submitted to DSS:

• Identify/assign a PCD to new members.
• Outreach to members who have not had a dental visit within 6 months of enrollment.
• MCO newsletter has preventive dental health information for members
• Recorded messages regarding the importance of dental care are played while members are on hold with member services.
• Outreach and case management targets members seen in the ED for emergent dental care. The case manager works with the PCD to coordinate the member's dental care access.
• Dental hygienist recruitment continues; Tolland County has two new providers. Members are also informed about St. Raphael's dental van.
• An infant consultation fee schedule has been established to enable an early relationship with the PCP/PCD for children <1 year of age.
• Monitor timely dental access through the `mystery shopper' process.

Dr. Smith commented that having the dental clinic within the same building and partnering dental screens and preventive care with the Primary care visit reduces member barriers to dental care.

Anthem BlueCare Family Plan

ABC has worked hard with DBP and PHS to develop the dental enhancement plan as both primary carriers use the same subcontractor. In addition, ABC:

• Identifies the PCD on the welcome call and does a 60-day and 6 month follow-up of members that have not accessed dental services.
• Sends post cards to families for children aged 2-3 years, reminding them of the importance of dental care.
• Generates internal, reports identify ED use for dental diagnoses and then follows-up with the member for appointments with their PCD.

The health plans have similar approaches to improving dental access. The discussion with MCOs and the Council revealed that the MCOs believe there generally is adequate service availability in member areas (previous DSS network capacity reports indicated areas of frozen enrollment related to inadequate dental access). The challenge is to reach families to educate them about the importance of children's preventive dental care at an early age and attempt to reduce the missed appointment rate that persists despite reminders, outreach and case management. Member education and the reduction of missed appointments requires MCO/PCP/PCD/consumer collaboration.

DSS Dental Projects

Martha Okafor reported on several DSS endeavors that focus on dental access:

• The department is working with the MCOs and their dental access plans, focusing on non-traditional service hour availability as many families are now working and performance measures that allow the evaluation of the impact of the MCO access plan.
• CT is applying for a HCFA dental access grant with the state of Maryland. The grant targets 3-4 year old Medicaid children for oral health promotion and preventive care, perhaps working with Head Start programs. The proposed program would involve collaboration with the Maryland University School of Dentistry and the State Health department and CT DPH, UCONN and the Dental Advisory Board.
• Legislation passed in the 2000 Special Session enables DSS, DPH and probably UCONN to develop pilots for a comprehensive dental plan in CT.

Council members raised the following issues regarding dental access:

• Patrick Carolan (BeneCare) stated that the dental fees are too low and need to be improved to increase access. Senator Harp stated that the Administration, the legislature and DSS have been trying, for the past several years, to increase dental rates. Overall, low rates for health care (State rates) are pervasive in CT, and this is becoming a crisis for the State. The Senator hopes that there will be an ability to move the rates issue related to the overall continuum of care forward in the upcoming budget session, recognizing that the discussion will continue to take place in the presence of the State spending cap limitations.
• Rep. Nardello commented that the purpose of the 1999 legislation related to dental hygienists in HUSKY was to identify eligible hygienists not involved in providing services to the population. Rather, the statute enables new providers to be identified and connected to new sites for alternative care (i. e. Head Start programs, integration with Primary Care, etc. ). Questions have arisen regarding this legislation; if they continue to persist, perhaps a meeting is needed with DSS and MCOs to clarify issues and move ahead to implementing access at new sites, with new providers providing dental screening, preventive care, treatment referrals and linkage to treatment. Rep. Nardello commended the MCOs for their efforts in improving access and suggested that through local initiatives, workable strategies can be identified and adjusted so they can be applied at other sites in the State.

Prenatal/Postpartum Care

The following summarizes the prenatal/postpartum care rates for the 3^rd quarter 1999 and the 3^rd quarter 1998:

*Of all the deliveries, the percentage of women receiving care in the 1^st trimester.

** Kaiser data removed form 3rdQ 99.

Senator Harp requested the MCOs to comment on the data, commending Preferred One for the highest number of women enrolled in the plan during the 1^st trimester (61%).

Preferred One: Linda Scofield stated that the challenge in getting women, especially teens, into early prenatal care (PNC) is identifying them when they become pregnant. P-1 approach may not be that different from the other MCOs; however some of what P-1 does is:

• Active outreach and team partnership with community agencies that work with pregnant women and teens.
• Uses an automated database for the OBGYN to give the plan notice of the pregnancy; the plan then connects the client to outreach.

PHS: The plan uses the OBGYN authorization form to identify the pregnant client, performs a risk assessment and implements case management for the high-risk pregnancy. The challenge is connecting with the pregnant teen before they seek medical help, which is often late in the pregnancy.

CHNCT: In addition to outreach and identification of the pregnancy from OBGYN contact, the MCO monitors pharmacy data, connecting those women prescribed prenatal meds with plan outreach.

BlueCare: Implements case management and outreach and proactively tries to identify pregnant women though pharmacy data and substance abuse mental health providers.

BlueCare has the highest rate of women with over 80% of the recommended visits (92. 4%) and PHS and P-1 have the higher postpartum visit rates this quarter (62. 5%, 72. 6%, respectively).

PHS: follows-up with all high-risk mothers with monthly phone calls and home visits as needed. Clients are called, postpartum, to emphasize the importance of the appointment.

P-1 uses the birth delivery database to identify postpartum visits, with outreach through home visits to women who have not had an appointment. The plan's internal quality improvement program focuses on the education process for women regarding the importance of the postpartum visit even though they may be feeling well after the delivery.

The Council will follow-up with the department in September regarding the Council request for DSS/MCOs to develop performance standards and incremental performance goals related to these issues.

Other

Senator Harp requested the department comment on the following: ophthalmology service availability for HUSKY children, Special Needs children referral for appropriate services and program plan changes.

Ophthalmology Services.

Senator Harp stated that it had come to her attention there are questions about the network sufficiency for ophthalmology services in HUSKY, in particular for BlueCare. Deborah Hine stated that there has been a long history in Medicaid of the inadequacy of ophthalmology providers that is unrelated to the media reports about Opticare, the vision carve-out for BlueCare (commercial and Medicaid). Opticare is the Medicaid subcontractor for vision and hardware only; not for surgical vision care. The problem is more related to timely routine vision assessment. Ophthalmologists are more than willing to perform surgery and the plan authorizes out-of-network services: however there are few pediatric ophthalmologists in Hartford. It is more difficult to secure routine eye assessments than obtain surgical eye care.

James Gaito reported that the department has been involved in discussions with ophthalmologists and the CT Eye Physicians Association regarding these issues. There had been concern that if ophthalmologists dropped their general participation in Medicaid, this would impact HUSKY; however it appears that this has not occurred and the HUSKY program has not been affected. The CT Association is compiling information on issues related to Opticare and the department will continue to track the issues. Dorian Long (DCF) stated that DCF have been able to access eye care with the assistance from the MCO.

Dr. Banco, representing the CT AAP, stated that from a provider perspective, eye care for Medicaid children is a serious problem. There are no ophthalmologists in Hartford County in the Medicaid network that provide care to Medicaid children. The majority of network ophthalmologists provide care to adults rather than children. What is needed is stratification of the program in which children that fail vision screens can be seen by optometrists working with ophthalmologists. This will improve the system of care. Senator Harp stated that lack of eye care is an emerging Medicaid issue and suggested DSS work with Dr. Banco and the CT AAP to assess the extent of the problem and develop the technology to monitor eye care, reporting back to the Council in September. Mr. Gaito stated the department is willing to have a dialogue with the MCOs and Dr. Banco. Marie Roberto (DPH) recommended that the two specialty hospitals, charged with health outreach to the community and the provision of preventive care, and the UCONN medical school, which may have residencies in ophthalmology, be included in the discussions with DSS. Senator Harp requested DSS take note of these suggestions as they work on the issues around eye care.

Children With Special Needs (CSHCN) in the 1915 (b) Waiver

Senator Harp asked the department to comment on the waiver renewal requirements special needs children and the process by which CSHCN will be identified in the HUSKY A. {At the June Council meeting there was discussion about up-front identification of these families at the time of enrollment, through Benova, using a broad, non-clinical screening question(s), similar to ones used by other states that have been shared with DSS. This information could then be given to the MCO to at the time of plan enrollment in order to facilitate MCO needs assessment and early case management}. Senator Harp asked DSS if they had given consideration to having the enrollment broker, Benova, include one or two basic questions about special needs at the time of enrollment. Mr. Parrella stated the department has not committed Benova to this, as they do not have access to clinical staff and assumes that the MCOs assess special needs during the intake (welcome call) interview. Rep. Nardello asked the MCOs if they knew the member response rate to the welcome call health risk assessment. The MCOs estimated a 60% response rate. All the MCOs reported following up members that cannot be reached by phone with home visits and P-1 stated their outreach workers make special attempts to connect with SSI families. Rep. Nardello requested the MCOs report the response rate to the welcome call, the health risk questionnaire and outreach home visits at the September meeting.

Senator Harp asked DSS how they ensure that HUSKY families that need services know about the services available, whether in Title V programs or HUSKY B. The HUSKY B PLUS programs have been historically underutilized despite adequate State funding. Mr. Parrella stated there has been HUSKY B outreach to:

• Katie Beckett families, a waiver program that has limited slots with several hundred families on the waiting list.
• Targeted outreach to Title V families (the eligibility income level was increased to 300%FPL when HUSKY PLUS was implemented).

According to Mr. Parrella, the underutilization of the HUSKY PLUS programs may be related to:

• The federal crowd-out provisions of Title XXI (HUSKY B) that precludes families from enrolling in B if they have private insurance (however, there are 10 eligibility exceptions for families covered by employee-sponsored insurance within the last 6 months that allow families to enroll in B).
• Families over 300%FPL may purchase HUSKY B premiums but state law precludes them from participating in the PLUS programs. Higher income families with Special Needs children would probably benefit from wrap around services like the PLUS program, yet cannot because of the current statutes. This is a barrier that the legislature and DSS need to grapple with through the legislative process.
• The robustness of the basic HUSKY B insurance package may be addressing the needs of some families, especially since the implementation of the mental health parity statute.

Again, as in the June Council meeting, Mr. Parrella stated that a lot of CSHCN are in HUSKY A. The use of the PLUS wrap around services are squeezed by low-income families in HUSKY A and higher end income families that are excluded from HUSKY PLUS. This leaves a narrow slice of families eligible for the PLUS programs. It is desirable to have the wrap around services available to a broader group of special needs families. In order to do this the State has to go back and look at the structure of the program.

Senator Harp reiterated her earlier question regarding the department and MCO's ability to identify CSHCN early in the enrollment process in order to connect them to MCO case management. There seems to be a problem similar to hospitalized children with behavioral health problems in that some children with physical special needs languish in hospitals for a long time because there is no place to discharge them to or there is no step-down care available. Children in prolonged institutional care move out of managed care and into Medicaid FFS. Early identification of the special needs family and implementation of case management before the child is hospitalized would allow the State to be more proactive for care management and discharge planning as necessary. The department stated that the MCOs identify special needs families:

• Through the member services welcome call health assessment.
• The department will now supply the MCO with an identifier for children on SSI.
• DCF children are known to the MCO through their coverage groups.

The Health plans described processes in addition to the welcome calls that enable them to identify CSHCN:

BlueCare: Asks families questions about multiple prescription use and behavioral health services, diaper use for children over age 3. Ms Hine is not aware of very many children in managed care remaining in hospitals; however prolonged rehabilitative stays generally result in the child's care/costs becoming the responsibility of Medicaid FFS.

CHNCT: Asks questions of families related to multiple health provider visits, children with more than one ED visit or hospitalization in the past 6 months.

PHS: has a one-page new member welcome questionnaire included in the new member packet in addition to the welcome call. This asks questions about pharmacy, frequency of provider visits and caregivers in the family.

P-1: In addition to the welcome call information, the MCO has initiated monthly data reports of multiple ED visits, high cost claims and diagnosis to identify children and adults with special needs and assign case managers to work with them. Ms. Scofield noted that she has met with the departments of Mental Retardation and Education about care collaboration for Birth-to-Three children and special needs children in schools. Both the MCO and agencies are frustrated with the limits on care collaboration secondary to federal law that prohibits the sharing of information about these children. It becomes very difficult, because of these legal restrictions, to provide community based timely services and collaborative care management when the MCO cannot even identify the child within these agencies and share care plans.

Mr. Gaito stated that the CHC was contracted by DSS to complete a consumer satisfaction survey that includes a separate survey of CSHCN , which will be completed in September. In addition, Pat Sulik (DSS) has helped convene a group of MCOs, the CHC (and the Medicaid Council) to look at how case management is delivered in the program to vulnerable groups. The department is developing a reporting format for MCO case management services.

Martha Okafor (DSS) reported that DSS is collaborating with the Department of Labor (DOL) to identify adults in the TANF population that have special needs, especially behavioral health needs and integrate them into the managed care system. The Director of DOL, David Parrella and Kevin Loveland (DSS) started this initiative.

Program Health Plan Changes/Future of the Program

Senator Harp requested DSS to comment on the overall status of the program and pending changes. Mr. Parrella stated that the program is good shape. Mr. Parrella read from a formal DSS statement that announced the loss of a HUSKY health plan, stating he could not comment beyond the statement:

The Department of Social Services was notified this week by HealtthChoice of CT that it intends to withdraw from the HUSKY A and B programs due to a decision to "cease operating both {its} commercial and Medicaid healthcare businesses. "

The notice cited a withdrawal date of October 11, 2000 (90 days' notice). This is regarded by the Department as an unacceptable transition period. The Department is reviewing the contractual situation with the Attorney General's Office.

HealthChoice, also known as Preferred, currently has about 26,000 adult and child members in HUSKY A (Medicaid) and about 1,000 child members in HUSKY B.

When a managed care organization withdraws from the public health coverage program, the Department works with other MCOs to add members to their health care provider networks. The priority in this transition is to ensure continuity of care for our clients, especially pregnant women and children with special needs.

Senator Harp commented that while this was probably difficult for the department to comment on publicly at this time, this information has been out in some communities already. The Senator hoped the department's work with P-1 and the partners of this organization would find a way for the health plan to continue to serve the population.

Senator Harp stated that the potential loss of the plan points to the fragile nature of the program and the need to identify alternative coverage models such as Primary Care Case Management (PCCM). The General Assembly authorized the department to prepare a report to the legislature on alternative coverage models including PCCM. Five or six years ago there was skepticism about the impact of managed care on this population but our experience suggests that it is working. It was a new form of service delivery for this population and the commercial businesses. Some of the problems seen in HUSKY are even greater in the Medicaid elderly populations. The Senator stated that the concept of managing care between the MCO and members that we have heard today suggest that this delivery system model is the way to deliver health care. It may not be the most cost effective way to deliver care in the future, but there are positive aspects of care management in a managed care model. We need to think about how we can assure the program's existence in the future as we move forward, shoring up this program and having a system that operates in the best interest of this population.

Rep. Nardello commented that she agreed with Sen. Harp: we do need coordinated care for this high needs population. The best way to deliver this coordinated care still is to be judged. The model the program currently operates under is a for-profit managed care model in which company decisions are based on making or not making money. When it is no longer profitable for the company, the carrier pulls out of the program. HUSKY A is now down to four, possibly soon to be three, managed care plans and HUSKY B may be left with two MCOs. While bottom line issues are understood, policy makers and the State have the responsibility to protect the population through decisions that are not based on profit considerations. This is why the legislature requested the State to look at alternative models in order to meet our responsibilities, as a State and as policy makers.

The Safety Net System

Dr. Judith Krauss was unable to attend today's meeting, as she had to be in Washington. She will present the Institute of Medicine report at the September meeting.

Subcommittee Reports

The subcommittee will report to the Council in September. Jeffrey Walter, Co-Chair of the Behavioral Health subcommittee reported that the Behavioral Health Outcomes study, a landmark study that is possible through the financial support of OPM and DSS, is moving forward, with provider training sessions being held throughout the state in July. Senator Harp thanked DSS for working with the subcommittee to make this study of the effects of outpatient care service delivery on the HUSKY A population. The Senator supports this endeavor and hopes the behavioral health providers will take this study seriously, participating in order that we learn more about our service delivery system and the best way to deliver mental health care to this vulnerable population. Senator stated that change is not a bad thing if we use it to learn what we need to do in order to better deliver care.

The department announced that Sheila Allen Bell will be leaving Benova, the HUSKY enrollment broker, at the end of July. The Council applauded Sheila Allen Bell's efforts, as Regional Director of Benova, to improve the enrollment process as well as her many valuable contributions to the HUSKY program. Senator Harp wished her well on behalf of the Council, stating that Ms. Bell will be sorely missed. Ms. Bell thanked the Council and DSS for their support as Benova worked closely with the department in addressing issues during difficult times.

THE NEXT MEDICAID COUNCIL MEETING WILL BE ON FRIDAY SEPTEMBER 15 AT 9: 30 AM. THE COUNCIL WILL NOT MEET IN AUGUST.

Enjoy the rest of the summer!