Meeting Summary: September 9, 2005

(Next meeting Friday, October 14, 2005 @ (9:30 AM)

Present: Sen. Toni Harp (Chair), Sen. Edith Prague, Rep. Vicki Nardello, Rep. David McCluskey, David Parrella & Rose Ciarcia (DSS), Thomas Deasy (Comptroller’s Office), Martha Okafor (DPH), Barbara Parks Wolf (OPM), Dr. Victoria Niman & Auralee Kamm (DCF), Jeffrey Walter, Ellen Andrews, Janice Perkins (MCO rep), Mary Alice Lee, Robyn Hoffman, and

Also Present: Cuyler Masiotti & Hilary Silver (DSS), William Diamond (ACS), Sylvia Kelly (CHNCT), Paula Smyth (Anthem BCFP), David Smith (POne), Chet Brodnicki (Child Guidance Clinics), Dr. Larry Loeb (Chair, DSS Dental Advisory Comm.), Dr. Kurt Koral (SDA), Deb Poerio (SBHC), M. McCourt (Council staff).

The Council recognized Martha Okafor, DPH, for her 12 years of leadership in creating initiatives to improve health care for children and families with a citation from the CGA.

Department of Social Services

Update: HUSKY Program Change Implementation Timeframes

Ø HUSKY B Premiums – new and increases- are effective 10/1/05. The MCOs have made their system changes once again and DSS has sent notices out to HUSKY members. Premiums are due 10/15/05 to the MCO. Failure to pay premium results in dis-enrollment (effective 11/1/05). Upon receipt of past due month (s) payments & current month payment, the member will be re-enrolled in the same plan AFTER a 3-month lock out period.

Council comments on this:

ü 96% of the HUSKY B children enrolled in HUSKY B are affected by this policy (Band 1=9778 children, Band 2=5458 & Band 3=670).

ü DSS anticipates a 10% dis-enrollment rate (In June 2004 the number of potentially dis-enrolled children was 3700 & DSS returned to the pre-Feb 04 premiums.)

ü Premiums, deducted from the MCO monthly PMPM payments, would reduce State dollars spent in HUSKY B, as would decrease enrollment.

ü Notices regarding the premium changes instructs families to contact ACS if their household income has changed as they may be eligible for HUSKY A (no premiums).

ü In general agency administrative costs for submitting waivers is around $100,000.

Ø Katie Beckett Model Waiver: Anticipated implementation date is winter 2006. Requires CMS approval of a waiver amendment to expand the number of slots from 125 to 180 (instead of to 200, the intent of the CT General Assembly). DSS was asked to review the change from 200 to 180 expansion slots and provide information on the financial rationale for the number of expansion slots in the waiver amendment at the October meeting. DSS will review with the Commissioner and OPM.

Ø Family Planning (FP) waiver, being developed with an advisory group, may be submitted in early spring 2006. State services consistent with federal FP guidelines receive a 90% federal match. Including services such as mental health that are outside the federal guidelines would result in a lower match rate for those services.

Discussion:

ü Provider sites include FP clinics, hospital and community health clinics and school based health centers, as well as other Medicaid providers.

ü FP services include basic gynecological screens, contraceptives, treatment of STD’s and other related health conditions.

ü DSS would consider coordination of CDC/DPH breast/cervical cancer screens with FP services if there is a mechanism to do this.

Ø HUSKY Children’s Presumptive Eligibility (PE) implementation date is Nov.1, 2005.

o Requires completion of the full HUSKY application.

o PE and expedited applications for pregnant women will go to 3 DSS regional offices: New Haven, Bridgeport and Hartford.

Ø Expedited pregnant women’s eligibility policy implementation is October 2005. DSS has been working with Healthy Start programs to define emergency 24-hour determinations and develop training programs based on the policy changes. The timeliness of application processing will be reported semi-annually, to the Medicaid Council.

State Services for Katrina evacuees

Some of the people evacuated after Katrina have come to Connecticut to be with their families or sponsored by individuals/groups. DSS has been receiving requests for services. The Department has been working with Washington on state processes to assist evacuees from the areas hardest hit by Katrina. While states expect to receive a standard waiver format to implement access to services, CT has taken the following interim steps:

ü Evacuees can apply to Medicaid (a one-page screening form can be used); self-verification of income and identification will be accepted. DSS regional offices (RA) have been instructed to expedite the applications.

ü 211 staff has been provided with a script to assist the caller to apply for cash assistance, food stamps and medical coverage.

ü The application process for food stamps has been expedited, in that the eligibility determination will be made the same day the application is received and the food stamps will get to the person in 3 days.

ü Social work staff in the RA will meet with clients, assess social & psychological needs and refer the person to appropriate services.

Eligibility Outcomes for HUSKY Transitional Benefits Clients (click on report below)

Cuyler Massicotte (DSS) provided data on the disposition of 10,300 families that had received coverage extensions through June 2005 and were scheduled to renew their applications when the legislature expanded HUSKY A adult/caregiver income eligibility from 100% to 150% FPL. DSS also extended coverage to 575 families due for April review and 725 families scheduled for eligibility review in May 2005.

Other reasons for coverage loss included adult income >150% (children would remain eligible if family income is < 185% FPL), child reached age19 (672 individuals), total family income exceeded the various income limits (children should have been referred to HUSKY B – DSS will confirm this), and person received coverage in other programs (1,339).

Council comments, recommendations:

Ø Can Human Service Infrastructure or communities find those who have not renewed? While DSS could contract with community organizations, the agency doesn’t have those resources. Other entities may fall outside the confidentiality and HIPAA protection.

Ø DSS has rewritten client notices; all notices need to meet a 6^th grade reading level.

Ø MCOs, who are paid a monthly rate based on per member/age/gender and county, have all contacted their dis-enrolled members by letter and phone and sent out HUSKY applications.

Ø SBHC had met with DSS twice regarding the growing number of uninsured in the Centers; however, according to DSS, lack of resources to pay SBHC for outreach and implementation of legislative changes have halted the discussions.

Ø Adding another field on the application to include contact information of the entity that helped the person with their application would be less costly than ‘churning’ enrollment. The entity could track the families that have not renewed their HUSKY application.

Ø DSS observed that on-line applications show promise in facilitating applications and renewals.

In order to target resources appropriately, the legislature needs to identify effective outreach strategies. In the past significant dollars have been spent on “outreach” with limited measurable success.

The Council recommended DSS develop a representative group to identify “what works” for outreach in getting families insured and keeping those eligible insured. Further, Rep. McCluskey strongly recommended that, since there is an established link between the status of a child’s health and school performance, that OPM coordinate an inter-agency initiative with DSS and the State Department of Education in addressing access to HUSKY health coverage.

Sen. Harp commented that DSS operations are constrained by budget options determined by OPM and the Governor’s budget. The state budget is limited by the spending cap and the political will to exceed the cap. It is important for the legislature to know the strategies and costs for effective outreach before a budget is released; after that point the agency cannot discuss options outside the Governor’s proposed budget.

HUSKY A and B Data Reports (click on report presented at the meeting)

Ø Revised total revenue/expense report provided (see last page of Util. Report above).

Ø Inpatient days/1000MM similar to same time period, average length of stay in 10/04-3/05 is higher (3.5) compared to about 3.2 for previous year time period.

Ø Emergency Room visits/1000MM remain unchanged at about 60 visits/1000MM. (Fee-for-service was 72/1000MM in 1994). This translates into 720visits/1000members over a 12- month period. CHNCT and Preferred One have higher rates. HUSKY B (children only) ER visit rate is less than half HUSKY A rates, at 24-25/1000MM. In light of the Health Care disparities in 2003 (CTVoices), which showed that Hispanic children were more likely that Caucasian children to have emergency care, Sen. Harp referred ED and disparity issues to the Quality assurance subcommittee.

Ø Maternal Care:

o 1^st trimester HUSKY enrollment rates slightly decreased to about 58% in the 2^nd half 2004 (members who change plans are excluded). Anthem was below this rate; however the plan reported 358 deliveries with insufficient data.

o The percentage of women that receive 80% of PNC visits decreased in the 2nd half 2004 (75%) compared to 80% previously. Anthem exceeded the average at 88%, Health Net reported 70% and PONE increased almost 10 points to 71%.

o The % of women that receive timely PP visits increased by 10 points to about 65%. Missing data or PP care outside the indicator parameter makes this performance data difficult to accurately assess.

DSS has received birth data from DPH to match with Medicaid data (will be done every six months) once DSS secures software to manage the large data file. This data match will provide more accurate data and relieve practitioners and MCOs of laborious data collection for utilization reports to DSS.

Ø HUSKY B reports:

DSS was asked to assess the 10% difference in dental access as HUSKY B utilization is actually lower than HUSKY A, and ED HUSKY A visits that are double that of HUSKY B. The differences in access are puzzling in that both programs share the same provider network with the same HUSKY A & B MCOs. The Council Chair requested that data reports such as ED visits be accompanied by comparable Medicaid data from other states and HEDIS measures.

HUSKY A & B Enrollment

William Diamond (ACS, State HUSKY Enrollment Broker) reviewed enrollment for September. Monthly enrollment reductions continue, cases are pending longer since the requirement for income verification was implemented. Summary of enrollment report:

Other HUSKY Program Changes

Anthem will change their dental vendor, with the conversion completed by November 1, 2005. Anthem was requested to provide information at the October Council meeting on the subcontractor transition and provider transition process including provision of fee information before the contract is signed

Child Health/Disparities: CT Voices, Mary Alice Lee (click on report)

Report identified 2003 continuously enrolled children, with encounter data for preventive, emergency, hospital care and those with asthma related services and calculated likelihood of care among African Americans and Hispanic children. There were differences among the three groups in that:

• Hispanic children were more likely than white children to have dental preventive care.

• Hispanic children were more likely than white children to have emergency or hospital care.

• African American and Hispanic children were more likely to have asthma and have had an ED asthma –related visit.

• African American children were less likely than white children to have well child care, other primary care, and preventive dental care.

Preferred One Improvement Plans

The Council requested DSS present PONE “turn-around” plans to the Council during the July discussion of revenue/expenses. David Smith (PONE) reviewed the plan’s focus on quality scores, access, medical benefits related to members and providers:

Ø Quality:

o The EPSDT screens were over 80% in the last half of 2004.

o Increased fees for teen preventive services and dental services as part of a focused attempt to improve service access in this area.

o Worked on Mercer audit areas, developing a corrective action plan.

Ø Access

o Working to expand network, in particular sub specialty care.

o Pilot: provide every other Saturday dental services focusing on families that had no dental care in the last 12 months.

Ø Provider rates:

o Targeted certain providers where service utilization is low.

Discussion:

• Do MCOs periodically review contracts and rates with network providers? Medicaid fee-for-service changes are automatically included in the fees. Fee change requests must come from the providers or at the time of contract renewals.

• Dental access: ‘any dental service” includes dental restorative care – reports include preventive and ‘any dental’ services. It is difficult for the Council to assess who actually received restorative services. Mary Alice Lee stated they found that about 20% of children received restorative services. Children receiving dental screens were eight times more likely to get treatment. Dr. Loeb stated that on the service form other planned visits are identified.

• Regarding EPSDT visit screens and PONE’s plan to increase fees: Sen. Harp stated that the Council will focus on the comprehensiveness of the EPSDT visit and will be looking to see how the MCOs address this.

Council Quarterly Report

A motion to accept the report for 1^st & 2^nd Quarters 2005 was seconded and the report was approved without change.

The Medicaid Council will meet Friday October 14 at 9:30 AM in LOB RM 1D.