Connecticut
Medicaid Managed Care Council
Public Health Subcommittee
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

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HUSKY Nutritional Services Work Group

Meeting Summary: January 15, 2003

Next meeting: Tuesday February 25; 5:30 PM @ CHA

Work Group Purpose

Define provider reimbursement process and treatment planning for obesity-related services, based on the MCO service matrix, within HUSKY Part A and Part B. There will be differences, as Part A is a the Title XIX federal program with service access based on ‘medical necessity’ and Part B is the CT Title XXI State Children’s Health Insurance Program (SCHIP) that is based on the State Employee benefit program. Connecticut chose to design the title XXI program as a stand-alone, non-entitlement program rather than an extension of the Title XIX entitlement program. The components of reimbursement include:

• Identify criteria for obesity and overweight that meets the ICD 9 diagnostic code (i.e. % Body Mass Index).
• Identify other appropriate diagnostic tests (i.e. insulin-resistance testing, hyperlipidemia, elevated triglyceride levels, etc) that support the diagnosis and identify potential or existing morbidities.
• Components of an assessment of the family/youth understanding of the significance of obesity, the need and readiness to participate in ‘healthy lifestyle change’ interventions.
• Identify services that match the sub-population with the appropriate interventions, taking into consideration a family focused, culturally sensitive intervention with measurable outcomes.
• Connect the identified high-risk subpopulation, based on specific criteria, to case management services.

Discussion Highlights and Next Steps

• When considering age appropriate interventions, assess the meaning of obesity to the family/child or youth, and level of family priority in accessing interventions. A hospital-based nutritional clinic provides non-reimbursed services. The ‘no-show’ rate is about 50% and meetings may be scheduled only once per month. The Nutritionist at the clinic recognizes the limitations of the service site (outside the school system) and the effectiveness of the services, noting that a ‘one size fits all’ model is ineffective.
• There was consensus that basic measurements of the efficacy of interventions need to be assessed.
• Health providers requested information on CPT codes for group interventions.
• Two participants described intervention programs:
• Yale New Haven Hospital nutritional clinic has partnered with a 4^th grade class in New Haven and has worked with them about healthy lifestyles, including physical activity and food choices. This has been a well-received program in the school.
• Elaine Gustafson from the Yale School of Nursing described their grant-funded research intervention study, initially reported at the Pediatric Obesity Forum. This was a Type 2 diabetes prevention 2-year pilot of 41 children in 2 New Haven middle schools. The intervention was a family-centered 16-week after school program that consisted of two exercise sessions and one sessions with a registered dietician each week. An experimental An experimental group received coping skills training in addition to the exercise & nutrition. Pre and posttest metabolic tests were performed. A high percentage of the children, included because of their high risk for Type 2 diabetes, initially were shown to be insulin-resistant. At the end of the program the metabolic indicators were improved; the child was no longer insulin resistant, despite minimal weight loss (in their age group weight loss would be minimal). Children & families in the experimental group demonstrated a change in their perception of themselves, based on their parent’s reports and maintained healthier lifestyles throughout the summer.

The work group, after the discussion, identified the information needed for the next meeting, scheduled for Tuesday February 25, at 5:30 PM at the CT Hospital Association in Wallingford:

Ø American Academy of Pediatric obesity guidelines

Ø CPT nutritional codes, including group intervention codes.

Ø Potential costs of obesity-related services, from the payer perspective.

Ø Begin to consider opportunities to incorporate multimodal treatments at sites ‘where the kids are’.