Quality Assurance Subcommittee Meeting Minutes February 2000

Connecticut
Medicaid Managed Care Council
Quality Assurance 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

MEETING SUMMARY

FEBRUARY 23, 2000

Chair: Paula Armbruster

Department of Social Services Update

James Linnane reported on the following;

· Money set aside for MCO incentives for two years has been reconfigured into the capitation rate to the MCO’s, with the exception of approximately $800,000 for the behavioral health outcomes study administrative funds and dental projects (see Medicaid MC Council report February). Mercer (State actuarial) has reconfigured the PMPM category rates, using the incentive money.

· DSS will be negotiating contract amendments with the MCO’s that include the capitation increases.

· Mercer will be the new vendor for managing the encounter data, focusing on the financial aspect of the claims data, allowing the State to determine capitation rates based on utilization patterns, within the Upper Payment Limit. MEDSTAT will overlap the data editing with Mercer into September. It is expected that Mercer will be managing the data as of July 1, 2000. Notice of this will be given to the plans March 1 (90 day notice per contract).

· The Qualidigm EPSDT special project should be reviewed by MCO’s and DSS and available to the Council in March.

· DSS is developing a new contract with Qualidigm: the current contract has been extended to March 31, 2000.

Children’s Health Council Project Update

Mary Alice Lee reported on the following CCHP projects:

· The survey of Children with special Health Needs (CSHCN) will be mailed to families in March. The survey will assess satisfaction with health care provided by the MCO’s and access to health care.

· Behavioral Health project, using 1998 data, looks at readmission rates within 30 days of inpatient discharge and BH ambulatory care follow-up within 30 days of discharge. The facility providing the care can be identified, however it is difficult to identify the provider from the encounter data.

· Third dental utilization assessment for HUSKY children aged 3-19 years who have received any service, preventive and treatment services; completion in 4-6 weeks.

· Assess utilization of EPSDT services based on the two changes made in 1999: 1) initial dental screen at age two rather than age three, 2) increase adolescent screen frequency to yearly screens. Considering tracking anemia screens as the prevalence of anemia is approximately 3% in low-income children and is associated with developmental delays and chronic infections. The Centers for Disease Control recommends screens at 9-12 months, 15-18 months, 2-3 years and 4-5 years of age.

· The Department of Public Health is completing the report on lead screen for HUSKY A children in five cities (Bridgeport, New Haven, Waterbury, Norwich and New London). Approximately 93% of children living in Hartford were screened in 1998. HCFA has required that lead screen be included in the annual 416 report and DSS and DPH has signed an MOU to match Medicaid /DPH lead level data for the report.

· Evaluating ambulatory care utilization by MCO, looking at comparisons of well child care with episodic visits and ED use. For continuously enrolled children with a plan.

SBHC provide more care to HUSKY children and yet cannot be designated a Primary care Provider (PCP) because of lack of 24 hour coverage and school calendar-based service times. Claims technology limitations and lack of insurance information on the student may result in service provision without claims submission. This not only reduces the recouping of reimbursement but also omits services in the encounter data. (SBHC can use the AVES system to determine HUSKY A eligibility). The linkage of SBHC care with the PCP was unclear. This will be referred to the Public Health Subcommittee that has worked with SBHC/MCO and has addressed safety net provider system issues, including data collection, with DPH.

ASTHMA WORKSHOP

Targeted audience: Health providers, MCO’s, state agencies and consumer representatives.

Format: Half-day event at the LOB?.

Content: After considerable discussion and input from providers, MCO’s, State agency, there was an agreement that the ‘workshop’ or roundtable discussion would initiate a series of meetings that would define specifics of covered benefits, based on medical necessity, as they relate to asthma management, identify barriers to securing these benefits, reach agreement to removing barriers (education, policy issues) and determine areas of commonalities in the process of asthma management across plans. It is important to first develop a common frame of reference and ground rules for the problem resolution process that is respectful of all participants.

Sources of information to better define the issues before the next meeting was suggested that included the health provider academies, the MCO’s, quatitative/qualititative data and consumer concerns. The Coalitions Against Asthma would be a valuable resource.

The next meeting of the Asthma Working Group will take place At the LOB before the QA subcommittee at 9 AM on Thursday March 30. The Subcommittee will meet at 10:30 AM.