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: HUSKY Nutrition Work Group

 

March 20, 2003

 

Review of February Meeting Questions

 

Dr. Beth Malko (ABCFP medical director) and the other 2 plans in attendance (Health Net, FirstChoice/Preferred One) provided clarification about pediatric obesity service coverage in HUSKY A.  There was general agreement that:

 

1) Medically necessary and medically appropriate services for pediatric obesity would be covered under the EPSDT provisions in HUSKY A. The MCO may require Prior Authorization (PA) for some services.

 

2) Dr. Malko stated that since MCOs do not generally match the ICD 9 code to the CPT code providers would be reimbursed for an office code that may be related to obesity with or without comorbidities. Her perception as a commercial and Medicaid provider is that a myth has developed about non-coverage of obesity services, perhaps related to the Medicare experience.  There was agreement that health providers should be informed about the HUSKY A process (which was the reason for the work group).

 

3) Nutritional counseling would be a reimbursable service, depending on the MCO contracts with these providers (i.e a clinic).  There was agreement that out-of-network provider services would be approved as needed (i.e. referral by a PCP to a Registered Dietician).

 

4) Obesity related services are varied and the provider can discuss the service request with the MCO medical director if there are any PA requirements or denials.

 

Non-PCP, participating providers

 

• The MCOs will clarify plan policies about acceptance of non-PCP (i.e. SBHC provider) referrals for services such as nutritional services.

 

• There was agreement that inherent in this issue is the importance of continuity of care & process for communication with the patient’s PCP.

 

 

Discussion

 

A nursing student attending the meeting commented on her experience as a parent of an overweight child, emphasizing that exercise, which needs to be attractive to the youngster, is a cornerstone of pediatric weight management.  She mentioned an exercise mat game “dance, dance, revolution” is popular with kids.  Dr. Malko commented that Weight Watchers, which in her opinion has the best outcomes, now has a pediatric program. Dr. Malko stated that a recommendation should be made for the new DPH Obesity grant to include elements of an inner city program that addresses racial/ethnic issues.

 

 

Upcoming Work Group Focus

 

MCOs define obesity, based on national guidelines, propose intervention guidelines for children and adults and provide this information to providers.  The Work Group can prepare an outline for providers that include the above as well as information about MCO network obesity services resources and MCO contacts.  Follow up at the next QA subcommittee meeting May 15, 10:30 AM.