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
(Next meeting:
Work Group @ 9:30 on 4/15, followed by QA SC @ 10:30 AM in LOB RM 2600)
· Clarify (Anthem and CHNCT) that obesity-related services in HUSKY A, under EPSDT medical necessity, are not predicated on evidence of co-morbidities, but on medically necessary assessments/interventions by the health practitioner. The EPSDT medical necessity would not apply to HUSKY B children nor to HUSKY A adults.
· Dr. Geertsma encouraged the MCOs to apply strict criteria for authorization for gastric surgery for members <18 years; consider criteria for mental health assessment as well.
· Editing changes were made per the suggestions of the work group. The matrices will be ready for the 4/15 meeting. Dr. Geertsma suggested Council staff contact the AAP Ex. Dir. as to how this information can best be disseminated to AAP providers.
Elizabeth Brown reviewed SB 357: An Act concerning Childhood Obesity. One part of the bill provides for 3 school-based pilots for the assessment of diabetes and BMI on the school physical form. Subcommittee participants suggested amending the pilot language to be less prescriptive and several members agreed to contact towns to gauge their interest in participating I the pilot.
(Addendum: On April 8, the Education Committee reported
favorably on a substitute bill 357, file no.520 that does not include the
school pilots but provides for physical activity daily/weekly in grades K-5,
makes available the purchase of dairy products, water on school site, expands
the federal school breakfast program to schools grades 8 and below in which at
least forty % of students are eligible for free or reduced lunches).
The Work Group participants and QA subcommittee, which include MCOs, state agencies, providers, commission on Children representative, will develop basic pediatric obesity recommendations. Dr. Geertsma and Dr. Karen Dorsey will take the lead on this.
The importance of early intervention at age 2-4 years through parental anticipatory guidance in preventing parent/child behavioral patterns that may lead to obesity has been noted several times in the work group. Will request that DPH bring their expertise to this topic and consider how this might fit into their early Childhood Partners program.
File: QA SC & Obesity
Mar-04
Meeting summary: Quality Assurance
Subcommittee – March 18, 2004
(Next meeting:
Thursday April 15 at 10:30 Am LOB RM 2600)
·
Agreement for regular
reports from MCOs on child/adult hospital & ED utilization rates,
identifying the top primary diagnoses that would provide the application of a
broader public health perspective, particularly for adult health issues.
The DPH sent the 1998 CHIME data reports that could provide a baseline
comparison.
·
Annual MCO report on
appropriate use of asthma medications based on the current HEDIS measure (see
attachment from Judi Greene, CHNCT).
o
Suggestion to contact John
Farrell about their software system that can produce data in response to
specific queries. (Spoke with Mr. Farrell: this system is proprietary, but
the capacity of the system could be discussed in the future).
·
Continued focus on obesity
in HUSKY population, and adolescent health.
Regarding the latter, the MCOs will provide a brief overview of their
adolescent projects at the April 16 Medicaid Council meeting.
o
The MCOs will develop
action plans for improving the delivery of adolescent health, which was
requested of the DSS by the Medicaid Council. (The contract requires MCOs to
submit a plan that includes measures to increase the volume of well care
adolescent screens and improvement of the quality and completeness of these
screens, based on AAP guidelines. Emphasis should be on improving health risk
assessments and anticipatory guidance during the visits.
The MCOs will work with the DSS and representatives of other state
agencies to develop a best practice model for adolescent care).
o
Maureen Fiore (Health
Net) sent us this great web site,
which includes adolescent preventive care & risk assessment recommendations, anticipatory guidance
items. Access this at: www.intermountainhealth.org
find specific items under hospital, clinic, services.
o
The subcommittee will
organize a meeting with the MCOs, DSS, and interested HUSKY adolescent
practitioners to 1) review and discuss the MCO adolescent pilots and 2) review
and comment on the expanded teen anticipatory guidelines that would be added to
the state EPSDT form.
The QA subcommittee will meet Thursday
April 15, 10:30 AM in LOB RM 2600