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: March 20, 2003
 

Chair: Paula Armbruster  Vice-Chair: Mikki Meadows

 

(Next meeting date: May 15, 10:30 AM)

Adolescent Report

 

Maureen Mullen reviewed the changes made in the report as recommended at the last subcommittee meeting.  Provider concerns regarding financial issues were sent to the subcommittee after the last meeting.  It was agreed that the recommendations should include the consideration of 3 questions that were beyond the scope of the report but important in service delivery:

 

• Adequacy of reimbursement for EPSDT services in Medicaid HUSKY program.
• Do teen well visits require more time than other visits and is this considered in the rates?
• Are there adequate numbers of health providers that have experience and expertise with adolescent health in the MCOs panels?

 

In addition, it was recommended that the effect of interventions implemented to improve the comprehensiveness of teen EPSDT visits be assessed in the future in a study similar to the Qualidigm 2000 study.

 

The report was accepted by the subcommittee with the above friendly amendments and will be reported to the Medicaid Council for approval at the next scheduled meeting.

 

Qualidigm Data Validation Report

 

Paula Doyle provided a written summary of the 2002 data validation project performed by Qualidigm as part of the EQRO oversight provision in the contract with DSS (copies are available through DSS  & in LOB RM 3000).

 

Purpose

 

The study purpose was two-fold: 1) validate the encounter data maintained by Mercer, the state actuarial consultant, 2) examine non-EPSDT and family planning visits of clients with no EPSDT encounter visits to determine if an EPSDT service was provided under another code, testing the hypothesis that actual EPSDT utilization rates were higher than reported.

 

Study population

 

A random sample of 120 members per health plan that met the study criteria of :

 

• Continuously enrolled in one HUSKY A MCO for 11 of 12 months during the study period of 10/1/00 through 9/30/2001.
• Between the ages of 10 to 20 years of age
• No encounter for a comprehensive EPSDT visit was identified during the study period.
• A family planning visit was documented during the study period for 20% of the total sample.

 

Results

 

1)      Encounter data validation: There was a 99% agreement of critical data elements between the encounter database, the MCOs’ database and client medical record.  There was variation among MCOs for the key elements of service provider ID and primary procedure code.  Ms Doyle state the MCOs are to be commended for their efforts and persistence in obtaining records for the project.

 

2)      EPSDT Services:  Comprehensive EPSDT services are not being provided and coded differently, as hypothesized.  At least one component of an EPSDT visit was included in 76% of the family planning sample and 55% of the non-EPSDT sample.  Three or more components were found in 19% of the sample, with 36% of family planning visits including 3 or more components and 15% in the non-EPSDT sample.  The common elements included were height, weight and blood pressure measurement.

 

DSS Update

 

Hilary Silver briefly outlined the changes in the HUSKY program:

 

• Service carve-out start dates have been moved forward to July 2004 for behavioral health and January 2004 for dental services.
• The implementation of recent legislation to disenroll HUSKY adult parents & caregivers at 100-150% FPL and the elimination of children’s 12-month continuous eligibility and 6 month adult guaranteed eligibility is effective April 1*.
• The Pharmacy $1.00 co-pay for Medicaid FFS, SAGA & HUSKY A clients >20 years of age will start in mid April. The pharmacist cannot deny Medicaid clients medication because of the client’s inability to pay the co-pay.
• The $1.00 co-pay for ambulatory services will apply to Medicaid FFS and SAGA clients only.

 

*Addendum:  On April 1, the US District Court issued a temporary restraining order to the State to maintain the status quo of HUSKY enrollees who were to lose their eligibility related to PA03-2.  The DSS has been working to reinstate the adult/child’s enrollment & put this information into the MIS system and the MCO database. Until the MCOs receive the new reconciliation enrollment tape, the MCOs need to do a manual lookup to authorize services for these individuals.

 

 

The subcommittee will meet on Thursday May 15 at 10:30 AM at the LOB –RM TBA.