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: May 20, 10:30 AM)
Suggested clarifications include BH services self referral for 1st visit, PA by BH provider for subsequent visits., add P-1 group counseling for specific disease process, other editing.
Dr. Kamens will send the subcommittee a copy of the BMI card given to providers by the Bridgeport Medical Society and see if the State Medical Society could assist in the provision of cards in other counties.
The MCOs noted that calculating the BMI for children requires the child growth chart form that can be downloaded from various web sites. Since these forms can be placed on the chart, the MCOs could consider encouraging providers to use this to calculate and document a child’s BMI.
The Education Committee substitute bill sSB357- An Act Concerning Childhood Obesity -eliminates the pilot programs that included a diabetes assessment and BMI on the school health assessment form. The bill contains provisions for regular activity periods for K-5th grade, school access to dairy and low-fat products as of 9/1/04 and lowers the threshold that triggers school’s mandatory participation in the school breakfast program. The Subcommittee expressed the view that is important to include such information as the BMI, and co-morbid conditions in the school physical form.
Anthem commented that member-incentives for participation in preventive care are being used successfully in other states. P-1 commented they have used incentives in the past for targeted populations with varying results. The DSS will identify CT rules on member incentive limitations and report back in May. Further discuss on this will continue in May.
Drs. Geertsma and Dorsey will present recommendations on obesity at the May meeting.
Next meeting: Thursday
May 20 at 9:30 AM.
(Next
meeting May 20, 9:30 AM)
· Sample forms related to adolescent health were distributed:
o Hillary Silver (DSS) provided the one page Arizona EPSDT tracking form that includes sections on history, screens, physical exam, immunization, anticipatory guidance items, referrals, assessment & plan.
o Maureen Fiore (Health Net) faxed the EPSDT Service work sheet that is now being used by 7 Medicaid plans in New Jersey. These MCOs encourage providers in their network to use the form. The purposes of the form are 1) promote accurate billing with appropriate codes, and 2) serve as a prompt to the practitioner to complete the components of an age-appropriate comprehensive EPSDT service.
o Preferred One described a letter that will go out to their providers as part of their adolescent project.
Discussion identified the best of each of the forms, that could meet CT’s need to improve accurate coding in the EPSDT claims, have a single page EPSDT form that records and prompts the practitioner to consider key EPSDT items and can become part of the chart, reducing provider documentation time. The group agreed to return to this item in the May meeting after the MCO presentation of their QI Adolescent project April 16th..
The Council asked managed care plans, through the DSS, to provide regular reports on use of appropriate medications for members with asthma. The goal of such reports is to identify the number of members with persistent asthma that are prescribed asthma medication appropriately. The health plans do target high risk/high service utilization members with asthma in their voluntary disease management programs. The intent of these reports is to provide information on overall “best clinical practices” in medication management for asthmatic HUSKY children and adults and overtime, assess the impact of best practices on the frequency of asthma-related hospitalizations and ED visits. The HEDIS 2004 asthma medication reporting guidelines, provided by Judi Green (CHNCT), were reviewed. Anthem BCFP will provide what reports they have on this measure (CHNCT will be asked to do the same) for discussion at the May meeting, which may help to define the content of the reports.
The Chair of the Council had requested, through the QA subcommittee, to identify regular reporting parameters for these service utilizations patterns by age and race/ethnicity. The 1998 CHIME hospital (CT) report, provided by DPH, was distributed and a summary of the key diagnosis reasons per group found in the report. Preferred One had reviewed their 2003 ED & hospital data, breaking ED services into non-urgent and urgent by age range. Their data showed that asthma is a key contributor to hospital admissions and ED use. The plan has subsequently revised their member asthma education information and has developed a fax alert to providers with their patient’s pharmacy profiles, for those with ED/hospitalization for asthma. The two other MCOs noted they do review this service utilization internally. The MCOs were asked to provide the most recent report of their members’ hospital & ED (urgent & non-urgent) utilization, identifying the top 10 diagnoses by age cohort at the May meeting. The health plan’s data would not include race/ethnicity.
Paula Armbruster commended the MCOs for their initiatives to ensure their members’ access to good health care and the committee will continue to collaboratively work toward this goal in the future.
· Brian Beisel, principle analyst with the Program Review & Investigations Committee, a non-partisan legislative committee, briefly described the Medicaid eligibility determination study the committee will initiate. Further information will be provided at the April Medicaid MC Council meeting.
· Hillary Silver, DSS, reported that the Department has contracted with Mercer as the Quality Review organization for the HUSKY programs. A brief report of the scope of their work will be presented at the April 16 Council meeting.
The next subcommittee meeting is scheduled for Thursday May 20: Obesity work group at 9:30 Am and the QA SC at 10:30 AM.