Connecticut
Medicaid Managed Care Council
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: July 15, 2004

Chair: Paula Armbruster

(Next meeting: Thursday September 16, 10:30 AM)

CTVoices (formally Children’s Health Council) Update

The CHC closed in the fall of 2003; however they now have a contract with DSS as of July 1, 2004. Mary Alice Lee stated they have HUSKY data and will resume the performance monitoring they had done in the past. Included in their scope of work is the Birth data match for 2002. DSS and DPH had signed a MOU for data sharing. They had discussed monitoring HUSKY A adult health utilization with DSS (reports on adult health- parents and caregivers of HHUSKY children had been requested by the Council, focusing on the health of the family health). The QA requested reports on ED and hospitalization patterns and asthma medication that include adults as well children.

The DPH also matches DPH lead data with Medicaid, which forms the lead screen data required in the federal Medicaid HCFA 416 reports. Health Net seemed to be the only health plan that obtains lead screens and lead levels from their own lab vendor Quest. Most lead levels are performed at state labs and the tests are paid by the State. Both private & state labs are required to report the screen & level to DPH. Since there is no service claim associated with the test performed by a state lab, the HUSKY MCOs do not know 1) if or when a test is done and 2) the lead level of the child, thus making it difficult for the MCO to track or case manage children. Dr. Geertsma stated his hospital primary care clinic does request the lab test results and tracks lead screens and level within their clinic practice. Linking the WIC hemoglobin tests with lead screens may better ensure these screens are done in Medicaid. While some providers may track lead screens for their patients, the MCOs really need to have more timely reports in their system.

Action: Staff will follow-up with the DPH staff on this.

Obesity Matrix Distribution

The Matrix developed and approved by the subcommittee has to date been sent to the SC, the Obesity work group and will be distributed at the Council meeting July 16.

Action steps:

· Council staff will send to the email list of FQHC and SBHC, the DPH contract person for these two safety net providers, the CT AAP and Family Practice Assoc., Infoline and will place this on the Council web site.

· The MCOs will distribute and place on their web site their plan’s matrix.

· The DSS will look into placing this and other access matrices on their HUSKY web site.

· Staff will send to legislative commissions, appropriate committees, & Parish nursing contacts (and will look to the CHA’s assistance in getting information to the hospital-based clinics).

Paula Armbruster will, with Drs. Karen Dorsey & Alex Geertsma, present the QA Obesity recommendations to the Medicaid Council on July 16. {Addendum: July 16, Sen. Harp asked the Council to further review the recommendations and come prepared to discuss and vote on these in September).

Department of Social Services: HUSKY Quality Measurement

Rose Ciarcia reviewed the various vehicles for quality measurement in the HUSKY program:

ü Mercer, the EQRO contractor, is in the process of performing operational audits, which includes review of three of each MCOs quality improvement projects. Mercer also will perform ad hoc special reports for DSS. The proposal was submitted to DSS after Mercer obtained input from the Council subcommittees and others.

ü The DSS now has a contract with CTVoices.

ü The MCOs have performance improvement projects (PIPs); DSS has discussed with the MCOs adopting a common PIP – not yet identified.

Adolescent Health:

Paula Armbruster discussed the commitment the QA committee has to follow-up on two areas originating from the June 9 MCO/practitioner meeting: more explicit teen anticipatory guidance items, and a voluntary user-friendly practitioner Teen well care visit form that would include anticipatory guidance areas, components of an EPSDT visit, and billing codes.

Action step:

The DSS will set up meetings with MCOs, providers, with Maureen Mullen’s assistance, to address the forms, bringing form recommendations back to the subcommittee in October.

The QA Subcommittee will meet Thursday September 16 at 10:30 AM in the LOB.

The Medicaid Managed Care Council will meet the following morning on September 17.

MMCC & QA SC Teen Health Meeting

June 04