Meeting Summary: July 19. 2005

Chair: Paula Armbruster

DSS Update

EPSDT form revision:

The EPSDT task force group met in July.

• It was noted that the anticipatory guidance items on the “matrix” needs to conform to the items on the actual EPSDT revised form that now includes specific items. The work group will consider this.

• EDS is developing a policy transmittal regarding the revised form and an introductory page (for the EDS website).

• The MCOs will have the age-appropriate forms on their web site: the revised forms appear to be more user-friendly for the practitioner (the billing code for that age is on the form as are more detailed Anticipatory Guidance items that can 1) act as a prompt to a provider to consider these areas and 2) promote documentation of the comprehensiveness of the visit, and space to note referrals and follow up for problems identified during the visit).

• “Kick-off” plans for revised EPSDT forms: The Family Practice Association has a conference at the end of October where this information could be highlighted. Given that editing changes are still contemplated, it may be more effective to work with professional associations (such as the Academy of Pediatrics, State/regional Medical Society, Practice Managers association, APRN Assoc) to inform and engage practitioners in using the form, which is voluntary.

2003 Preventive Care: adults with no documented use of services

A report on HUSKY A members by age that identified members with no documented claims-based encounters in the calendar year showed that for adults 18-29 years and 30 years and over, health plans varied considerably in the percentages of those that did not use services. Anthem stated the plan implemented an aggressive outreach to all members. It was suggested that:

• DSS request 1) the MCOs to assess their data to determine the reason for the variability in numbers, look at benchmark indicators and evaluate TPL services and 2) DSS break out the 18-29 group by gender. The SC requested a report back on this in September.

• The SC will identify specific questions that can be asked of the encounter data from a one-time Mercer report on adult health in HUSKY A.

Other

Anthem BCFP asked for more information on the prenatal pre-registration form that has been standardized by the CT HMO Association, described at the July Council meeting and how this form will be used Medicaid plans. It was suggested that this be an item of discussion at the next DSS/MCO meeting, scheduled for October. Staff will follow-up with Janice Perkins, Health Net, who reviewed this at the MMCC meeting.

MCO Adolescent Performance Improvement Projects (PIP)

Since 2003 there has been increased DSS/MCO attention and activity toward outreach to HUSKY adolescents/families to use preventive care services resulting in significant gains.

Several of the QA Subcommittee’s Adolescent Work Group recommendations, accepted by the Medicaid Council, have been addressed by two State agencies:

• The DSS work group revision of the EPSDT forms was an outgrowth of the Work Group’s recommendations that included more explicit anticipatory guidance (for all ages).

• In response to the QA SC Adolescent Work Group recommendations the DSS/MCO contract included MCO PIPs that would address access, quality and comprehensiveness of adolescent care in HUSKY A. The MCOs chose the component they would focus on.

• DPH has recently completed a CT adolescent health strategic plan.

In the 2004 PIPs, the plans reported positive results (at end of chart below). Three of the 4 MCOs addressed the important issue of getting teens engaged in preventive care visits and reported improvement in teen preventive care access. Overall preventive adolescent care:

• HUSKY A Teen screening rates have gradually increased between 2003 -04: 10-14 year old screening rates increased from 67% to 73% and 15-18 year olds increased from 57% to 63%.

• In 2004, the overall EPSDT screening rates (all ages) increased above 80% - for the first time ever, in managed care and Medicaid FFS.

All MCOs will participate in the 2005 adolescent health PIP, with utilization being the primary measurement unit. The 2004 individual plan PIP results would influence the design of the 2005 PIP. While 3 of the 4 MCOs’ initial PIP descriptions presented to the MMCC in April 2004 included some plan to inform providers about the components and importance of a comprehensive teen well visit, only Anthem reported implementing an evaluation of the comprehensiveness of care in the visit. This was a key recommendation accepted by the Medicaid Council but has not become a mandatory component of the 2005 MCO Adolescent PIP. There was concern expressed that focusing on numbers without attendant quality level of EPSDT services does not lead to changes in the outcome of the comprehensiveness of services, in particular for adolescents.

The distribution of the revised EPSDT forms provides an opportunity for each plan to inform providers about the necessary components of an EPSDT visit. And encourage the use of the state form as part of the chart documentation of services.

The QA Subcommittee will meet in September – no meeting in August. The date – September 20^th -presents a conflict for Anthem: will look for another monthly meeting time that can accommodate all the MCOs, Chair, providers and others.

2004 MCO Performance Improvement Projects: Adolescent Care