Meeting Summary: July 12, 2006
Chair: Paula Armbruster
(Next meeting dates: September 14^th and October 19^th at 9 AM at the LOB)

Department of Social Services Update

Hilary Silver reviewed some of the DSS activities:

• Periodicity schedule: clarifying dental services by age 3 years, two preventive visits/year and referrals if hearing loss identified in newborns.
• Immunization schedule updated.
• BH carve-out reports being developed– how the MCO's look at the impact of the carve-out. Include pharmacy (type of prescriptions, diagnosis), non-emergency transportation, quarterly reports on ED visits for psychiatric diagnosis versus other ED visits/diagnoses.
• Finalizing prior authorization reports, reviewing how to account for denied services for which a fair hearing is scheduled.
• Lead data extract given to MCOs on children enrolled in the plan that have never been screened or that require follow-up screens for lead poisoning. Plans will be receiving current data that can be used by the plan to alert child's primary care provider.
• Assessing that of those children that had dental (treatment) services, those without a preventive visit in FFY05 and follow up to identity if they received subsequent preventive services. Discussion:

Dr. Donna Balaski (DSS) described activities related to two children's oral health initiatives included in the 2006 budget. DSS is working with the CT Dental Association and American Academy of Pediatrics (CTAAP) to implement pre-molar sealants and the Access Baby Care (ABC) program. DSS is also working with UCONN to develop pediatric provider education program. Dr. Balaski noted that Dr. Silc at St.Francis & UCONN medical school is training all medical students on oral health exams.

There was discussion on oral health during pregnancy and possible reimbursement for services (root scaling and planning) currently not covered by Medicaid that may be required by about 30% of the pregnant women in HUSKY. Healthy oral health status, especially during pregnancy, is important in reducing the future introduction of bacteria in the oral cavity from mother to child, thus reducing early childhood caries. In addition a growing body of research is showing a relationship between oral infections and preterm deliveries.

There was no funding approved for periodontal services for Medicaid pregnant women (although the services would be covered under EPSDT for those under age 21 years if deemed medically necessary). In the interim, Amy Gagliardi stated there is a clear need to focus attention to HUSKY member education and OBGYN inclusion of questions about last dental visit, and referral for services as needed.

• All the MCOs include oral health questions as part of pregnant women's risk assessment for those women in their intensive case management programs.
• Amy Gagliardi (CHC, Inc) stated all pregnant women in her clinic are asked about recent dental care and referred for preventive/treatment visit as appropriate.

Paula Armbruster suggested that visuals such as posters for oral health care during pregnancy- “good for Mom, good for baby” idea displayed in health care sites along with other education initiatives would begin to shape women's attention and behaviors to this often neglected health care area. Carol Stone (DPH) will bring this to Dr. Ardel Wilson (DPH) and Amy Gagliardi will follow up with Dr. Wilson about existing initiatives and support for member and provider educations.

ED Utilization
Jennifer Susi, QA Analyst, Health Net, provided information on CY 2005 ED utilization (see attached report). The plans will send staff their reports, which can be added to the MCO ED project descriptions.

Obesity-related Nutritional Codes
CHNCT provided billing code guidelines for hospital-based nutritional services. The plans were asked to email staff their information so it can be added to the matrix. A memo requesting the information was sent to clarify the request.

Next Subcommittee meetings: Thursday September 14 and October 19^th. Meetings will convene at 9 Am at the LOB. No August meeting is scheduled.