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: August 1, 2002

Chair: Paula Armbruster

Nutritional Services in the Husky Program

At a previous meeting, a representative from the provider community suggested the subcommittee develop a matrix of MCO authorization for nutritional services. The meeting participants used a very early draft of a matrix and made the following recommendations (see accompanying grid):

Nutritional services should be inclusive, rather than limited to pediatric obesity.
There will be differences in medical necessity for children in HUSKY A (EPSDT), HUSKY B and adults in HUSKY A.
Address nutritional service prior authorization criteria by the top diagnoses that would require these services.
Include the range of services authorizations per diagnosis (i.e. for obesity, include nutritional counseling, pharmacy, exercise programs).
Identify type of nutritional visits approved (i.e. group/individual sessions) limitations.
Identify provider level and affiliation limitations in approval process.

Providers have stated they have difficulty receiving approvals and/or reimbursement for nutritional services; however a representative from the YNHH Primary care Clinic stated they have access to nutritional counseling within the clinic and have not encountered problems. Service site may influence the authorization process. Judy Blei, representative of provider groups, was asked to provide general information about barriers to services, from the health provider perspective at the September meeting.

Qualidigm Update

The fourth operations audit has been completed and all the plans scored well. Two new categories and twice the indicators from 2001 had been added. The MCOs will respond to their individual reports, Qualidimg will re-visit the plans to review the correction action plan and finalize the report. A review of the report should be available to the Council in December.
The chart abstraction for the data valid project is underway. There has been a significant improvement in obtaining the charts because the health plans have been more assertive in obtaining them from providers. The data validation looks at encounter data, excluding EPSDT services for HUSKY A members aged 10-20 years, then assess if EPSDT services were provided and incorrectly coded. The final report for this study is due October.
The third phase of the psychotropic study is in process, identifying multi- drug prescriptions within a 3-month period for children 0-18 years, with a chart review by an expert panel to determine appropriateness of the prescriptions. Phase II found that the majority of psychotropic drugs prescribed young children were for medical reasons rather than for psychiatric diagnoses. The MCOs have prescription data by pharmacy/provider and could assist Qualidigm in identifying prescribing provider type. Paula Armbruster had been appointed by Senator Harp to participate in the psychotropic study; however she has not participated beyond the 1^st phase. Qualidigm was requested to continue allowing the Council to participate in the study.
Qualidigm will present the 2000 & 2001 ‘Mystery Shopper’ studies and the 2001 data validation results at the September meeting.

Children’s Health Council Update.

The CHC budget for FY03 was reduced another 10% to $1.2M. The CHC will rewrite their contract with DSS, which will include performance monitoring, policy development and the ongoing linkage of birth data and Title V data between DSS and DPH. The CHIL function has been assumed under the United Way; CHC will sign an MOU with United Way for data sharing and case discussion.
Community education and provider training programs have been in place during FY02; Mary Alice Lee was uncertain as to the availability of information from these endeavors because of staff reductions. Provider information needs are important for the improvement of the operations of the program.

DSS Update

Hilary Silver reported that there is an initiative underway to match substance abuse data among the different agencies that provide these services. This data linkage among State agencies for a specific population is a significant and important undertaking.

The Subcommittee is scheduled to meet on Thursday September 19, 10:30 AM. One agenda item will be to review the data provided by the MCO’s on nutritional services.

The Adolescent Work Group will meet September 10 at 4:30 PM (although a later meeting start time has been proposed, perhaps moving the meeting site to mid-state).

Accessing Nutritional Services In the HUSKY Program

Health Plan: Anthem CHNCT Health Net _ FirstChoice/Preferred One