Meeting Summary: Sept. 14, 2006

Chair: Paula Armbruster
(Next meeting: Thursday Oct. 19 @ 9 AM in LOB RM. 3800)

Department of Social Services Update
• Working on identifying top diagnoses for inpatient HUSKY adults as requested by the SC.
• Assessing those children that received dental treatment but no preventive services while enrolled in one MCO for the period 10/04 – 9/30/05 and evidence of preventive care.
• “Mystery Shopper” is looking at timely access to services that include pediatrics, dental and certain specialty services. Be reported to the MMCC in the fall.

CTVoices: Mary Alice Lee
• CTVoices reported on Impact of Pregnancy-Related & Maternal Factors on Well-Baby Care in HUSKY A, 2003 at the Sept. 8^th Medicaid Council meeting. Mary Alice Lee reviewed the salient points of the study for the SC (for the report go to www.ctkidslinks.org):

o 55% of HUSKY A babies received 6 or more well-care visits by 15 months.
o 56% of babies between 31 days and 15 months had at least one ED visit; of those that had ED care, there was an average of 2.3 ED visits per baby. Well-baby visits were not associated with decreased ED use.
o HUSKY Infant enrollment begins to drop at 15 months with 81% remaining enrolled, 74% at age 18 months and only 37% of the cohort is enrolled in HUSKY at age 24 months. The Council encouraged DSS to look at associations of parent eligibility loss with the child's loss of enrollment at that time. Parent/caregiver income eligibility level is at or below 150% FPL. Pregnant women with incomes at 185% FPL are eligible for HUSKY coverage through 60 days postpartum. Some of these mothers may then become ineligible for HUSKY as a parent if the family income is above 150% FPL.
o There were about 2500 births in Medicaid non-managed care, the data for which was not available for this study. The 'new' DSS data warehouse can answer questions about maternal/child outcomes in FFS as well as the number of deliveries under the Medicaid Emergency Medical Assistance category. It is thought that undocumented women, most of whose babies will be eligible for Medicaid, are in this coverage category that pays for labor and delivery, not routine prenatal care.

• Working with DSS to determine how the birth data match information can supplement the required MCO reports to DSS.
HUSKY Nutritional Service Billing Codes

The health plans were requested to provide the SC with outpatient provider billing codes for nutritional services. There was a lengthy discussion about which codes each plan uses that is in provider contracts. It was agreed that information would be finalized in October that would describe child/adult acceptable codes by clinical setting by provider type, identification of required diagnostic code, restrictions/limitations. Janet Davis, WellCare, offered to put together individual plan grids based on the information provided by each MCO to the SC in July. Individual plan grids were then sent to each plan for their internal review and final information at the October meeting.

Women's Forum Recommendations
Draft recommendations were further discussed related to perinatal care issues: oral health and depression. Comments;
• HUSKY collaboration with the DPH perinatal depression public awareness was deemed important.
• CHNCT has linked their dental vendor and Healthy Beginnings program, in which Benecare does outreach and facilitates dental appointments for the pregnant women who the Healthy Beginnings program identified as having had no dental care in the past 6 months.
• The plans continue to find they need to do pregnancy risk assessments for their members as the pregnancy 'registration form' information submitted by the provider site is often incomplete for risk factors.
• Suggested that ValueOptions attend this QA Subcommittee meeting to discuss co-management of high risk maternal members.

Other
Mary Alice Lee noted that the FDA has approved Plan B as an over-the-counter (OTC) drug for those 18 and older. In Medicaid, need a prescription in order to have the OTC drug covered, thus negating the intention of access of the FDA policy.