Connecticut Medicaid Managed Care Council

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) 240-0023
www.cga.ct.gov/ph/medicaid

Meeting Summary: October 21, 2004

Chair: Paula Armbruster

Lead Poisoning

ü Ronald Krantz, Projector Director of the LAMPP project, had presented an overview of the project at the September MMCC meeting, after which Sen. Harp, Council Chair, requested the QA Subcommittee follow up on Medicaid Lead Poisoning & Screening. Project Coordinator Amy McLean Salls provided the SC with information on the LAMPP project as well as the Hartford-based Healthy Homes project.

The LAMPP project is an innovative State of Connecticut early intervention and prevention program to reduce lead hazards for Medicaid enrolled children under 6 years. The DSS is the primary sponsor for LAMPP along with DPH and the CT Dept of Economic and Community Development. The goal is to protect children before lead poisoning occurs, intervene at lower blood lead levels (10-19 ug/dl) as well as prevent lead exposure to children occupying the same housing in the future. In CT, landlords must legally abate household units where a child has lead levels at 20ug/dl; however private landlords seldom reduce lead hazards in rental units where children may have lower lead levels. LAMPP referrals can come from landlords, practitioners, community organizations and HUSKY MCOs.

· LAMPP is funded by two grants ($5.6M) from the US Dept of Housing and Urban Development (HUD) and by over $5M matching contributions from state and community partners.

· Project participants include six target communities – Bridgeport, Danbury, Meriden, Norwalk, Waterbury and West Haven – plus Enfield, Hartford, New Britain, New Haven and Stamford.

· The DSS has contracted with the CT Children’s Medical Center to operate the program along with the two regional lead treatment centers at Yale New Haven Hospital and Hartford.

o Education and risk assessments of families with Medicaid enrolled children under age 6 years who live in pre 1978 housing as well as landlord and contractor education on low cost lead hazard interventions, lead safe work practices and disclosure rules.

o Low-level lead hazard reduction for 433 units, more intensive lead hazard abatement in 129 additional units.

· Property owners that participate in the project contribute $600/unit & assist with temporary relocation of occupants. The LAMPP project will provide on average $6,500 per unit for lead reduction.

· The owner agrees, for a 3-year period, to give rental priority to families with children <6 years, maintain affordable rent levels and rent to lower-income families (defined by HUD) and maintain the units in accordance with the federal Housing Quality Standard.

ü The Healthy Homes program, funded by EPA, and the Hartford Foundation for Public Giving, uses the lead poisoning prevention model, extending this to environmental aspects of asthma and injury prevention. The program utilizes community outreach and medical staff to provide families with education & remediation of asthma triggers as well as home education about household injury prevention. (See www.saintfranciscare.com, click on ‘children’s programs’. For more information on this Hartford-based initiative contact Sue Sarvey at SFH 860-714-5184).

The LAMPP program, the Lead Treatment centers and Healthy Homes exemplify community-based case management and care coordination for families at risk for or affected by environmental risk. Families are referred by providers, local health department and others. The Healthy Homes program seems to provide an efficient home-based intervention for several environmental hazards that adversely affect children’s health. It is important that these programs create linkages with the existing health care delivery system, including primary care providers and the Medicaid Managed Care Organizations. Measurement of the outcomes of the programs, in particular LAMPP and Healthy Homes, need to be shared with the MCOs through the QA SC in order that initiatives can influence the future delivery of care in the HUSKY programs.

ü The Department of Public Health discussed the status of the DPH/DSS lead data match. Matching DPH lead screens and lead level data with Medicaid enrollees is necessary for compliance with the CMS 416 reports as well as providing this data to the managed care organizations, responsible for health care management in HUSKY A. Justin Peng, the DPH Lead Data Management epidemiologist and Eileen Bouley, DPH Program Director for the agency’s Childhood Lead Program, discussed the DPH new lead surveillance system that is being tested by matching 2002 Medicaid files with DPH lead data for children aged 0-6 years. Since lead tests are generally performed at state labs at no cost to the MCOs, the MCO does not have claims data to track tests done for their members. The plans do not know which children have been tested, if follow up confirmatory tests have been done and their members’ lead levels >10-19ug/dl; therefore the MCO have little basis to assign case management services, under EPSDT guidelines, to their members as needed. In the near future, it is essential that DPH, DSS and the MCOs establish timely data match reporting parameters that will allow the MCOs to fulfill their responsibilities for health service management under EPSDT. The SC will follow up on this with DSS.

Updates

ü Mary Alice Lee, CTVoices, stated they just received the enrollment files and will now proceed with independent monitoring of children & pregnant women’s care in the HUSKY A program. At this time CTVoices has funding only for the 2002 birth data match, although 2003 DPH birth data is available.

o Hilary Silver (DSS) has been working with the MCOs, AAP and Council/SC representatives to revise the state EPSDT forms and develop more explicit anticipatory guidance items, particularly for adolescents.

o DPH has contracted with Ct Association of Humans Services (CAHS) to develop a teen health care tool kit for providers. Maureen Mullen has met with CAHS about this initiative.

o The DPH has contracted with an organization to develop a statewide Adolescent Health Strategic plan; the QA SC is anxious to have input into the process.