Behavioral Health Partnership Oversight Council Coordination of Care Subcommittee
Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
Meeting Summary: June 14, 2006
Chair: Sheila Amdur
Next meeting: Wednesday September 13, 12-1:30 PM
The subcommittee reconvened to review the status of previous subcommittee recommendations related to care coordination between the HUSKY MCOs, the BHP agencies and the CTBHP ASO, ValueOptions.
Transportation complaints related to BH services in HUSKY A are collected by HUSKY Infoline (HIL), DSS and VOI/CTBHP.
ü For CY 2005 HIL reported 274 transportation cases, which represents 3% of HUSKY A access to care cases (10,119) to HIL. 87% were helping members use the transportation process vendor contact while 13% involved policy, eligibility and authorization issues.
ü The Quality Subcommittee will discuss adding questions to the client satisfaction survey (addendum: final review at the July 28th meeting).
ü There is also a provider perspective related to problems with patient transportation. DSS stated when a problem is brought to their attention DSS contacts the MCO and/or the vendor.
o When a provider expects multiple trips/month, fax this to the vendor 2 days before the 1st of the month to allow the vendor to schedule transportation.
o Members < 12 years require adult escort; the clinics sometimes provides this.
Independent evaluation of the BHP program
The statute provides for the BHP OC to evaluate or have an evaluation on the BHP program that would go beyond performance measures. The subcommittee will refer the issue to the full Council in September as to the scope of the evaluation and recommendation for financing such an evaluation.
The work group had recommended additions to the current DSS/MCO pharmacy reports. DSS data was reviewed with the SC. The percent of total requests for prior authorization (PA) of the total scripts filled ranged from 1.94% (Anthem), 2.73% (HN), and 0.65% (CHNCT).
Since the SC met in Sept. 2005:
• WellCare/PONE implemented a formulary with the automatic temporary supply (TS) of the prescribed medication similar to CHNCT.
• Both Anthem & Health Net changed their electronic message to their local pharmacy contractors regarding Medicaid Temporary Supply of prescribed medications.
Discussion of pharmacy report:
ü Who is not getting meds when they present script at the pharmacy? DSS said they have data on this but it is not in the report. They do not have numbers on the scripts presented where the provider failed to request PA. The Chair stated that this remains a major issue, since it is unknown how many members leave the pharmacy without the medications.
ü Under Medicaid FFS & SAGA anti-retroviral and MH drugs are exempt from the formulary (preferred drug list). Under the PDL waiver, clients would receive 5-day TS.
ü DSS routinely meets with DCF and MCOs to address medication problems for DCF children.
ü DSS was requested in subsequent reports to routinely identify BH PA/denials.
ü There continues to be significant differences among the MCOs in issuing TS of drugs.
Emergency Room (ED) Visits
The subcommittee recommended that a process be developed by which the ASO would be informed of ED visits related to psychiatric diagnoses in a timely manner. VOI/CTBHP is currently working with EDs, calling them daily to identify BHP members that are held over in the ED, identify reasons, intervene with the BHP agencies and tracking inpatient, residential members with delayed disposition by reason code. There are billing issues for ED stays beyond the 23 hour observation period under the HUSKY waiver. The Operations (Transition) SC will be monitoring the VOI/CTBHP reports.
Medical/Behavioral Health Coordination
The MCOs and VOI/CTBHP have contract language regarding responsibilities for prior authorizations (PA) of admissions with medical/BH diagnoses. The ASO may offer Intensive Care Management (ICM) to clients. If there are conflicts between the two entities, they would be resolved with input from the BHP agencies. DSS is tracking difficult-to-resolve situations.
Dispute Resolution Process
In the case of family/system dispute of patient disposition, the SC recommended a provisional 24-hour authorization process, determined on a case-by-case basis. DSS has asked VOI/CTBHP to develop a policy to address this. Since concurrent reviews are being done, may not need provisional authorization (though discharge from ED that parent/family is seriously concerned about would need some sort of temporary resolution for intensive intervention). Lori Szczygiel (VOI/BHP) noted that the ASO would refer family to peer/family specialists and/or implement ICM to help family/patient/health provider through a crisis. The ASO emphasis is on follow up care post discharge from inpatient/intensive services to ensure connection to next appropriate level of care.
Primary Care/Psychiatric Consultation
How can BH consultation to Primary Care practitioners (PCP) be developed beyond the Enhanced Care Clinic proposal? A significant percentage of medical practitioners manage both their patient's medical and behavioral health needs. DSS stated their perspective is to apply a clinically appropriate cost efficient model through the ECC program; these outcomes would inform appropriate expansion of the consultative system. The chair stated that the ECCs will not be able to provide all of the consultation and integration of care needed. This will be a central issue of focus for the Coordination of Care Subcommittee.