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: November 29, 2006
Chair: Sheila Amdur
Next meeting: Wed. January 24, 2007 @ 9:30 AM Room TBA
November meeting summary review: subcommittee members provided and accepted the following changes to the meeting summary that were included in the November 1, 2006 summary:
• WellCare stated that the plan has incorporated a local pharmacy message similar to Anthem & Health Net. In addition, once the local pharmacy contacts WellCare because of a denial/rejection of a script, an automatic override for a temporary drug is always made.
• Sheldon Toubman provided 2002-2003 data provided by Health Net under oath in discovery in the Karen L v. Health Net and DSS case showing that, for its entire Medicaid managed care population, there were about 3,000 rejections at the pharmacy each month for lack of prior authorization for a covered drug, and that about 2 to 3% of these rejections resulted in a TS of the drug being issued within 24 hours.
Dr. Mark Schaefer (DSS) reported that a BHP Operations Committee composed of MCOs, DSS and DCF, and CT BHP/ValueOptions has been formed to work on issues related to clients' ability to access services. Transportation is a key focus area. The Committee agreed there was lack of clarity about the transportation guidelines and plans to, with consumer, provider and transportation vendor input, articulate clear guidelines for clients, providers and the vendors.
Most of the information about transportation problems comes from anecdotal reports. VOI, MCOs and transportation vendors receive few complaints other than clients calling the vendor when a ride is late. Quantitative data on BH-related transportation will be available in 2007 from:
• The VOI member satisfaction survey, which includes a broad question about transportation; the provider survey had apparently been started, so transportation questions could not be added. The member survey results will be finalized in January or February 2007.
• The Committee will identify the specifications of the quarterly HUSKY BH transportation report that may include identifying unduplicated users vs. multiple users by service type. It is expected the reporting period would begin in December 2006. It was suggested that this BH transportation data report could inform quantitative data reporting on medical transportation.
• Drivers' 5-year criminal history check is done by DMV through the licensing process. A question was raised as to whether the Medicaid transportation vendor does/or should perform random drug tests on drivers. DSS will report back on the DMV screening process.
The Committee and the BHP are interested in soliciting qualitative data on transportation issues through:
• Transportation vendors' discussion with livery drivers for their perspective on transportation problems and improved efficiency of the system.
• BHP would bring issues to periodic BH provider meetings and follow up with guidelines as part of provider education about how the transportation system for BH services functions and resources for client assistance.
• Logisticare is meeting with the local collaboratives and 3 Local Area Development Plans (LADP) have identified transportation as a key area to be addressed. The CTBHP/VOI Consumer Advisory gathers information and is considering creating posters for health care sites.
• The BHP invited the Coordination of Care SC to host a separate meeting on BH transportation issues for consumer input into the guideline development. Organizations with statewide parent/family member representation such as FAVOR, the DCF Children's BH Council, the state foster parent association, etc. would be a starting place for developing such a transportation forum.
Primary Care (PC) & Psychiatry
• Judith Meyers (CHDI) reminded the group about the Request for Proposal (RFP) for 3 PC centers to build infrastructure for PC/BH integration. Information can be found at: www.chdi.org
• Dr. Steven Kant (CTBHP/VOI Medical Director) spoke about the PC Advisory Committee that is providing feedback regarding PC/BH practice integration. One issue for the PC providers is timely PC screening when the PC knows the patient can access services. While ECCs will be an important part of addressing this concern, the CTBHP/VOI currently is a primary resource for PC provider assistance in connecting HUSKY A & B members to BH services in their areas. It is important for the HUSKY MCO Medical Directors and MCOs work with this Committee on the integration process for co-morbidities.
• Perinatal depression recommendations from the Medicaid Council Quality SC were approved by the BHP OC Quality & Management SC. This SC may want to discuss this as well. Dr. Schaefer noted that HUSKY adult care reports are left out at times; services for perinatal depression could be provided by an ECC, as some clinic applications for ECC status do provide adult BH services.
Sheila Amdur reviewed the study outline (see below) developed in the SC work group. The SC participants agreed with the study outline.
Advocates noted that WellCare has relocated member services to Florida, where the WellCare corporate office is located. According to Rob Diaz (WellCare) this change should not impact CT members' access to member services and HUSKY services.