Behavioral Health Partnership Oversight Council

Legislative Office Building Room 3000, Hartford CT 06106

(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306

www.cga.ct.gov/ph/medicaid

 

Coordination of Care Subcommittee

Meeting Summary: September 30, 2005

Chair: Sheila Amdur

Attendees: S. Amdur, K. Diamond(Anthem), R. Ciarcia, M.Schaefer (DSS), K. Colvin (CHNCT), A. Kamm (DCF), Dr. R. Walia, C. Montesi (PONE), M. MCCourt (Staff).

Status of Work Group Recommendations in Coordination of Care Document

Below are the original recommendations from the Work Group with “Outcome” referring to the action by the BHP agencies.

The MCOs will identify BH NEMT data versus medical NEMT data in their NEMT reporting to DSS as a baseline measure.

Outcome: Developing a reporting measure to go forward. There is no available bench mark data by service type.

Going forward, DSS will collect BH vs. non-BH NEMT data comparable to the baseline data indicators.

Transportation-specific questions will be included in the client satisfaction surveys going forward.

Outcome: Client satisfaction survey questions, which will include transportation questions, will be developed by families & ASO after January, 2006.

DSS will collect any NEMT complaints from the ASO.

Outcome: process for transportation complaints:

Under the waiver amendment, CMS will not require an evaluation of the program by an External Quality Review Organization (EQRO). The DSS stated they would be adding a BH evaluation component to the Mercer HUSKY quality evaluation. The Work Group stressed the importance of program evaluation by an independent contractor that currently does not have a contract with DSS or DCF.

Work Group Recommendation:

There be an ongoing independent impartial comprehensive evaluation of the BH program by an expert entity that has no contracts with CT State agencies, managed care organizations or the ASO.

The BH Oversight Committee, along with DSS and DCF, have input into the development of the evaluation process and review of the evaluation reports.

Outcome:

The four HUSKY A and three HUSKY B managed care organizations will continue to be responsible for pharmacy services in HUSKY A and HUSKY B.

The Work Group recommended the following, with the goal of preventing parents of children with MH diagnoses or adults with MH diagnoses leaving the pharmacy without the prescribed medication:

Additions to the current MCO pharmacy reports to DSS that would be available no later than Oct 1 2005:

A provisional recommendation was made that would be implemented if the above data suggests the need for such implementation:

Status to date:

Emergency Care remains within the MCO responsibility. The work group recommended that there be a process developed by which the ASO will be informed of BH ED visits in a timely manner. DSS will be reviewing this with the MCOs in the near future.

Outcome:

Recommendation: add in ‘admission’ and ‘concurrent’ reviews section “All times are measured from the time the Contractor receives all information deemed reasonably necessary. (DSS added this in the document DETERMINATION OF PRIMARY DIAGNOSIS SUMMARY after the meeting).

Outcome: added.

Outcome:

Outcome:

Outcome: Hospital will bill the BHP and the MCO . BHP and VOI are still looking to identify process to ensure and capture timely transfer of patient from medical to BH services.

The Coordination Work Group will no longer meet. Monitoring of recommendations will be part of the Quality Management and Access Subcommittee and other subcommittees as deemed necessary by the BHP Oversight Council.

Sheila Amdur thanked the agencies and participants for their diligent and work and looks forward to continued work on these recommendations through the other subcommittees.