Recommendations

Behavioral Health Oversight Committee

Coordination of Care Work Group

Chair: Sheila Amdur

The four managed care organizations will continue to be responsible for providing HUSKY A Medicaid non-emergency medical transportation (NEMT). As noted in the May 3rd meeting, anecdotal reports illustrate client transportation issues in HUSKY; however there has been no quantified assessment of the adequacy of the transportation services. The discussion included the following vehicles for assessing transportation access in the current program:

The Work Group recommendations for transportation in the restructured BH system include:

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

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.

DSS will collect any NEMT complaints from the ASO.

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.

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. Discussion at the May 3 meeting and this meeting conveyed the sense of urgency in resolving pharmacy access issues, especially in light of the ‘carve-out’ of BH services from managed care. DSS stated they don’t currently have data to quantify the extent of the PA problems; work group participants noted that the current process of prior authorization (PA) creates a major obstacle to HUSKY clients’ access to mental health drugs: PA rejections and the associated process for the provision of temporary drugs per DSS/MCO contract remain flawed in the two largest MCOs (Preferred One does not have a formulary and CHNCT implements close to an automatic override at the pharmacy for rejected drug authorizations).

The DSS continues to work with Anthem and Health Net on creating an electronic screen message about the temporary drug provision in HUSKY A. DSS will continue to review each MCO’s compliance with pharmacy contract provisions and the new DSS staff will meet with each MCO to become familiar with each MCO formulary/pharmacy process and available data in order to be prepared to work with the MCOs on reporting specs. Further, DSS supports the continuation of the previous BH SC initiative to develop a list for providers of psychotropic drugs that require PA by each MCO.

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:

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.

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).

A statutory BH Oversight Committee will identify the ongoing work groups & function.

Sheila Amdur thanked the participants and the DSS & DCF staff for their time, energy & expertise in reviewing documents and making recommendations for the agencies to consider as the process moves forward.