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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.

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:

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.