BH Oversight Committee

Coordination of Care Work Group

Meeting Summary: April 4, 2005

(Next Meeting: April 18 @ 1-3PM at the Hartford DSS, 11th Floor)

Present: S.Amdur (Chair), M. Schaefer & R. Ciarcia (DSS),), L. Berkowitz, D. Consiglio Anthem), C. Catrone (SBHC), K.Colvin (CHNCT), J.Panzo(PONE), A.Kamm (DCF), MA.Fischer (HN), L. Pierce (VOI), S.Toubman, V.Veltri.

Handout Updates: PCP Notification, Timelines for PA/concurrent review, Determination Primary DX.

Coordination of Benefits

Dispute Resolution Process

There were two issues noted, with the example of a dispute occurring in off-hours:


The discussion focused on approvals of temporary drug supplies when there is no prior authorization for non-formulary and/or formulary drugs that require such authorization initiated by the prescribing provider. The DCF has tracked psychotropic drug denials. Specific existing policy issues in DSS/MCO contract were noted:

The Pharmacy issues also pertain to quality of care and access to care and as such may be referred to the QA Management & Access Work Group for recommendations for the ASO analytic process in appropriate prescribing of psychotropic medications that reflect `best practices'. The DCF protocols developed for prescribing and managing psychotropic medications for DCF children should be considered in this process.

Next meeting: Follow up

Next Coordination of Care Work Group meeting is April 18 at 1-3 PM at the Hartford DSS building, 11th floor.