BH Oversight Committee Coordination of Care Work Group
Meeting Summary: April 18, 2005
Chair: Sheila Amdur
(Next WG meeting: Tuesday May 3, 1-3PM at DSS, Hartford)
_ The BH waiver amendment to the Medicaid (HUSKY A) 1915(b) waiver and DSS/DCF responses to public comment will soon be sent to the legislative Committees of Cognizance.
_ The Appropriation budget proposal released 4/18 does not concur with the Governor's recommendation for the additional $9.8M BH dollars nor the proposed carve-out of BH services (Husky A child/adults, HUSKY B children & DCF Voluntary Services populations). The DSS stated the Administration would be discussing the reasons for the proposed restructuring with legislative leaders in the coming weeks, since the waiver amendment will have been sent to the legislative Appropriations and Human Services Committees.
_ The agencies' contract with the Administrative Service Organization (ASO) will be ready for negotiation after the waiver amendment is reviewed.
Review of Work Group Recommendations up to 4/8/05
The chair reviewed the updated list of recommendations and DSS responded to several items with an update:
· Identify standardized information required of providers for service authorization/concurrent review. The DSS supports this recommendation, will work with the ASO on this and will refer this to the Provider Advisory Work Group to develop these standards related to levels of care authorizations.
· Dispute resolution: The DSS agreed to have a "provisional authorization process within 24 hours" and "telephonic immediate appeal process within 24 hours". The determination of primary diagnosis was revised for clarification on 4/4/05 (see attachments). The ASO & MCO authorization timelines may differ, but MCOs would be expected to honor their time frame of a decision by the end of the business day.
· MCO Pharmacy: DSS stated DCF has provided Rose Ciarcia (DSS) with a list of the medication denials for DCF children and DSS will report on psychotropic drugs excluded from the current MCO formularies. Sheila Amdur requested that the DCF report be provided to the subcommittee.
HUSKY BH Carve-out Coverage & Coordination of Medical & BH Services Document
The Chair raised the following topics in the document for discussion
· The Medical/BH Coordination of Care document will be attached to the DSS/DCF/ASO contract, and they have agreement future changes can be made without opening the ASO contract.
· Medical/BH Co-Management meetings (pg.5), which ensure appropriate management of clients with co-occurring conditions, will be held at least once /month. The frequency will be determined by the ASO & MCOs. Sheila Amdur suggested that monthly meetings may be insufficient, particularly during the transition phase of the restructured BH care delivery system.
· Coordination of medical & various levels of BH care coordination (case management) was discussed in relation to home care services (pg 6) and the broader PCP medical homes initiatives:
o Complex pediatric cases with co-occurring diagnoses (e.g. spina bifida & bipolar D/O) at best require a balance of medical and BH expertise. DSS stated there is language in the HUSKY B PLUS BH and physical health contracts that identify which payer (medical/BH) takes the lead in home care service reimbursement.
o The AAP and CMS are collaborating on identifying approved non-direct service reimbursement codes that will be approved by CMS in 2006.
o Within the HUSKY health care system there are several entities responsible for care coordination: PCP CSHCN Medical Homes providers, MCO case managers, the ASO intensive case management and DCF community collaboratives care coordinators (and EMPS care coordinators for DCF children). Action steps:
_ Dr. Schaefer asked the MCOs (Joanna Panzo -PONE, Kevin Colvin-CHNCT volunteered) to discuss the coordination of various levels of care coordination/case management with DSS & DCF.
_ The DCF had agreed at the March BH Oversight Committee to develop a workflow outline on coordination process of various care management levels in KidCare.
· Medical Primary Care notification of patient BH services was identified as an important component of quality clinical care and care coordination. The work group had recommended the departments clarify the ASO role in communicating with the MCO/PCP in the ASO contract. DSS updated the group on the agency's legal opinion that it is possible to for BH services to be routinely communicated to the PCP as part of the PCP care management responsibilities in Medicaid. Further discussion of issues:
o Youth in school-based health centers may not want PCP/parent to know they are seeking MH counseling.
o Need to ask each MCO what their current procedure/policy is on notifying PCPs of BH services, new or changed medications.
There was agreement that sharing BH service information with the patient's PCP needs to be clarified and standards developed before the ASO contract is completed (and consideration in any DSS/MCO new contracts). Next steps:
o DSS will provide the Chair with the agency legal opinion on this issue.
o Sheila Amdur will ask FAVOR to obtain family opinions regarding BH/medical communication. However, Ms. Amdur stated it is often not really a parent issue, but rather how the BH providers present this to the family/patient, identifying the PCP role in coordinating medical/BH services.
o Dr. Geertsma suggested looking at American Academy of Pediatricians (AAP) policies to develop standards.
· Notice of Action coordination between the ASO & MCO- there is concern that one is denying services and hopes the other picks the services up. Mark suggested that the MCO be bound by their contract timeframe and the ASO be bound by their contract timeframe. This way, the provider is not experiencing anything different than what they are already experiencing with respect to response timeframes. It also avoids the need to amend HUSKY contract requirements.
The next work group meeting, scheduled for Tuesday May 3, 1-3 PM at DSS Hartford office, will include the following items on the agenda:
· A revised Coordination of Care Document, incorporating the agreed upon recommendations.
· DSS/DCF reports on Pharmacy
· Coordination of MCO transportation services for BH.
· Flow diagram on DCF/ASO care coordination processes.