Behavioral Health Partnership Oversight Council
Operations Subcommittee
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
Meeting Summary: July 7, 2006
Chair: Stephen Larcen & Lorna Grivois
Next meeting Friday September 8th, 12:30-2:30 PM
Claims Resolution Under Managed Care
Each of the four managed care organizations (MCOs) reported on the status of their behavioral health claims projects:
ü Anthem reported on 23 cases, indicating “closed “for all of them; however documentation in report suggests continued work on several projects. The “closed” designation reflects completion of Anthem review and not provider agreement with review, in some cases Anthem hasn't heard back from providers regarding the outcome of the reviews and assumes provider agreement. Anthem reported 2 -3 providers are not in agreement with the reviews at this point.
ü CHNCT: disposition (reconciliation checks mailed out) for all
but one. YNHH expects to review case further with CHNCT next week. Ms. Collins
expressed appreciation of CHNCT's rapid response to YNHH on claims projects.
o CHNCT/VOI: Clifford Beers has had limited response from VOI on these claims. Mr. Glazer stated that a spread sheet has been sent to the clinic.
ü Health Net reported on 23 claims projects. David Glazer reported that many claims in on 5/31 when VOI had less staff working on them. There are three large projects open that include Natchaug, Clifford Beers and Hall-Brooke. Five projects have received payments and 8 additional projects are pending final processing & review.
o VOI is trying to be flexible about claims resolution process.
o Interest from 2005 claims paid January 6, 2006.
o Providers need to inform VOI of TPL claims as these claims are expected to be open for awhile, pending private payer reimbursement.
ü WellCare/Preferred One reported on 17 claims projects. Eight are 'completed', three have reached verbal agreement on claims resolution and four projects awaiting provider response to proposed MCO resolution.
Discussion points:
• DSS perspective: expect the final claims run-out for 2005 in August/September 2006. DSS will ask MCOs to provide information on the number of cases closed without provider challenge versus the number of cases contested. While it may not be necessary, DSS would undertake an independent assessment of claims resolution depending on the outcomes of project resolution per the initial DSS letter to the MCOs.
• Stephen Larcen (SC Co-Chair) stated that the final MCO reports should include an objective assessment of the amounts claimed and amounts paid in aggregate. It is difficult to assess the magnitude of the disputed claims/payments in the current reports.
• All four plans expect to have these projects completed by the time of the September 8th committee meeting.
VOI/CTBHP Report (click on icon below to view power point presentation)
Key discussion points included:
• VOI/CTBHP has internally 'cleaned' authorization and concurrent review duplicates which impacted some claims payments with duplicate authorization numbers. Some authorizations were tied to claims beginning May 1 (PHP/IOP/EDT, detox). Providers can call the Rapid Response Team for assistance in identifying which non-duplicate auths are in the system. BHP Rapid Response Team is available to problem solve billing issues. Contact Paul Piccione (DSS) 424-5160, fax 424-5799.
• Inpatient authorization tied to claims as of 7/1/06.
o Care coordination and crisis stabilization new auth processes are pending until level of care criteria completed.
o Home-based services auth/claim process begins 8/2/06 (MST, IICAPs, MDFT, FFT). Winfax process will capture members currently in care. Family Support Services will begin registration in August as registered rather than authorized services.
• Outpatient Services registration for 26 sessions begins via web registration 9/1/06. Trainings will be done in July/August; providers can begin registering members currently in care in August. Anticipate providing interim winfax as alternative for providers without web access.
o Per DSS, completion of the screen takes about 4 minutes, less time than completion of past registration & OTR forms. Under BHP 26 sessions will be authorized for new patients registered compared to previous multiple re-authorizations.
o Initially clinicians may need to fill out the registration form, but overtime clinics may organize their intake information in a manner that will allow ancillary staff to enter registration information.
o The current system doesn't include electronic submission of registration forms, but going forward this can be considered. There was considerable discussion regarding total time required by providers during August start-up period to register what DSS estimated may total 30,000 outpatients. DSS agreed to review the 30 data elements required and determine which of these can be “waived” during the initial registration process.
• In June, there was a 65% decrease in ED calls to ASO for intensive care management of members “stuck” in the ED. VOI/CTBHP is making daily outreach calls to ED effective July 1, 2006.
• Discharge delays (inpatient, PRTF, Residential) reports are being generated. In the June report, 6% (87 clients) of all clients in 24-hour level of care have discharge delays, with the greatest percentage (60%) in residential care, and about 20% or 17 at inpatient level of care. Remains unclear if 6% accurately measures discharge delays. Four hospitals (IOL, Hall-Brooke, Natchaug, Yale) reported internal data with 31 HUSKY patients with discharge delays. Going forward BHP will need to develop an agreement with providers over the validity of this measure and common definitions for discharge delays through further SC discussion.
o The BHP has developed codes to define the delay reasons. Important to identify the status of the client and reason for delayed disposition to next level if care. Future meetings will report the data at this detail level.
o DSS has complete reinsurance data under managed care from March 2005, which analyzed acuity and can serve as baseline for new delivery system.
o Karen Andersson
described RiverView Hospital's work on protocols that will allow some beds to remain open to accept children needing to be discharged from an inpatient setting or admitted from ED. Dr. Andersson stated it is important to develop demographic and clinical information on patients with disposition delays in order to help the BHP agencies work with other agencies in finding solutions.
• VOI/CTBHP System Managers worked with each of the 15 DCF regional area families, providers and DCF staff to assess service access/gaps and develop, with a regional core team, a priority development plan for each region. The report has been submitted to the BHP agencies for review.
Next Subcommittee meeting is September 8th at 12:30 PM, the subcommittee will not meet in August.