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

CTBHP/ValueOptions Report (Please see handout below)

Highlights of report and SC discussion:
• Update on provider Web registration for outpatient services: VOI sent provider alerts to 498 EDS/Medicaid providers who had not obtained security access/User ID to register patients for outpatient BH services. VOI received responses to the alert from 213 providers. Service reimbursement is initially contingent on provider/patient registration.
• As of 10-23-06, 17,253 registrations for outpatient services were completed. Registration timeline had been extended until 10/31/06 for registration for Sept. 1, 2006 dates of services. As of Nov. 1 the 21-day registration time limit began as did the requirement to complete all fields on the registration form for new patients. (See web registration user manual below: also on www.CtBHP.com)

Provider related calls to CTBHP/VOI have increased; customer staff received cross training so they can be a first responder to provider calls.

• Pre-cert & CCR process revisions are completed, redundant information was deleted and the system will be reprogrammed mid-November. Clinician orientation and re-tooled forms will be on CTBHP web site the week of 11/13/06. If there is no observable improvement in system efficiency, the BHP & VOI will revisit required fields.

o Call backs to providers take about 5 days. While shortening the review process may reduce the call back time interval, CTBHP/VOI does “back fill” the authorizations.
o VOI will discuss with their staff if several client reviews could be accepted during one provider call.
o Home based services require telephonic pre-cert; other outpatient services such as medication evaluations, require the OP web registration. The BHP was asked to consider implementing a process to consolidate the pre-cert for these services.

• Update on Residential Care Team: CTBHP/VOI is currently testing the IT infrastructure changes, including a referral/placement tracking system and evaluation tool, updating the provider file information. Anticipated transition - December 1, 2006.

o DCF has 22 group homes established with 6 more due to open. There may be potential additions in the next fiscal year; however barriers such as siting and staffing issues remain. In addition DCF will re-look at the therapeutic foster homes model for younger children awaiting residential/group home placements.

• In November and December BHP will expand utilization reports. Reports will be generated on the percentage of discharge delay status for every level of care by local area. In January other reports on admissions, authorizations, average length of stay and home-based services will be reviewed with the Subcommittees.

o Hospital discharge delay numbers seem at variance with individual institution experience. Medical boarding report (10b-9), separate from the psych hospital delay discharge reports, reflects pediatric medical unit delayed disposition.

• Intensive Care Management (ICM) referrals: all delayed status members in inpatient care are assigned to ICM. Co-medical managed cases with the HUSKY MCOs are reviewed monthly; the number of these cases are increasing.
• CTBHP was asked to provide feedback from the VOI Consumer Family Advisory SC to this SC and/or the full Council on a regular basis.

BHP (DSS & DF) Report
Dr. Schaefer (DSS) reviewed the reports below.

Discussion highlights:
• The reinsurance benchmark report of children's delay status in hospital and non-hospital settings for more than 15 days shows a decrease from 45% in October 2005 under managed care system to 10% in October 2006 under the BHP system. BHP reports (10b) forthcoming will provide more meaningful data over time, identifying delay status less than 15 days.
• 10/24/06 paid date claims denial rates are higher (32.3%) than the previous period (27.2%) (See 4^th report above). The second report above shows the increasing number of denials for services that require prior authorization – related to outpatient non –registration. Even with the expansion of allowing back dated claims and provider outreach outpatient claims problems remain.
• Questions arose around the 60 days timely filing:

o TPL updates take longer than the 60 days. EDS suggested re-billing for services when a commercial denial available. Mr. Piccione ( Paul.Piccione@ct.gov) requested providers send him examples of 4 – 6 month delays in the TPL process to expedite problem solving.
o EDS is working on override parameters, have back dated inpatient override. Providers were asked to identify certain situations that an override can be applied; discuss further at next meeting.
o Capturing denial rates by provider type or service may shed more light on the billing issues. DSS will look at this, but believes the provider case-by-case processes are most effective in resolving the claims issues.