Behavioral Health Partnership Oversight Council
Transition 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: November 29, 2005
Co-Chairs: Steve Larcen for Steve Fahey Susan Zimmerman
(Next Meeting: January 3, 2006 @ 11 AM in LOB RM 1A)
Attendance: Stephen Larcen & Susan Zimmerman (Co-Chairs), Rose Ciarcia, Mark Schaefer (DSS), Stacey Gerber (DCF), Judi Miller (Natchaug), Vickie Veltri (GHLA), Erin Clark (CCPA), Ed Hackett, Linda Russo & Hedi Warseck (Wheeler), Jody Rowell (Clifford Beers), Elizabeth Collins (YNHH), Tony DelMastro (Children's Center), VOI –Jennifer Pease, Lisa Carrico, VOI BH Subcontractor: David Glazer; Health Net: Janice Perkins, Colleen Chesney, Maggie Taylor; CHNCT –Kevin Colvin; WellCare/PONE- Chely Montesi, M. McCourt (Council staff).
Member Education on BHP Program
Key discussion issues:
ü Susan Zimmerman discussed the Public Forums held November 28-30 that had modest attendance. It was suggested that forums be held again in early 2006 and the presentations be more “family friendly”. The BHP and ASO agree this will be helpful. Lisa Carrico of ValueOptions (VOI) reported on family input after the first public meeting and adjusted the content for the following November forums. Participant evaluations rated the meetings as helpful in providing information about the BHP program.
ü At this time the VOI member brochure is only on the VOI website or distributed at public meeting forums. It is not included in any member mailings or being sent to community-based sites. The Subcommittee recommended that the BHP and ASO develop a one-page flyer that can be distributed to community-based sites, including health care sites. Janice Perkins (Health Net) noted that this was a major source of disseminating information about the Medicaid managed care program when it first started. Communication to provider sites is a major education opportunity for practitioners and their patients. Dr. Schaefer (DSS) responded that while a one-page flyer would give limited information on the BHP program, the Partnership would consider putting together a one-page flyer from the 4 page VOI brochure (which will be added to the VOI web site www.CTBHP.com) and ask family groups for comments.
ü VOI distributed the member and provider communication plan/timetables. The “warm line” phone transfer from MCO to ASO started in December. DSS will be sending letters to HUSKY A & B members the first week in December, and the MCOs will send follow-up with letters to their health plan members after the DSS letters have gone out.
ü The BHP is providing in-service to the CT Infoline staff. Infoline has been receiving mainly provider calls about the BHP program. Rose Ciarcia (DSS) stated that the CT Covering Kids Coalition (CCKC), funded by RWJ Foundation until the end of December 2005, can also provide public information if some type of funding continues beyond December 2005.
ü The ASO brochure identifies the BHP “target population” as HUSKY A & B members, although others can call the ASO about potential receipt of services. Inclusion of the DCF Voluntary Service population in the BHP program remains unclear. Families and providers do not know how intensive home based-services such as IICAPS, which is being converted to fee-for-service reimbursement, will be applied to the Voluntary Service population in the BHP and what impact that will have on IICAPS families and on provider reimbursement levels for that portion of their service population. DCF Voluntary Services are being referred back to DCF. Stacey Gerber (DCF) stated that the ASO staff is receiving training about connecting families to DCF Voluntary Services.
ü VOI's member's “Frequently Asked Questions” document is being finalized for inclusion on the VOI site and will be distributed at the December 1 2005 Provider Forum. DSS stated they would create a link to the web sites for professional trade associations and the Hospital Association so that information can be downloaded from the sites.
Provider Network
Key areas of the discussion include:
ü Network provider recruitment is underway. The ASO (VOI) is contacting those providers (Masters level, MD, PHD, and APRN) in the VOI subcontractor networks that are not listed in the CT Medicaid Assistance Program (CMAP) EDS Medicaid list. To date:
o Of the 1506 providers in the three MCOs (Anthem, Health Net & CHNCT) BH network, 279 are in the process of applying with EDS (277 MA level, 1 each of MD, PHD level),
o 244 (228 MA level) providers have requested enrollment packages and 80 MA level providers are already in CMAP.
o Of the 190 that declined enrollment in Medicaid, 136 are MA level, 19 MDs, 34 PHD level.
o 149 providers in the VOI MCO subcontractor network could not be located.
Dr. Larcen stated that the number of MD and APRN level practitioners in the network are critical to medical management; an inadequate network of these practitioners often leads to appointment delays. Since many providers associate Medicaid with low reimbursement rates, it is important to educate providers that:
o Rates under the BHP are higher than in Medicaid Fee-For-Service (FFS).
o CMAP enrollment would allow the provider to limit their involvement in the BHP program to the HUSKY patients they are currently seeing.
ü The ASO stated that their strategy in December is to talk with the providers not enrolled in CMAP and give them with information on CMAP enrollment. DSS stated CMAP enrollment turn-around time is 45 days, though the enrollment can be retroactive to January 1, 2006. The BHP can't offer guaranteed retroactive reimbursement associated with delays in CMAP enrollment as credentialing issues may result in some providers not being enrolled in CMAP. Those providers that want to participate providing services only to their current HUSKY patients, not taking new referrals, still have to complete the forms.
Subcommittee suggestions related to provider outreach included:
• VOI continue to follow up with trade associations in engaging providers in enrolling in CMAP, as providers need to be in the EDS system in order to receive reimbursement as of 1/1/06 (there can be retroactive reimbursement if the provider's enrollment is pending and then become enrolled).
• The EMPS teams can be a resource for VOI to identify independent providers within a geographic area that accept the EMPS referrals. DCF is compiling a list of EMPS and subcontractors by catchment area that DCF will give to VOI.
ü VOI sent out 1,234 provider verification forms and have received 500 back. Clinic mailings went out the last week of November requesting information on the practice site(s), type and hours of services offered, linguistic capacity, etc. This information will be entered in the system so the ASO customer services can search this, based on the caller's need and better match the member to a service site. Eventually this information will be available on VOI web site for external access.
ü Initially VOI will manually identify and update the provider network system for active and inactive BHP providers. Eventually providers can do this; however providers who do wish to be listed will not be included in external lists.
ü A primary care/BH task force, focused on pediatric settings, has resulted in decisions and/or initiatives that include:
• MCOs would pay PCPs for a primary care visit that includes BH diagnoses.
• Co-locate licensed BH providers in selected PCP sites.
• Provide some reimbursement for case management for BH cases.
• VOI will establish PCP phone access for prescriptive medical consultation pilots. This consultative service pilot, based on a UMASS model will be discussed further in January.
Claims/Appeal Process
Ø Erin Clark (CCPA) described the survey sent to their child guidance providers that will gather information about the status of unpaid (A/Rs) claims under the managed care/BH subcontractor system. An initial report from the returned surveys will be presented at the 12/14/05 BHP Council. Dr. Larcen stated he is working with several hospitals to identify the scope of A/Rs within the current system. The goals of these reports are to:
o Develop a picture of the scope of “tail” claims. This perspective may help MCOs as well as they project expected expenses for the program.
o The surveys contribute to the development of an ongoing tracking system for paid versus unpaid A/Rs through 2006. For example, CCPA was asked to consider repeating their survey after 60 days to monitor changes in the A/Rs.
Ø Several providers stated that the bulk of their A/Rs are outstanding >120 days and have not been resolved. For example one clinic has A/Rs of >$200,000 that are over 120 days, for which the clinic has documentation of prior authorization for these services and yet there is no resolution by the MCO/BH vendor. Dr. Larcen commented that the resolution process of long standing A/Rs is labor-intensive for both the provider and the BH vendor and suggested that the VOI BH subcontractor have a claims resolution team available to address these disputed claims. ValueOptions (BH subcontractor to 3 HUSKY MCOs) was asked to comment on the issues and in particular their human service resources capacity, going forward, for the reconciliation process and tracking the resolution of A/Rs. David Glazer (VOI) replied:
o The NYC VOI staff is available and will be working into 2006 on the A/Rs. VOI will engage other staff outside the specific CT teams as necessary. Mr. Glazer stated there are only a handful of providers with outstanding claims issues. The 2005 claims issues have been dealt with. Older claims remain to be resolved.
o Checks for services August through mid-November 2005 have been 'cut 'and sent; interest will be paid for those checks held that resulted in payments beyond the 45-day payment period. VOI will open the appeals time window in order to accommodate appeals associated with delayed payments during this time period.
o VOI will assess interest payments for older delayed claims (similar to August-November 2005 delay).
o VOI is doing two check runs/week; this will improve the payment process and reduce the period of time checks are held.
Ø Several providers noted they have been unable to contact the VOI CT team through the usual phone line: Mr. Glazer will look into this, emphasizing that the CT VOI teams remains intact – there are no staff layoffs.
Ø DSS, the agency responsible for the Medicaid HUSKY program, will track the resolution of unpaid claims.
Ø Health Net stated that the BH dollars are not capitated to the BH vendor: adjudicated claims will be paid.
Ø Preferred One stated that their BH vendor, CompCare, will work with providers to resolve any A/Rs. Preferred One asked that providers also inform the MCO of any claims issues.
Ø Anthem and Magellan were not present to comment on claims resolution issues.
BHP Claims Issues
Ø Natchaug Hospital will test the VOI/EDS claims system, although there is limited time to do this before Jan. 2006. Dr. Larcen requested BHP consider paying all claims for intermediated levels of care during the first 60-days of the transition period, to offset any system payment glitches. Providers would still be expected to obtain service authorizations, but claims processing would not reject claims for absence of the authorization, given the complexity of the service levels covered in this category. Dr. Schaefer stated that the BHP expects to trouble shoot initial problems through EDS/VOI system. If catastrophic payment problems occur, the BHP would then consider interim payments to avoid provider cash flow problems while the claim problems are corrected.
Ø VOI will have updated their billing manual within next two weeks, with prior authorization by provider type. Dr. Schaefer stated there are uniform service codes by provider type (i.e. all hospital-based EDT services would have one code and all clinic-based EDT services would have a different code).
Ø Service codes by provider type and specialty will put on the BHP agency web site after the 12/1 Provider Forum- www.CTBHP.state.ct.us . Billing codes and processes will be explained in the breakout session at the December 1 Provider Forum. Providers are encouraged to view the website after the Forum and give feedback to BHP on areas that may need to be fixed.
The BHP Council's Transition Subcommittee will meet Tuesday January 3, 2006 in
LOB RM 1A.