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: March 10, 2006
Next meeting is April 7 from 12:30 – 2:30 at the LOB1A

ValueOptions/CT BHP (VOI/CTBHP -ASO) Report (please click on icon below for ASO report)

Highlights of report/discussion

• Readiness reviews (pg 1 in report)
o Clinical on-site review was done 1/24-25. There will be additional training, staff planning and further refinement of UM plan.
o IT On-site review was done 1/31-2/1/06 resulting in Mercer recommending additional end-to-end testing of authorizations/claims: UM of inpatient/acute care date to be determined after further testing. Proposed date is April 1, 2006 (pg 4).

• MIS Set-up: Provider information file and eligibility file in production.
• Rapid Response Team (EDS, DSS, CTBHP) meeting bi-weekly, developing protocols for problem resolution and reviewing live claims data, determining follow up actions (pg 5).
• Provider Network Status:
o Increase of 424 providers since 12/12/05, numerous providers in EDS process. No increase in psychiatry.
o Of the 302 unknown providers (pg 6) there are now only 55 “unknown “ providers, represents 97 clients. Some of these providers may be in clinics; follow up continues; ASO will evaluate the Medicaid (CMAP) status of the “found” providers in regard to the care disruption analysis.
• Call Management (pg 10-11):
o The numbers of calls to the ASO are increasing and 72% of total call volume is from members.
o 5% are crisis calls – the Customer Service staff has direct contact with the CTBHP clinician for these calls. The ASO is finalizing policy with DCF on Emergency Mobile Crisis Service (EMPS) access.
o Outreach to members to connect them to BH services: through their MCO member services with warm transfer to ASO, directly through the ASO, through 211 Infoline, including perinatal warm link to ASO. The ASO calls do not reflect difficulties in this area; will the BHP look to assessing client awareness, difficulties with these other sites to assess member problems and work with advocates to? The MCOs will alert DSS if there is an influx of calls.
• Community outreach (pg 13):
o 4 forums held since 2/06; participants provided feedback on needed services such as respite. ASO invited them back to discuss these issues. The ASO system managers will assess geographic needs, service gaps, reporting to BHP in July 2006.
o 33 Family/Peer cases that reflect creative community engagement in helping families receive traditional/non-traditional services.

• Through ASO concurrent review data on members “stuck” in institutional settings will be available in 6 months and will be reflected in terms of service needs in the system manager reports. Statutory requirement for ASO to manage (through ICM) cases for those remaining in ED beyond 48 hours or inpatient 5 days beyond medical necessity. Children that have no discharge home require the collaborative efforts of DSS, DCF and the ASO to move the child/youth to the least restrictive care setting. Another discussion point was the fact that some flex funding dollars are currently being used for services that can be billed through the CTBHP. Billing services through the CTBHP will free up flex dollars to more appropriately fund in-home services such as respite services.

Claims Update
DSS presented the department's proposed plans for ongoing claims resolution process:

• Fact finding:
o DSS staff will review random claims within the MCO projects to identify denial reasons, MCO turnaround time in informing provider of denial.
o Identify process for claims review variations among MCOs.
o Follow up with providers and MCOs regarding certain denial reasons such as “not a contracted service”. Dr. Larcen noted that a change in coding may more likely result in these denials, as it is unusual for providers to give services outside their contract.

• Develop draft plan to present to the Subcommittee.
• Once implemented, DSS will monitor weekly updates on resolution process, and periodically report back to the SC.

Subcommittee suggestions regarding the process:

ü Sample claims by level of care as well as high volume providers.
ü Resolution process could be accelerated if DSS looks to providers that have already identified administrative-based denials that account for about 80% of the variance.
ü Health plan suggested looking at codes first, then the dollars owed.
ü Regarding the sampling of claims, best progress would be made with DSS working together with providers and MCOs.

Dr. Larcen thanked DSS for their thoughtful attention to this serious and labor intensive process and requested DSS consider the Subcommittee input (above) and inform the Subcommittee of the department's claims resolution process. BHP OC letter to DSS regarding claims resolution

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Next Subcommittee meeting is Friday April 7 from 12:30 – 2:30 at the LOB.