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: April 7, 2005
Chair: Dr. Stephen Larcen
Next meeting: May 5 from 12:30-2:30 at the LOB)

Attendees: Stephen Larcen (Chair), Karen Andersson (DCF), Rose Ciarcia, Mark Schaefer (DSS),Lori Szczygiel(VOI/CTBHP), Susan Canning, Gail DiGioia, Dian Kochol (Anthem), Elizabeth Collins (YNHH), Bob Caporaso & Joseph Lender (Child. Cnt, Hamden), Tina Houston (Health Net), Chely Montesi, Tony Tedeschi (Wellcare/PONE), Paul Maloney & Christina Rizzo (Natchaug), Jody Rowell (Clifford Beers Clinic),Linda Russo (Wheeler Clinic), Rich Spender (CHNCT), Susan O'Connell (Village), Blair MacLachlan, M. McCourt (leg.staff)

VOI/CTBHP Report (Please click on icon below to view meeting handout)

Key Points about the BHP program system process:

• Intensive Care Management (ICM) criteria are being reviewed by the Quality Management & Access Subcommittee. The ASO currently has 28 mid-long term cases and 34 short-term high risk cases.
• Peer Family outreach/coordination cases have increased to 47 this month, a 72% increase over February.
• Phased in approach to Service authorization based on level of care: summary of implementation status:

o Discussion points:

§ When the dates for implementation of a prior authorization are finalized, the Council requested VOI direct mail this information to the appropriate level within the organization to ensure utilization management and business staff are informed.
§ Hospital clinical management: hospitals currently receive a letter for service authorization that will not have the PA #. Eventually both VOI & EDS will have web-based service PA status updated in 24 hours. Providers noted the importance of having authorization numbers at the time of the call and/or web-based confirmation to reduce administrative denials of claims.

• The Quality Subcommittee completed the review/revision process and approved the outpatient screen elements that include Enhanced Care Clinic items at the 4/7 meeting. Dr. Schaefer commented that implementation of the registration screen for outpatient services will most likely start July 1, 2006.

• Eligibility file issues:

o Husky B eligibility status has been added to the DSS Automated Verification Eligibility (AVES) system. VOI may have a 24 hour lag in updated files compared to the EDS system, so EDS is the back up for providers if client eligibility is in question. DSS is satisfied with the tests of the eligibility file interface with VOI.
o EDS has fixed the system problem that overrode HUSKY B eligibility consideration and put the ineligible HUSKY A application into Medicaid spend down.

• If current claims denied are related to client eligibility, the BHP Rapid Response Team is available to problem solve. Contact at DSS: Paul Pacconi 424-5160, fax 424-5799. BHP will be reporting reasons for claims denials by provider type and system, with the goal of fixing denial issues at the provider and/or system level. Update on BHP claims reports will be given at the May SC meeting.

• VOI/CTBHP will discuss outreach to school personnel that manage/refer clients with BH problems with the Council State Dept. Education representative.

DSS Claims Resolution Process
Rose Ciarcia and Mark Schaefer met with Jeff Walter and Rep. Sayers to review the department's reconciliation plan. While this process may continue, Mr. Walter was concerned about delay on work to resolve outstanding claims during the fact finding phase. DSS has drafted a letter to the MCOs consistent with the guidelines for claims resolution outlined in the letter from the Council co-Chairs. DSS will provide Council staff with a copy of this letter for distribution to the Subcommittee.
Discussion:
• Dr. Larcen noted that the MCOs and providers will continue to work on claims resolution based on criteria in the Council letter and that the DSS fact finding process will be a “fail safe” mechanism.
• Rose Ciarcia noted that June 1^st will be the expected end date for the claims resolution for BH services under managed care, though this would not super cede the MCO time line for claims payments.
• The health plans provided updates on each claims project status they have been working on. Responses have been sent to CCPA that had compiled the ARs from their provider respondents.
• All the plans use similar information shown in the spread sheet provided by CHNCT for Subcommittee review and distribution to provider groups (click on icon to view the spread sheet, the MCO contact grid and summary of MCO claims project from Stephen Larcen).

The health plan would follow up with the provider for clarification/verification of ARs. If there is no response from the provider as June 1^st approaches the A/R case will be closed. Rich Spencer (CHNCT) stated that despite the 2/28/06 close date for Magellan BH claims, CHNCT still has some outstanding claims in process and has reached an agreement with Magellan to process claims included in these projects.

Many providers reporting AR balances have not submitted claims spreadsheets or projects or have not responded to MCO inquiry. Given the June 1 deadline, it will be important to communicate with providers regarding this.

Dr. Larcen thanked the MCOs for their work on the outstanding claims and will contact CCPA and CHA regarding the communication with providers regarding submission of spreadsheets and the MCO claims project status reports.

Next meeting: May 5, 2006 from 12:30-2:30 at the LOB