Behavioral Health Partnership Oversight Council

Operations (formerly Transition) Subcommittee

Meeting Summary: June 2, 2006
Co-Chairs: Stephen Larcen & Lorna Grivois
Next meeting: Friday July 7, 12:30 PM in LOB RM. 1A

Managed Care BH Claims Status
Each of the four HUSKY health plans provided a summary of BH claims projects. A brief status summary:

ü Anthem (VOI): of the 25 current projects, 18 are closed, of the 7 open cases, most have had interactions with MCO in May up to June 1, 2006. The plan cannot accept new schedules after June 1, 2006.
ü Health Net (VOI) reported 23 open claims projects as of June 1, 2006. Since 2/06 the plan reports no spread sheets from 4 agencies. Of the 19 agencies that submitted claims information, 2 projects have been completed, the remaining are process with MCO & VOI. Nine agencies submitted claims data from May 16-31, 2006.
ü WellCare/Preferred One (CompCare) completed 9 of the 17 agency claims submission. Five agencies' spread sheets have been submitted during May 2006.
ü CHNCT (Magellan, current VOI): CHNCT CEO Sylvia Kelly will review resolution process of the outstanding Magellan claims that represent 18 of the 20 agency projects. Seven of the 20 agencies have both Magellan & VOI unpaid claims and 2 are with VOI only.

Subcommittee Comments:

• One agency experienced described four requests for re-submissions of same claims data. Of the more than $50,000 outstanding, the agency to date has received $600. (It is unclear from the status reports what amounts/percentages of the project A/Rs have been paid).
• The Co-Chair and DSS expect David Glazer from VOI to attend the July meeting (Mr. Glazer confirmed his plans to attend the July 7^th subcommittee meeting). Given the magnitude of the VOI accounts (BH subcontractor for 3 of the 4 HUSKY plans) Dr. Larcen questioned if VOI has sufficient staff resources to resolve the number of disputed claims. There has been progress, though slow, with VOI reconciliations..

Subcommittee Refocus
The subcommittee will refocus now toward the operational issues of the CTBHP. The primary focus areas include:

• Review implementation of BHP claims monitoring systems, denials of provider claims, implementation of authorization linkages to claims payment,
• Implementation of authorization look-up technology, IVR and web technology for outpatient registrations, and improvements to efficiency of initial and concurrent reviews,
• Review data on network adequacy, member access issues and member complaints,
• Review ongoing member and provider education initiatives,
• Review impact of Intensive Care Management (ICM) on emergency room utilization and discharge from inpatient levels of care,
• Review ongoing operational issues.

The subcommittee will benefit from additional consumer/family participation as well as providers from various levels of care in order to effectively fulfill the Subcommittee functions.

ValueOptions/CTBHP Report (click on icon below to view the ASO report)

Summary of discussion related to the report:

• In May 6 hospitals reported children remaining in the Emergency Departments (EDs) because of placement issues, with stays ranging from 1-6 days with an average of 3.5 days. Many hospital did not report and VOI/CTBHP will continue to meet with EDs to explain the ASO's responsibilities in responding to ED calls to the VOI about individuals with primary psychiatric diagnoses remaining in the ED. Going forward, patients with primary psychiatric diagnoses temporarily placed on medical units because of lack of appropriate MH placement will be tracked. At the July meeting VOI/CTBHP will have data on discharge delays from institutional care.
• BHP expects to link inpatient authorizations to claims 7/1/06 (pg 2 for operations update.
• The ASO contractual provisions include:

o Quality initiatives that will be discussed at the upcoming Quality Management/Access SC meeting.
o Field testing the provider satisfaction survey in June before sending it to CTBHP providers.
o A member satisfaction survey will be implemented in July, once the Quality Subcommittee reviews and recommends approval of the final survey tool.

• Dr. Larcen suggested VOI/CTBHP review the information required at the time of phone authorizations and concurrent reviews. Loading demographic data into the ASO system prior to contact with the requesting provider may reduce the processing time for authorizations.

Third Party Liability Process
Paul Pacconi (DSS) reviewed the EDS processes and answered questions raised at the May meeting on TPL billing when the client has commercial insurance coverage, leaving Medicaid as the payer of last resort. The BHP Rapid Response Team will respond to provider questions, difficulties. Providers can call EDS directly with questions about billing, claims issues. This often complex process will be included in future EDS forums

Other
BHP is looking at allowable billable provider case management units, perhaps defining allotment for clients with serious clinical issues versus less intensive service needs. BHP will provide feedback to the Provider Advisory Subcommittee and Council on care management requirements.