Minutes
Transitions Issues Workgroup
September 27, 2005
Co-Chairs: Steven Fahey, Susan Zimmerman
Attendance:
Rose Ciarcia; DSS, Elizabeth Collins; YNHH, Tony Delmastro; Children’s Center of Hamden, Steve Fahey; Hall-Brooke, Alice Farrell; CCCFS, Stacy Gerber; DCF, Gina Hoff; Wheeler Clinic; Jody Rowell; Clifford Beers Clinic, Linda Russo; Wheeler Clinic; Mark Schaefer; DSS, Barbara Sheldon; Parent advocate, Gary Steck; Waterbury Child Guidance, Susan Zimmerman; FAVOR
Meeting called to order at 11:15am.
It was decided that the meeting minutes will be taken by various members of the workgroup on a voluntary rotating basis.
The charge/focus of the group was outlined. The group will focus on making recommendations for strategies related to two basic issues:
Members: to ensure that members do not fall through the cracks or experience a disruption of services, given the large movement of members to the ASO
Providers: making sure that the providers are “on-line” and receive payments for all services to the date of the changeover as well through the transition, after 1/1/06.
The workgroup is a time-limited group which will meet on a monthly basis for 1 ½ hours through the transition into March 2006, possibly. It will be assessed on an ongoing basis if more frequent meetings will be needed.
DSS ran through a list of issues that they and the subcontractors will be focusing on as an integral part of the changeover. A complete document detailing the trends/strategies that each MCO will be applying to the transition will be shared by DSS in the next workgroup meeting.
• The MCOs are mailing a letter to their network providers within the week encouraging them to enroll as a Medicaid provider if they are not already one.
• Each MCO is coming up with a list of FAQs for the providers which contains information concerning the BH carve-out pre- and post- 1/1/06.
• DSS will be mailing a similar recruitment letter/FAQ list in the weeks to come. Existing CMAP (Connecticut Medical Assistance Program) providers were mailed letters regarding the changeover last week. Current CMAP providers do not need to do anything additional to remain an in-network provider under the ASO.
• Each MCO health plan is revising in their member handbook and will include information about how to access behavioral health care after 1/1/06.
• Each MCO health plan is revising and reissuing their member ID cards to reflect the ValueOptions behavioral health plan phone number by 1/1/06. BCFP will attempt to complete their card reissuance by 1/1/06, but may not be able to due to an internal system conversion.
• All MCO health plans will have the ability to directly transfer behavioral health telephone calls right to the ASO after 1/1/06.
• DSS is changing their eligibility notices for Husky to now include information about the ASO and how members can access behavioral health services after 1/1/06. It was agreed by workgroup members that there should be as much communication as possible to members concerning the ASO, since some members are especially transient, and the information is complex in its nature. This workgroup voiced the desire to have the opportunity to review any letters to members concerning the ASO prior to them going out. VOI (ValueOptions, Inc.) will present at the next workgroup meeting its own communication plan to consumers and providers.
It was further recommended that there be a large-scale educational campaign with major “after hours” providers such as 24-hour emergency departments, walk-in crisis units, etc.
There will be much data sharing between the MCOs and the ASO:
• Provider file sharing to give information on providers (helps the health plans know who and where to send a pharmacy denial/NOA to). Pharmacy benefit management will continue to remain unchanged, and will continue to be managed by the separate health plans.
• Data sharing around high utilizers, pregnant women on methadone, etc.
• Electronic authorization file sharing on members in care during the 1/1/06 transition whose provider authorizations extend beyond 12/31/05.
Providers will have the ability to look up authorizations online with EDS. Units remaining will not be tracked (counted down as claims hit) due to claims lag. All claims inquiries should be directed to EDS first. They will research it, and if there is a question about an authorization issue, then the question is referred to VOI. EDS will provide training to providers which will include a review of all claims requirements. Billing codes will be defined for providers by 12/1/05 and will be made available on the council website.
Edits will be lifted for several months for outpatient care, allowing providers time to re-register patients for outpatient services under the ASO. For higher levels of care (IOP, PHP, Extended Day), there will be a heavier reliance on a successful file transfer. Providers should receive an authorization letter for covered services beginning 1/1/06. There will be a willingness on the part of the ASO to be flexible and reconcile any discrepancies around service authorizations with providers and back-date as needed. Some workgroup members voiced concern that this may be a set up where the burden of proof is on the provider to prove that an authorization existed and/or should be granted. Historically, it has felt this way, and there is concern around how time-consuming and frustrating this can be, not to mention the possibility on interruption of service to the members caused by these problems.
DSS acknowledged providers’ worries, stating an understanding of where they emanated from. DSS was assuring towards providers that they, as well as VOI are attuned to avoiding any problems around transitional authorizations, cash flow, and disruption of services to members. The public sector team at VOI responsible for the implementation are doing everything possible to make things run as smoothly as possible. They are a very experienced team who have participated in other public sector implementations and are sensitive to the issues which are important and can adversely impact members and providers. DSS agreed to invite VOI to the next workgroup meeting to present its consumer and provider education plans.
Further concerns were stated in the workgroup having to do with the fall-out left by contractors as they left the Husky program. Historically, whenever a health plan or sub-contractor terminated, providers had a difficult time collecting on outstanding balances for claims. Without any MCO representation at the workgroup this day to participate in a discussion, some attendees were questioning the effectiveness of raising concerns about collecting payments/AR, and continuity of care issues. DSS will invite the health plans and behavioral health sub-contractors to the next meeting to take part in this discussion. DSS will also make available to the workgroup its contract language with the MCO’s. Providers, in turn, were asked to provide information to Rose Ciarcia (DSS) on their current AR balances with the MCOs and a shortlist of commonly experienced themes which act as barriers to collecting payments. The examples will be filtered through DSS and presented as a means to generate strategies for a smooth transition. This process is not meant to re-hash or immediately solve providers’ specific AR problems with the MCOs. Instead, the value lies in the opportunity for the MCOs to hear what the general issues have been, help identify a process for resolution, formulate possible strategies, and potentially increase provider buy-in.
The following meetings of the Transitions Issues Workgroup have been scheduled:
Tuesday, October 25, 2005 9:00am-12:00pm
Place: Legislative Office Building Room: To be determined
TOPICS: Consumer Transition Issues
MCO transition plans
VOI provider and consumer education plans
It will be determined at the October 25th meeting whether there will need to be an additional meeting of the workgroup scheduled prior to the November 29th meeting.
Tuesday, November 29, 2005 11:00am-12:30pm
Place: Legislative Office Building Room: To be determined
Minutes submitted by: Linda Russo