Provider Advisory Workgroup

Minutes

May 4, 2005

3:00-4:30 LOB 1A

Attendees:

Susan Walkama, Paul Piccione, Dana Marie Salvatore, Jill Benson, Linda Russo, Gina Hoff, Sheldon Toubman, Phil Guzman, Karen Andersson, Mark Schaffer, Alice Farrell

 Meeting was called to order 3:15 due a power outage.

Minutes

Minutes from the last meeting were reviewed and approved without change.

Format for the minutes was acceptable to group.

Review of Guidelines

“Guidelines for Making Level of Care Decisions and the Acute Care Guidelines”

A copy of the guidelines incorporating the recommended changes from the last meeting and feedback that had been obtained from other interested parties since the meeting was distributed for review. 

Guidelines for Making Level of Care Decisions

• The addition of “and providers” in the first paragraph was approved
• Changing the second paragraph first line to read “ Under Connecticut Medicaid rules, and deleting “ in order to receive Federal reimbursement” was accepted.
• It was recommended that “costs may be factored into decision making only when two alternative treatments are equally effective” be added to the first paragraph.
• It was recommended that “ The ASO is responsible to create the level of care needed to meet the individual needs of the client.” be deleted from mitigating factors.  It was suggested that the ASO might be empowered in the first year with a pool of flexible funds to develop and pay for specific services that might be unavailable but needed to meet the needs of the client.  There was some concern expressed that the system may not be adequately developed in the first year to do this successfully.  
• Add to the first paragraph “ In all cases, there will be a high degree of collaborative decision making in all care determinations between the provider, care manager and family.” 

Acute Care Guidelines

• Group accepted the addition of “This service is generally” to the last sentence in the first paragraph.
• There was concern expressed that the authorization process to Riverview be handled differently than any other acute care facility.  The aim would be to utilize utilization review to assist the facility in managing the care to insure the client remained at this level of care only for the time needed.  Karen Andersson and Mark Schaffer will consult with the superintendent of Riverview to determine how the review criteria might be applied more consistently between Riverview and other similar private facilities.  The workgroup will revisit this issue once a meeting has taken place and new information is available.
• In the last sentence of the first paragraph, it was suggested that “periodic” be changed to “monthly.” 
• The group seemed to feel that care determinations should be individualized to the client and not predetermined by set authorization procedures that identify how many days should be authorized at each care review point.   Sheldon Toubman sited the Medicaid regulations and stated regs reflected that the number of days or sessions in any level of care should be determined by the provider. 
• Mark Schaffer will provide a specific statement for the guidelines on EPDST.

Input from Trade Associations

Susan indicated that contacts have been made to many of the trade associations discussed at the last meeting.  Jim Rush from the Connecticut Hospital Association has indicated that CHA member organizations are in process of a review of the guidelines.  Susan will let him know the deadline for the documents reviewed today will be May 16^th.

Intermediate Levels of Care (PHP, IOP and Extended Day Treatment)

A new set of guidelines was distributed for review.  Participants were asked to review these with these the following two questions in mind:

1.  Does the grid and guideline adequately differentiate between each level of care?

2.  Do the continuing care guidelines fit extended day treatment?

Next meeting May 16, 2005 3:00-4:30 LOB 1A.