Minutes

BH Medicaid Provider Advisory Group

May 16, 2005

Attendance: Susan Walkama, Heather Gates, Sheldon Toubman, Donna Mercandante, Karen Andersson, Linda Pierce, Vicki Veltri, Mark Schaefer, Gina Hoff, Jim Rush

The meeting was called to order 3:00.

Guidelines for Making Level of Care Decisions and Acute Inpatient Psychiatric

Sue Walkama did not receive an e-mail transmission from Mark Schaefer containing a definition of EPSDT. Mark will re-send this information to be included in the Guidelines for Making Level of Care Decisions.

Jim Rush from the Connecticut Hospital Association provided feedback from CHA member organizations on these guidelines.

§ CHA members do not have any comments or recommendations for Guidelines for Making Level of Care Decisions

§ Inpatient:

1.) The number of days for continued authorization of care should be based of the professional judgment of the psychiatrist and not on a pre-determined number of days in a guideline

2.) Utilization of the Global Assessment of Functioning Scale score <30 is problematic. There is a perception that the scores may not accurately reflect the client’s condition and need for inpatient care. A suggestion was made to utilize the wording from the scale as a substitute for the number. Mark Schaefer from DSS will investigate this possibility.

3.) Suicide and homicide risk criteria there were concerns expressed that utilizing language such as a “well formulated plan” might deny hospitalization to a high risk client. Jim Rush will seek alternative language suggestions on this from CHA members.

4.) A.1.2.3.4 There is a concern that excluding mental retardation and autism disordered clients from this statement disregards the psychiatric needs of these populations

Intermediate Care Guidelines (PHP, IOP and Extended Day Treatment)

The grid defining each aspect of each service level was reviewed. In order to provide the greatest degree of flexibility and to encourage service implementation of evidenced based practice models on an IOP level, it was suggested that the number of days for IOP be changed from 3-5 to 2-5 for 2-4 hours per day.

Review of these guidelines will continue at the next meeting on May 31, 2005 at 3:00 at the LOB.