Provider Advisory Group

Minutes

May 31, 2005

3:00-4:30

Attendance: Susan Walkama, Jill Benson, Karen Andersson, Paul Piccone, Gloria Merritt, Marie Mormile-Mehler, Reginald Simmons, Gina Hoff, Robert Zavoski, Dana Marie Salvatore, Vicki Veltri.

Meeting called to order 3:10.

Minutes from last meeting approved.

Guidelines for Making Level of Care Decisions

The EPSDT language that was proposed by Mark Schaefer was reviewed and discussed. There was concern expressed that the language may be confusing as it is unclear how behavioral health issues will be included in the EPSDT exams. The role and process that would be utilized by the ASO to address BH needs as a result of these screenings is not clearly defined. Vicki Veltri would like to prose some alternative language which will be distributed to the group. Susan Walkama to convey the concerns raised regarding coordination issues between primary care, behavioral health and the ASO to Sheila Amdur’s workgroup. They are charged to review these issues.

In addition, the group felt that including the EPSDT definition as part of the care guidelines was critical, but that this definition and others (medical necessity and appropriateness) be included in a new section titled Definitions. The group will adopt this as a recommendation.

Acute Care Guidelines

Recommendations on these guidelines are nearly complete pending receipt of some proposed language changes to the suicide/homicide criteria from CHA.

Intermediate Care

Group had no recommendations for the PHP level of care.

Recommended that IOP cover a range of 2-5 days per week and not be site specific. A suggestion was made and supported by the group that IOP be defined and authorized not only as a site based defined program, but as an individually tailored plan for a child/family. The rate should be the same regardless.

The Extended Day Treatment model has wide variation in its clinical focus. While there are commonalities among programs, the clinical level and intensity of services provided vary. Karen Andersson has stated this is something DCF intends to address. It is recommended that the clinical intensity section of the grid for extended day be modified to state both acute and persistent symptoms. The providers in the group agreed to obtain more information from their specific extended day programs in order to finalize recommendations for this level of care.

Next meeting scheduled for June 14, 2005 from 3:00-4:30 at the LOB.