BH Medicaid Advisory Group

July 20, 2005

Attending: Susan Walkama, Linda Russo, Paul Piccione, Jim Rush,

Dana Marie Salvator, Jill Benson, Linda Pierce, Jean Adnopoz, Karen Andersson

Meeting Called to Order 3:10pm

Group Process and Feedback from Interested Parties

Discussion regarding: Dr. Steve Kant’s concerns regarding group process to determine levels of care, his concerns that it’s not inclusive enough. Reviewed process of contacting trade associates for feedback – Susan contacted CAN – they think process is working well to get feedback (135 individuals are receiving communications). Message left with CCPA to get further input. Susan will try to follow-up with Dr. Kant (call him again) and ask about concerns.

Group reiterated decision to not go back and change levels once they have finished discussion and recommendations so they can move on to next level of care review.

• - For consideration at a later date: When all levels are completed, send out to a wider distribution, with a brief structured questionnaire for feedback, to help group incorporate feedback one last time

One recommendation group might want to make is to suggest time lines for re-review of guidelines after they are adopted.

Psychiatric Residential Treatment Facility

F.1.3.12 “have been examined and have been determined” and further correction

Add to definition: On occasion it may be appropriate for children to be admitted directly from community.

This level of care was adopted by the group with the above changes.

IICAPS

Jean Adnoposz stated that the document basically captures essence of IICAPS. Following issues were discussed:

• She recommended changes in the definition.

• GAF score needs to be clarified (Jean will review with Joe Woolston.)

• Recommendation: Certification process should be modeled on IICAPS credentialing criteria.

• # of units recommended base on assumption of existing system – (a class of service-interchangeable between both codes) if the rates methodology is different there is a need to revisit this.

• Change units to 88 to reflect Medicaid – 4.3 weeks in a month.

• Changes 1.4.3 – and 1.4.1 or 1.4.2 or 1.4.4

Take out 2.1.4

• Value Options needs more specific guidelines for concurrent authorizations. What other services can be or should be authorized in conjunction with this level of care – IICAPS wants to maintain existing treatment relationships so recommendation is there can be authorization for concurrent services. Goal is to engage existing providers in treatment plans.

• Residential stay as well as IICAPS services – can ASO paid for overlap? Group recommends this. DSS needs to either change existing edits in billing or include in rate setting. IICAPS is appropriate for residential discharge in certain circumstances – Jean will give guidelines.

Jean agreed to try to incorporate many of the discussed language changes in the next draft of the IICAPS level of care criteria for discussion at the next meeting. Jean will come back on August 3^rd to finish discussion on IICAPS.

Susan will send out revisited drafts before next meeting.

Next level of care to be discussed is Outpatient Services

Next meeting is August 3, 2005 at 3:00pm

Submitted by Jill Benson