Behavioral Health Partnership Oversight Council
Quality Management & Access Subcommittee
Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
www.cga.ct.gov/ph/medicaid
Meeting Summary: March 31, 2006
Chair: Dr. Davis Gammon Vice-Chairs – Paula Armbruster & Sheila Amdur
Next meetings: April 7, 10:30-12 in LOB RM 3800 and April 28 from 1:30-3 PM at VOI/CTBHP
Attendees: Dr. Gammon, Paula Armbruster, K. Andersson, A. Pritchard & A. Kamm (DCF), M. Schaefer & T. Creel (DSS), L. Szczygeil & J. Geiger (VOI/CTBHP), S. Graham (DMHAS), V. Mulkern (HSRI),
R. Franks, M.A. Lee, E. Luchansky, S. Niemitz, S. O'Connell, L. Russo (M.McCourt leg. staff).
HUSKY A Behavioral Health Care 2004 Baseline data: CTVoices (click on icon below for proposal)
This is a descriptive study of BH services used by HUSKY A children and adults in CY 2004 in BH or primary care settings that will evaluate the impact of changes in the delivery system for behavioral services. The Chair requested the subcommittee review the proposal and bring comments /questions to the April 7th meeting.
Intensive Care Management (ICM) Referral Form (Click on icon below to view form)
• VOI/CTBHP revised the 3/17 draft ICM referral form in response to Janice Woods (family advocate) objections to pejorative language. The changes reflect consumer-focused, strength based language in the referral document.
• There are 13 active ICM cases since January 1, 2006. The anticipated case load of the ICM case manager is 40-50 members, similar to the DMHAS targeted case manager case load of 30-40 client/CM.
• There are 8 regional ICM teams comprised of case manager, clinicians and peer support staff.
• Subcommittee discussion/recommendations:
o Approval of changes in response to the family perspective on ICM triggers.
o The ASO was asked to outline the co-morbidity BHP ICM/MCO case management process as well as ICM interactive process with practitioners and families at the 4/28 meeting.
o Add perinatal depression/ other MH diagnoses as separate clinical risk item.
o Under child/adolescent referrals: consider special clinic issues in the category of child/youth with unresolved trauma.
Action: The SC agreed with the ICM format with the 3-31 added revisions.
Plan: ASO will review the coordination of MCO & ICM CM process and how ICM process interacts with practitioners & families at the APRIL 28 SC meeting
Registration Screens (click on icons below to view web registration screen questions & deleted items.)
The registration screens are for outpatient services, although the levels of care services included in the screens still need to be determined. The purpose of the screen is to collect data on client characteristics, provider practices and assessment of co-occurring conditions. It is expected that the form would be submitted after the completion of the client/family evaluation, about 2 weeks from the start of the process. Providers/clinics will determine the internal changes and tracking that are required to ensure timely forms submission.
Discussion:
ü Race/ethnicity: DSS will eventually implement the federal guidelines into their system. Since congruency between the registration screen information and DCF and federal information requirements, there was consensus that dual race/ethnicity choices be added (1) check all appropriate race categories, 2) yes/no ethnicity).
ü Referral source categories: SC consensus that these are appropriate & inclusive.
ü Date of referral screening (pg 1): SC agreement this should be defined as first direct communication with member.
ü Referral type: SC agreement that this be based on BH clinic determination.
ü All OP providers would complete the first 5 items; the Enhanced care clinics (ECC) would complete the last two (1) for routine or urgent referrals, 2) for emergent referrals.
ü All ECC & non-ECC (pg 3):
o SC agreement on 1st two questions.
o Co-morbid conditions (Axis III); suggested that added conditions be considered such as cardiac, arthritis, neurological (includes traumatic brain injury) and functional/sensory impairment. This will be reviewed by the BHP & ASO with follow-up on April 7th.
o Contacted member's school/medical provider: SC recommended to go back to “have you obtained consent to contact” with drop down box. Since clinics may want to ensure submission of registration before 2 weeks, the clinician may not have time to actually contact the entities the family/client has consented for contact.
o Currently prescribed and/or using psychiatric meds: SC agreement to ask is the member 'currently taking' psychiatric meds. More in-depth information would be in the clinical evaluation write-up.
o Reword assessment of co-occurring mental health & substance use disorder to does the member have a co-occurring mental health & substance use disorder.
o Collateral contacts item: SC proposed 1) omitting collateral service list, substituting language that taps into the federal reporting questions and DCF questions; follow-up at 4/7 meeting, 2) adding “Has member been informed of peer support/self-help options?
Non-traditional Services: HSRI Indicators
Dr. Mulkern (HSRI) explained that the Robert Wood Johnson (RWJ) Foundation is interested in measuring non-traditional services and individualized supports (Axis II). See below suggestions at the 2/24 SC meeting related to measuring non-traditional services:
In order to not complicate this measure, the committee decided that we should consider tracking:
1) Traditional licensed agency with cultural specialty - Asian Family Services
2) Number of providers a) licensed or b) certified to offer non-traditional "rehabilitative" services - EMPS, home-based, etc.
3) Number of clinic subcontracts to local non-licensed agencies, whether faith based, cultural, etc. offering services that are a) reimbursable under CT BHP or b) not reimbursable under CT BHP but accessible to CT BHP members.
4) Number of clinics offering linkage to indigenous agencies in SED service plans.
Dr. Mulkern will send the SC information defining “non-traditional” services, measurement items from the literature on this topic.
Discussion Items in April:
Draft provider satisfaction survey tool (to view, click on 1st icon) that is included in the ASO performance targets associated with financial incentive/withhold (click on 2nd icon)
Next meetings
Since final recommendation/SC approval is needed for the registration screen & ICM referral form, provider survey and HSRI indicators, the subcommittee agreed to meet twice in April:
April 7, 10:30-12 in LOB RM 3800 and
April 28 from 1:30-3 PM at VOI/CTBHP