Behavioral Health Partnership Oversight Council

Quality Management & Access Subcommittee

(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306
www.cga.ct.gov/ph/medicaid
 

Meeting Summary: September 29, 2006

Chair: Dr. Davis Gammon Vice-Chair – Paula Armbruster
Next meeting: October 27, 2006 @ 11:30 Am at VOI-Rocky Hill

Update on registration system/resolution of technical issues – VOI
Outpatient Registration
As of September 22, 2006 the ASO ValueOptions has generated 1631 provider user IDs for the outpatient registration. There are approximately 3300 providers in the EDS system; however some of these represent single providers with multiple billing sites. On September 19, 2006 mailings went to every individual/facility provider alerting them to the necessity of requesting the user ID number. ValueOptions received 250 returns – there were some file discrepancies in the mailing file. EDS will update the file when BHP providers re-enroll.

Forty-four (44) providers are using paper registration as they do not have access to the web. While the ASO accepts the paper registration, it is hoped that this registration process will be phased out over time. As of September 22, 2006 there are over 11,000 providers that use the web-based registration process.

About 400 of 3000 providers attended the ASO provider training for the registration process. Subcommittee participants noted that the VOI Provider Relations staff has been very helpful to providers working through their questions with the new system

Security Issues Security issues have been resolved.

Authorization Issues
Authorizations are tied to the vendor level – site ID rather than the provider ID for group practices. Group practices will receive the second registration (beyond the initial 26 session) based on the original registration submitted. Authorizations may be voided by ASO because of procedure errors (i.e. provider site, start date of services, etc.). The provider unit will be contacted so that a new corrected authorization is sent to EDS. Providers can look up the VOI authorization on the CTBHP
web site that will start with the last authorization. This system is updated weekly with EDS updates.

On November 1, 2006 all registration fields will be required to be completed for new patient registration. A provider alert will sent out.

Individual providers described some delay issues related to registration. While similar issues will be taken up by the BHP OC Operations Subcommittee, Scott Greco said he will contact the corporate office to determine common reasons for the slowness of the system during registration.

ASO Contractual Target on Emergency Department Utilization
The BHP/ASO contract calls for 100% of the amount of the applicable withhold related to this measure would be returned to the ASO if VOI achieve the target level of performance which is less than 1.70 ED (BH) visits per 1000 member months (MM). The performance target was based on HUSKY A data for ED visits for BH per 1000MM. From 2001 to 2004, the rate was 2.03, 1.94, 1.92, and 1.80 respectively. Extrapolated data to SFY06 was 1.70 total visits/1000 MM as the target. What was surprising was a significant increase in 2005 ED visits to 2.04 visits/1000MM. The increase in the last year of BH services under managed care makes the ASO target of 1.70 visits/1000MM unrealistic. The reason for the 2005 increase is unclear at this time. Dr. Schaefer said the BHP agencies need to review the ED visit trends and ASO 2006 performance target number, considering the options of 1) establishing a new target mid year in the 2006 calendar year performance target contract or 2) disregarding the measure for 2006 and returning the withhold to ValueOptions. The BHP will review the accuracy of the 2005 data obtained from a Mercer extract and determine next steps. The Subcommittee did not endorse either option at this time as there is more information needed on the meaning of the 2005 ED visit rate. Child Health & Development Institute (CHDI) report on ED use has been completed and can be presented at a future QA meeting.

HSRI/BHP Quality BH Indicators: Update
Virginia Mulkern, BHP agencies and Subcommittee participants discussed proposed questions to be added to the outpatient re-authorization screen that will support some of the SC's recommended quality indicators. The Chair stated the clear intent, agreed upon by HSRI and BHP agencies, that questions should be meaningful YET KEPT TO A MINIMUM in respect for practitioners' time. BHP and HSRI will review the questions, based on the performance indicators, and review with the subcommittee at the next meeting.

The BHP QA Subcommittee will meet Friday October 27 from 11:30 – 1:30 at VOI, Rocky Hill. The agenda items will include the re-authorization indicator list/questions, the CHDI ED study and overall update on the quality indicator project.