Behavioral Health Partnership Oversight Council

Operations 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/BHPOC

Meeting Summary: December 8, 2006
Co-Chairs: Stephen Fahey & Lorna Grivois
Next meeting: Friday January 12, 2007 at 12:30 PM in LOB RM 1C

CTBHP/ValueOptions (VOI) Report

Presentation/discussion highlights:
• Outpatient (OP) web registration: 104 providers currently use paper registration. Change from Nov. to Dec reporting period:

• Rapid Response Team (RRT) reviewed authorization related claims issues for 30 providers. The Team is doing onsite visits, working with individual practitioners to identify, resolve issues.

• Authorization trends (pg 6) show steady use of intermediate services (EDT, IOP, PHP), Oct. and Nov. increase in inpatient services thought to be seasonal, Average LOS excluding Riverview includes data by town, with the highest in Danbury and Stamford and the top discharge delay reason remains RFT placement (37.5%). There was a discrepancy noted between facility and CTBHP/VOI discharge delays. Action steps related to the discrepancy included:

o VOI will report the actual number of children with delayed discharge by facility at the January 2007 subcommittee meeting.
o DCF, BHP, VOI and facility providers with extensive discharge delays will meet to develop problem resolution steps to reduce excessive delays.

• ED delays (pg 9): graphs show < number of children “stuck” (10) compared to last month (16); however average days of being “stuck” in ED increased (6.60 related to 3 outliers), which is close to the June number (7.20). In Nov, it seems that the 10 “stuck” in the ED were DCF members as non-DCF member category was shown as 0. ED delayed patients were most likely to be admitted inpatient services. The SC requested tracking of pediatric medical unit psychiatric discharge delays in the next reports.

• The revised Pre-cert & concurrent review (CCR) format was implemented during the week of 11/20/06. Average time to complete this is about 18 minutes. Providers noted the smoother process does take less time.

• Residential Care Team (formerly CPT) transition began 12/1/06. There were about 100 cases that were under process before the transition and will be manually matched to appropriate service levels. VOI is calling every residential provider to establish baseline bed availability. Providers, if they want to remain part of the referral system, need to report beds weekly to VOI (as well as complete the provider data verification forms).

• VOI is concerned about the low number of member complaints received and the team is discussion how to better present the complaint option to the member.

• Percent of claims denials are mainly due to administrative process issues than medical necessity issues. There was discussion about individual practice/institution claims issues that were informative to the group; however resolution of specific issues is through the Rapid Response Team process.

o Retro reviews can be done up to 48 hours: the time is counted from the date/time the message left for VOI if there is no contact with the call. Providers can appeal a denial if the review is after the 48 hours (i.e. inpatient adm. on a Friday night).
o Authorization is applied to each level of care, which is an industry standard: there must be differentiation of discharge from one LOC and admission to another LOC (i.e. from PHP to IOP) in order for claims to be accepted.

DSS Claims

ü Managed Care claims resolution projects are completed with the exception of several being completed by Health Net.

ü DSS will review claims data (not presented at this meeting) as there may be over-counting of PA –related denials. EDS is working on this.

ü Rapid Response Team is meeting weekly to address issues as well as making practice site visits.

ü EDS has updated the inpatient authorizations where there were not enough days included (about 300 claims); BHP is reprocessing the claim so EDS can make full payment to the provider.

ü Upcoming Provider Bulletins:

o IICAPS telephonic authorizations and the separate OP registration for medication management process have been revised by BHP. Telephonic review will include medication management; codes were added to the IICAPS unit/month bundled services, so providers can bill for medication services, case management and in-home services. Providers will receive a provider bulletin about this.

o Delays in the TPL billing beyond 30-60 days, discussed at the last several meetings, has resulted in a provider bulletin being issued next week to clarify the billing issues.

ü Health Net uses a different member # than the Medicaid number and had agreed to cross-walk these numbers for authorizations. Questions about this should be referred to Rose Ciarcia, HUSKY program manager: rose.ciarica@ct.gov.

ü The Provider Advisory Group will review clinical management case management guidelines. Upon completion of this review/recommendation process, additional units (two hours) will be added to the annual outpatient provider case management total hours.

ü A provider representative commented that the telephonic review for continuation of outpatient services after the initial 26 session was lengthy (about 50 minutes) for one case. BHP/VOI will review the time it takes to gather information for this authorization. (The QA SC did not review final information requirements for this OP authorization process for sessions beyond the initial authorized 26).

o Some providers commented that they could project the number of cases that will soon require authorizations for additional OP sessions. The volume for auths. for additional OP sessions may put a strain on VOI's system. The BHP and VOI will review this.