Medicaid Care Management Oversight Council

Connecticut

Consumer Access Subcommittee

Legislative Office Building Room 3000, Hartford CT 06106

(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-5306

/ph/medicaid

The Consumer Access Subcommittee will work to improve consumer access to health care. The Subcommittee will elicit consumer input and gather information, identify barriers to care, consider remedies and make recommendations to the Medicaid Managed Care Council.

Co-Chairs: Christine Bianchi & Heather Greene

Meeting summary: March 23, 2011

Submitted by Hannah Beesley, Intern for Appropriations Committee

Next meeting: Wednesday April 20, 2011

Provider Network Update: DSS

The Department is in the process of reviewing all provider data available from multiple reports and systems. Significant challenges exist due to the various ways providers classify themselves, the way an MCO classifies and enrolls a provider and the way DSS classifies and enrolls a provider. Additionally providers do not consistently use only one ID. Providers may have multiple NPI numbers, tax IDs, and even Medicaid IDs. When a key identifier is found in more than one database a match can easily be made. When this is not the case, it becomes particularly challenging in matching providers across networks and requires manually review of the data.

The Department will continue working on these initiatives for both the current network reporting and the future ASO. Network development for the ASO will be a coordinated effort between DSS staff and ASO staff. We are assessing the MCO networks and the FSS network which so far has been better then expected in the number of MCO providers who are in the FFS network as well. DSS will keep the SC periodically informed as DSS continues with both the current network assessment and the prospective ASO network assessment.

Discussion points included:

Issues: determining if providers are still accepting members. Providers, by contract with MCO, need to inform the MCO if their panels are closed other wise the MCO won’t know this.
Credentialing application issues related to information providers need to submit that may include:
Determine how providers would be reported (I.E. if the providers have more than one practice or areas of specialty).
How does provider type fit into recording?
Did they provide an NPI number?
Taxonomy number provided for specialty?
Fee for service provider network assessment is going on as well
Reports crosswalk comparison to providers: reports are being done manually
Members can influence their providers to keep them as their PCP in the CTMAP Medicaid network, for example asking “could you consider participating with the DSSprovider network system?”
Under ASO there will be enhanced standard FFS rates. Streamlined system will:
Improve communication with providers: “here’s how it affects you…”
Single member ID cards, single point of entry and single customer service resource.
Do you anticipate knowing in advance about changes?
DSS would like to do parallel reporting
DSS is discussing with CMS about out-of- network services in the ASO/Medicaid CTMAP.
ASO will assist DSS with provider recruitment & identification of gaps.
Potential of 600,000 members with very diverse needs, yet there is support for a single ASO.
PCP’s meet barriers for getting specialists to see Medicaid patients. Discussion points included:
ASO role in improving specialty service access?
Fee for Service providers and matching up with location and county. Breaking down gender or areas to see what types of services are needed
Provider acceptance of Medicaid patientsand number of Medicaid patients/practice is voluntary provider process.
DSS does not have staff for a provider relations team to get providers to sign on

{Addendum from R. Spencer DSS: DSS does have staff mentioned but we are limited at this time and will be working cooperatively with the new ASO on provider recruitment ...and providers can and do call the DSS provider line which is fully supported by staff to handle inquiries as to how to join and handle any other questions...we do not go door to doort we do engage in provider recruitment and will be working with the ASO on developing and recruiting providers statewide which will mean meeting with providers and doing outreach to providers offices).

HUSKY 2008 report: Mary Alice Lee: (Summary report will be posted on

CT Voices has had a 1 year lapse in data
Report is the first utilization report of managed care data under the transitional Pre-paid Inpatient Hospital (PHIP) system.
During 9 months period from PHIP to MCO: 50,000 members were covered under Medicaid fee for service that essentially had no customer service or case management services.
Dental carve-out was in Fall 2008 during the PHIP period.
Enrollment in 18 month period:
Overall enrollment increased 7%, but mostly in adults
April 2008: those who did not choose plan defaulted to traditional plan
Pending cases, backlog of application processing related to the strart of Charter Oak Health Plan operations, combo cases (HUSKY B & COHP) enrollment was a factor in backup. October 2008-February 2009 backlog, after, HUSKY B climbed back up
HUSKY B enrollment numbers dropped 17% in 6 months due to administrative burdens of new program, size never reached the highest point again
HUSKY A plan changed in 12 month period. Double the normal number changed from PLHP and Medicaid
Plans exiting, members that didn’t change plans got defaulted: higher number of default rate in the high 20% and higher.
Of note, after January 1, 2012 everyone will be in the ASO system & won’t be a default to plan (but may be a default to a primary care provider).
Report looks at well child visits (participant ratio of well childcare visit: data looking at annual visits vs. screening ratio: expected number of visits/ actual number of visits).
Both ratio’s high overall because children under 2 have more visits: see low performance for preventive visits by age cohorts.
Developmental screening rate increased but still below acceptable rates perhaps due to:
Failure to file a claim for formal standardized testing
Department has not specified which tests or tools used
Is there an under-coding issue?
Statistics from 2006-2008 did not change all that significantly. Fees increased dramatically April 2008. Too soon for data to show change.

Managed Care enrollees vs. members defaulted to Traditional Medicaid: report found that managed care enrollees less likely to have emergency care and more likely to have dental.
During the transition period, safety net providers such as FQHC’s stayed in the HUSKY program and kept services available during the transitional coverage period.
Need to identify who is the primary source of care for Medicaid members including OBGYNs by geographic area.
2008 and 2009 birth data this week and data can be provided
OBGYN care primarily done in hospitals
Lessons learned from the previous delivery system change (2008 - 2009) that can be applied to the MC to ASO change include:
Needs to be mechanism to develop real time information. Info line needs to communicate to the department key issues so they know about coverage gaps.
Info line develops themes about problems related to coverage and enrollment
CAPs (Human Service Infrastructure) agencies role also needs to be looked with standardize feedback to DSS.
The “Hard to reach” families successful outreach may be best done by community based organizations; the quality of communication to consumers needs to be improved.
Recommendations for this system change: staffing and member functions need to be ramped up in anticipated increase of call volume. Member letters regarding the transition to ASO should not be sent out unless an adequate call line and member supports are in place.

Enrollment Highlights

Discussion points:

LIA transition 1500 members out of Charter Oak in October 2010
Change in payment method for non-subsidized member costs in Charter Oak
Generally processing 8,000 applications state wide for the department

Beginning of the Month received/processed applications: on the ACS report the chart BOM needs to be added to the processed number. And then the actual percentage of completed applications is more clearly shown.
Many clients have been moving from HUSKY B Husky A
Referral for Husky Plus: no applications done by referral. Can be referred by parents, PCP’s, specialists, etc…
14% (261) of children in Husky B have special health care needs. Most children in Husky B bands 1 & 2 are referred to the PLUS if they need services not covered by regular Husky B.
How do we more clearly identify children with special medical needs in HUSKY B and A?
No handle on % of kids in Husky A, so no comparison.
Standard screen: DPH program. English and Spanish. It is required for Husky B
Going forward we need to better identify special needs children (and adults). Who are they? What services do they need? Is a case management report needed to answer questions? Look at DPH regional medical home for special needs children data.
Are HUSKY B families (Husky B band 1 and 2) aware of Husky physical Plus program?
Decrease in Husky A. Default enrollments at 28%. ACS said the automated call process has reduced the default rate.
Assume the transition happens on January 1. How do we place people in December? Or how do we place people after the overlap in January to expand 6 months after? Members can/will get lost in transition

Primary discussion point at the next Meeting April 20th