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Connecticut Behavioral Health Partnership

Connecticut Behavioral Health Partnership. Report to the Behavioral Health Oversight Council December 14, 2005. Status report. Contract execution complete Waiver questions received – 11/9/05 Response to waiver questions submitted - 12/9/05 Decision expected within 2 weeks

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Connecticut Behavioral Health Partnership

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  1. ConnecticutBehavioral Health Partnership Report to the Behavioral Health Oversight Council December 14, 2005

  2. Status report • Contract execution complete • Waiver questions received – 11/9/05 • Response to waiver questions submitted - 12/9/05 • Decision expected within 2 weeks • Client notice mailing underway

  3. EDS - Provider Recruitment • More than 800 applications requested and mailed • 27 approved (2 group) • 95 in process at DSS (11 group) • Many applications returned to provider for additional information

  4. EDS – Provider Assistance • EDS has mailed all requests for applications within twobusiness days • Continues to meet performance requirement to forward complete applications to DSS within sevenbusiness days • EDS often exceeds expectations by reducing theprocessing time by working overtime • Calls are either responded to at the time of the call or within two business days if follow up isneeded

  5. EDS – Provider Assistance • Recent enrollment applications may not be processed and approved by 12/31/05 • EDS has been advising providers that their BHP enrollment will be effective retroactive to 01/01/06, if approved

  6. Fee schedules • Propose school based health center fee methodology change • Old: uniform weighted average • Proposed: uniform weighted average adjusted to pay as a fixed percentage of MH clinic (90%), most codes increase slightly, case management decreases

  7. Fee schedules • All fee schedules completed and posted at www.ctbhp.com • MH and SA Clinics • Hospital outpatient clinic • Independent practitioners • School based health centers • Home health

  8. Enhanced Care ClinicsOverview • Approximately 130 freestanding mental health and substance abuse clinics participate in CT BHP • Propose to establish a subclass of clinics referred to as enhanced care clinics. • CT BHP will pay enhanced care clinics fees that are, on average, 25% higher than the standard CT BHP clinic fee schedule in return for meeting special requirements. • Higher fees do apply to routine outpatient services (CPT codes 908XX and 961XX), • Higher fees do not apply to PHP, IOP, EDT, EMPS, and HBS.

  9. Enhanced Care ClinicGeneral Requirements

  10. Enhanced Care ClinicAccess • Emergency assessment of walk-in crisis clients within 2 hours of presentation • Urgent outpatient evaluation visit within 1 business day of referral • Routine outpatient evaluation visit within 10 calendar days of referral • Emergent/Urgent/Routine within 10 calendar days (separate requirement for med vs non-med f/u visit) • Extended hours of operation - Open for business two weekdays until 8pm and at least four hours each weekend

  11. Enhanced Care ClinicAccess • 95% performance threshold assumes that the clinics may not be able to arrange for clients to be seen at the clinic within the required timeframe. • 5% margin allows for clients that do not show up for follow-up visits, that are unable to accept an appointment within the 10-day timeframe, or who are successfully referred to a more appropriate, alternative level of care

  12. Enhanced Care ClinicCoordination of Care • Coordination Agreements with two or more primary care practices that serve clinic clients • E.g., Agreements provide for transition of medication management to PCP; clinic consultation for PCP clients; co-management of patients with serious medical and behavioral conditions; communication processes for shared clients.

  13. Enhanced Care ClinicPeer Support • Peer Support – Clinic hosts peer support groups • E.g., Active peer support groups meet at least 9 months of each year for each area of clinic licensure (SA adult, MH adult, child psychiatric)

  14. Enhanced Care ClinicOther requirements • Adoption of one evidence based practice - E.g., Policy and procedure with screening procedures, client flow diagram, clinician training, supervision, fidelity monitoring and demonstrated application of EBP • Co-occurring capable - E.g., Clinic screens 95% of clients for COD and demonstrates effective management when COD exists through linkage and referral or on-site co-occurring capable intervention • Clinical Specialization - E.g., Clinic offers specialty care in at least two areas (e.g., trauma, OCD, eating disorders, etc.); two or more staff have documented education, training, and supervised experience

  15. Enhanced Care ClinicProposed Implementation Schedule

  16. Questions?

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