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Report to the Transitional Sub-Committee February 10, 2006
Disruption Analysis Methodology • Pulled paid claims from MCO’s • Slight variation in time frames (i.e., 8/1/05-10/31/05; 8/1/05-11/30/05) • Claims lag, possibly reflecting 1st or 2nd Quarter information • Anticipate that many clients now would now have completed episode of care
Disruption Analysis cont’d • 15 inquiries, no complaint filed, referrals given • 4 complaints • 2 closed • provider enrolling • member choosing to continue in care • 2 open • provider enrolling • no application located at EDS
Disruption Analysis Providers Clients
Drilldown(Unable to Locate, further research occurring ) Providers Clients
Drilldown(Decline) Providers Clients
CT BHP Activity • Over 1000 outreach calls to providers • Consulted the following resources: • Yellow and white pages • ValueOptions commercial provider file
Additional Resources Reviewed • http://www.dph.state.ct.us • http://www.ct-clic.com • http://www.ctnurses.org • http://www.ctmedicalprogram.com • http://www.physicians.dph.state.ct.us • http://www.schoolnurse.vserver.com/ • http://connecticut.uscity.net • http://www.vnasc.org • http://www.yellowbook.com • http://therapists.psychologytoday.com/ • http://connecticut.uscity.net
Next Steps • Will compare providers against DCF contract list • Continue to work with EDS (performer not enrolled) • Manually check for: • Additional phone numbers • Providers embedded in group practice (10%)
A Phased in Approach to Authorization Based on Level of Care • Residential and Group Home Treatment • Inpatient/Acute Levels of Care (23 hour observation, inpatient, PRTF) • Intermediate Levels of Care (Resi Detox, Partial Hospital, Intensive Outpatient,Extended Day Treatment) • Home-Based Services (IICAPS, FFT, MST, MDFT) and Outpatient Services
Phase 1RTC and Group Home Authorizations • Effective 2/1/06 • 28 packets received • 19 packets reviewed • 13 authorizations to 10 programs • On-site reviews to be scheduled • Census information collected and entered
Phase 2 Inpatient/Acute Levels of Care Effective March 1, 2006 (New Admissions) • All new members presenting for inpatient/acute levels of care will need to be pre-authorized for service. • These members will also be subject to continued stay reviews (CCR).
Phase 2 Inpatient/Acute Levels of Care – cont’d Effective March 1, 2006 (Members in Care) • Submission of a modified review form for all members in care as of March 1, 2006 • Fax between March1, 2006 – March 15, 2006 • In order to receive an authorization, providers must call on the day of discharge, or by March 15, 2006, whichever is sooner