Report to the

1

• Report to the
• Transitional Sub-Committee
• February 10, 2006

2
CT BHP Provider Network
3
CT BHP Provider Network
4
CT BHP Provider Network
5
Disruption Analysis Methodology

• Pulled paid claims from MCOs
• 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

6
Disruption Analysis contd

• 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

7
Disruption Analysis

• Providers
  Clients

8
Drilldown(Unable to Locate, further research
occurring )

• Providers
  
  Clients

9
Drilldown(Decline)

• Providers
  Clients

10
CT BHP Activity

• Over 1000 outreach calls to providers
• Consulted the following resources
• Yellow and white pages
• ValueOptions commercial provider file

11
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

12
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)

13
Treatment Authorization and Registration
Transition
14
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

15
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

16
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).

17
Phase 2 Inpatient/Acute Levels of Care contd

• 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

18
Questions?