Report to the

Transitional Sub-Committee

February 10, 2006

CT BHP Provider Network

(TYPE) - SERVICE DESCRIPTIONS

12.12.05 12.29.05 1.30.06

(Geneal Hospital) - Psychiatric Hospital – Under 21 5 6 3

(Geneal Hospital) - Psychiatric Hospital - Aged 2 2 2

(Geneal Hospital)- Psychiatric Hospital - Outpatient 2 3 3

(General Hospital)- Inpatient 47 47 45

(General Hospital) - Outpatient 47 47 46

(State Institution) - Psychiatric – Under 21 5 5 5

(State Institution) - Psychiatric - Aged 4 4 4

(State Institution) - Psychiatric - Outpatient 2 2 2

(State Institution) – Mental Health Clinic 4 4 4

(Special Services) - Psychiatric Residential Treatment Facility       0 0 5

CT BHP Provider Network

(TYPE) - SERVICE DESCRIPTIONS

12.12.05 12.29.05 1.30.06

Residential Treatment Center 0 0 62

Group Home - 1.0 0 0 33

Group Home - 2.0 0 0 6

(Community Clinic) - FQHC Medical Clinic 13 12 14

(Community Clinic) -FQHC Mental Health Clinic 7 6 8

(Community Clinic) - Methadone Maintenance Clinic 18 18 18

(Community Clinic) - Mental Health Clinic 134 135 133

(Community Clinic) -Medical Clinic 50 50 49

(Community Clinic) -Rehabilitation Center 8 8 8

(Alcohol and Drug Abuse Center) - Inpatient 10 10 10

(Alcohol and Drug Abuse Center) - Outpatient    17 17 17

(Home Health Agency) - Home Health Agency 88 88 88

CT BHP Provider Network(TYPE) - SERVICE DESCRIPTIONS

12.12.05 12.29.05 1.30.06

(Physician, MD) - Psychiatry 281 271 285

(Physician MD Group) - Psychiatry 22 22 25

(Nurse Practitioner) - Psychiatry 95 90 91

(Nurse Practitioner - Group) - Psychiatry 15 15 17

(Behavioral Health Clinician) - Lic Clinical Social Worker (LCSW) 15 32 88

(Behavioral Health Clinician) - Lic Marriage and Family Therapist   (LMFT) 6 12 27

(Behavioral Health Clinician) - Lic/Certified Alcohol & Drug Abuse Counselor (LADC) 2 4 7

(Behavioral Health Clinician) - Lic Professional Counselor (LPC) 2 5 14

(Behavioral Health Clinician) - Psychologist 201 201 208

(Behavioral Health Clinician Groups) - Lic Clin. Social Worker Grp 1 1 6

(Behavioral Health Clinician Groups) - Lic Marriage and Family Therapist Group   0 1 2

(Behavioral Health Clinician Groups) - Lic/Cert Alcohol & Drug Abuse Counselor Grp 1 2 2

(Behavioral Health Clinician Groups) - Lic Professional Counselor Grp     0 0 0

(Behavioral Health Clinician Groups) - Psychologist Grp 23 24 27

1127 1144 1363

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

Enrolled 331 7,238

Accepts 382 2,158

In Process 23 106

Declined 72 301

Unable to locate** (Further research)

302 1,073

Waiting call back 52 262

Totals 1,162 11,138

Drilldown(Unable to Locate, further research occurring )

MD 91 431

PhD 38 129

Masters 145 406

APRN 28 107

Totals: 302** 1073

Providers Clients

Drilldown(Decline)

MD 15 149

PhD 17 44

Masters 36 73

APRN 4 35

Totals: 72 301

Providers Clients

CT BHP Activity

Over 1000 outreach calls to providers

Consulted the following resources:Yellow and white pagesValueOptions 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%)

Treatment Authorization and Registration Transition

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 2/1/0628 packets received19 packets reviewed13 authorizations to 10 programsOn-site reviews to be scheduledCensus 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

Questions?