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Analysis of Provider Network Disruptions in Connecticut Behavioral Health Program (CT BHP)

This report outlines the disruption analysis methodology of the Connecticut Behavioral Health Program (CT BHP) as of February 10, 2006. It details the process of pulling paid claims and varying time frames, inquiries made, and complaints received regarding provider enrollment and client care continuity. After extensive outreach and resource consultation, upcoming steps include comparisons of providers against DCF contract lists and the implementation of a phased approach for treatment authorization based on levels of care, effective February 1, 2006, with detailed processes for inpatient and acute care.

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Analysis of Provider Network Disruptions in Connecticut Behavioral Health Program (CT BHP)

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  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 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

  6. 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

  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 – 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

  18. Questions?

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