Report to the Transitional Sub-Committee February 10, 2006

CT BHP Provider Network (TYPE) - SERVICE DESCRIPTIONS (Geneal Hospital) - Psychiatric Hospital – Under (Geneal Hospital) - Psychiatric Hospital - Aged222 (Geneal Hospital)- Psychiatric Hospital - Outpatient233 (General Hospital)- Inpatient47 45 (General Hospital) - Outpatient47 46 (State Institution) - Psychiatric – Under (State Institution) - Psychiatric - Aged444 (State Institution) - Psychiatric - Outpatient222 (State Institution) – Mental Health Clinic444 (Special Services) - Psychiatric Residential Treatment Facility 005

CT BHP Provider Network (TYPE) - SERVICE DESCRIPTIONS Residential Treatment Center0062 Group Home Group Home (Community Clinic) - FQHC Medical Clinic (Community Clinic) -FQHC Mental Health Clinic768 (Community Clinic) - Methadone Maintenance Clinic18 (Community Clinic) - Mental Health Clinic (Community Clinic) -Medical Clinic50 49 (Community Clinic) -Rehabilitation Center888 (Alcohol and Drug Abuse Center) - Inpatient10 (Alcohol and Drug Abuse Center) - Outpatient 17 (Home Health Agency) - Home Health Agency88

CT BHP Provider Network (TYPE) - SERVICE DESCRIPTIONS (Physician, MD) - Psychiatry (Physician MD Group) - Psychiatry22 25 (Nurse Practitioner) - Psychiatry (Nurse Practitioner - Group) - Psychiatry15 17 (Behavioral Health Clinician) - Lic Clinical Social Worker (LCSW) (Behavioral Health Clinician) - Lic Marriage and Family Therapist (LMFT)61227 (Behavioral Health Clinician) - Lic/Certified Alcohol & Drug Abuse Counselor (LADC)247 (Behavioral Health Clinician) - Lic Professional Counselor (LPC)2514 (Behavioral Health Clinician) - Psychologist (Behavioral Health Clinician Groups) - Lic Clin. Social Worker Grp116 (Behavioral Health Clinician Groups) - Lic Marriage and Family Therapist Group 012 (Behavioral Health Clinician Groups) - Lic/Cert Alcohol & Drug Abuse Counselor Grp122 (Behavioral Health Clinician Groups) - Lic Professional Counselor Grp 000 (Behavioral Health Clinician Groups) - Psychologist Grp

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 1 st or 2 nd 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 Enrolled3317,238 Accepts3822,158 In Process23106 Declined72301 Unable to locate** (Further research) 3021,073 Waiting call back52262 Totals1,16211,138

Drilldown (Unable to Locate, further research occurring ) MD91431 PhD38129 Masters APRN28107 Totals:302**1073 Providers Clients

Drilldown (Decline) MD15149 PhD1744 Masters3673 APRN435 Totals:72301 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

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 1 RTC 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

Questions?