Connecticut Behavioral Health Partnership

1. ConnecticutBehavioral Health Partnership Report to the Behavioral Health Oversight Council November 9, 2005

2. Implementation Update • Go-live: January 1, 2006 • Lori Szczygiel, LMHC selected as BHP Service Center Vice President • Waiver amendment – no response from CMS to date • Contract execution pending

3. Implementation Update • Outreach to independent practitioners • Successful DCF identifier test file • Eligibility test files week of 11/14/05 • Communication plan completed • Provider and Member orientation plans underway

4. Implementation Update • Completed - Coverage and Coordination of Medical and Behavioral Services • Covered services table • Service class matrix (guide to authorization classes) • Posted to www.ctbhp.state.ct.us

5. Clinical Management Committee • Completed • Child psychiatric – inpatient, intermediate care, outpatient, IICAPS, residential • Adult psychiatric – inpatient, outpatient • Pending • Adult and adolescent substance abuse • Adult psychiatric - intermediate care, home health • Child psychiatric – MST, MDFT, FFT, GH1, GH2, home health • Psychological testing

6. Provider Specific Rates • Interim rates • Provider specific rate calculations are underway • CHNCT, FirstChoice/Wellcare and HealthNet, have provided requested rates in effect July 1, 2005 • Departments will establish interim rates based on rates in effect on July 1, 2005 and Anthem rates in effect on March 1, 2004

7. Provider Specific Rates • Interim rates • Letters informing providers of the BHP interim rates will be sent out the week of November 21st • Upon receipt of provider-specific rates from Anthem, final rates will be calculated • Payments will be retroactively adjusted to January 1, 2006 in accordance with the final rates

8. Provider Specific Rates • Final Rates - Appeals • Providers will be afforded the opportunity to appeal the calculation of the final rates • Final rates will be adjusted if rate calculations are determined to have been made in error • Payments for affected providers will be retroactively adjusted to January 1, 2006

9. Provider Specific Rates • Methodology • Provider-specific rates will be based on the MCO contracted rates weighted by HUSKY A enrollment by county • Only the enrollees for which a provider has a contracted rate will be used in the rate calculation

10. Table 1: Enrollment by County

11. Provider Specific Rate Methodology • Rate formula – four MCO rates (Rate1 x ENR1) + (Rate2 x ENR2) + (Rate3 x ENR3) + (Rate4 x ENR4) (ENR1 + ENR2 +ENR3 + ENR4) • Four MCO Rate Example – Hartford County: ($125 x 57,242) + ($130 x 11,202) + ($115 x 13,968) + ($120 x 6,728) (57,242 + 11,202 + 13,968 + 6,728) 7,155,250 + 1,456,260 + 1,606,320 + 807,360 = $123.68 89,140

12. Provider Specific Rate Methodology • Rate formula – three MCO rates (Rate1 x ENR1) + (Rate2 x ENR2) + (Rate3 x ENR3) + (Rate4 x ENR4) (ENR1 + ENR2 +ENR3 + ENR4) • Three MCO Rate Example (Hartford County): ($130 x 11,202) + ($115 x 13,968) + ($120 x 6,728) (11,202 + 13,968 + 6,728) 1,456,260 + 1,606,320 + 807,360 = $121.32 31,898

13. Fee schedules • IICAPS rate is $24.26 per 15 minute unit • Independent Practitioner fees adjusted per fixed percentage methodology • Fee schedules are being posted to www.ctbhp.state.ct.us as calculations are completed

14. Fee Schedules • Enhanced Care Clinics • Draft program model under development • Presentation to BHOC in December 2005

15. General Implementation Updates • Connecticut Service Center Vice President • Lori Szczygiel, LMHC • Focused Recruitment on 19 Key Positions • Active Recruitment and Hiring of Line Staff Positions • Service Center Relocation to Rocky Hill (Temporary Space November 11th)

16. General Implementation Updates • Submitted 11 Deliverables to Departments • Key Person • Implementation Plan • Member Appeals Process • Provider Appeals Process • Care Management Program • Key Positions (50%) • Member Brochure • Member Complaint Process • Partnership Website • Payment Problem Resolution Plan • Security and Privacy Plan

17. General Implementation Updates • Participating in Meetings with DSS/DCF • Developing and Customizing Policy & Procedure’s and IT System • Pre-implementation Readiness Review • Offsite Desk Review Nov 9th • Clinical Operations On-Site Review Dec 7 & 8 • Information Systems On-Site Review Dec 9& 12

18. Provider Communication Plan

19. Provider Communication Plan

20. Provider Recruitment Plan

21. EDS Enrollment Report • Independent Practitioners • EDS has sent out over 500 applications for enrollment requested by independent practitioners • Approximately 10% of these applications have been sent to prescribing practitioners (MD and APRN)

22. Member Communication Plan

25. Coordination and Transition of Care • HUSKY Behavioral Health Carve-Out - Coverage and Coordination of Medical and Behavioral Services and Exhibit D Covered Services Table, both finalized • “Coordination Agreement” between MCO’s and ASO, being developed • MCO’s authorizing behavioral health care beyond 12/31/05 and ASO will honor MCO authorizations