MD’s Corner: Sexually Transmitted Diseases (STDs) and HIV Screening Recommendations

STDs are hidden epidemics of enormous health and economic consequence in the United States. They are hidden because many people are reluctant to have an open discussion about sexual health issues with their providers, even though they’re interested in STD prevention. . . read more

Despite the barriers, there are many individual and community based interventions that are effective and can be implemented immediately. The process of preventing STDs must be a collaborative one and involves many stakeholders. A successful national initiative to confront and prevent STDs requires widespread public awareness and participation.

Here is a brief overview of the Centers for Disease Control STD and HIV recommendations:

  • At least one test for HIV of all adults and adolescents from ages 13 to 64.
  • Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
  • Annual gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
  • Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women starting early in pregnancy, with repeat testing as needed, to protect the health of mothers and their infants.
  • Screening at least once a year for syphilis, chlamydia, and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STDs (i.e., at 3-to-6 month intervals).
  • Testing at least once a year for HIV for anyone who has unsafe sex or shares injection drug equipment. Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).

Waldemar Rosario, M.D., F.A.A.P.

Senior Vice President and Chief Medical Officer

Community Health Network of Connecticut, Inc.

The HUSKY Health Pain Management Microsite Is Online Now!

The new HUSKY Health Pain Management provider microsite is now available at www.ct.gov/husky. Click “For Providers” then “Pain Management” to access a comprehensive set of tools, resources and continuing education for the treatment and management of your patients with chronic pain.

Ready, Set, HEDIS®!

Community Health Network of Connecticut, Inc. (CHNCT) is gearing up for another great HEDIS season in 2016, and we need your help. HEDIS–Healthcare Effectiveness Data and Information Set–is a tool that measures provider and health plan performance on important dimensions of care. . . read more

As the Administrative Services Organization (ASO) for the State of Connecticut’s Department of Social Services (DSS), CHNCT will be collecting, processing, and reporting the data for this annual project. HEDIS results are used for continuous quality improvement efforts.

HEDIS 2016 will address services that were rendered in 2015. Beginning in February 2016, CHNCT will contact providers for required clinical information. These requests will end in early May 2016, but the sooner the required clinical information can be submitted to CHNCT, the smoother the process will go. Medical records may be submitted to CHNCT by fax, mail, email, on-site pick up, or at an on-site review. Patient privacy and protection are extremely important to us, and CHNCT complies with applicable Health Insurance Portability and Accountability Act (HIPAA) regulations.

If your practice has a centralized location where all medical records are stored, and would prefer that CHNCT contacts that site directly for all requests, please call 1.866.317.3301 or email us at HEDIS@chnct.org. CHNCT works to reduce the administrative burden on providers in any way possible during the HEDIS season, so if there is a way we can make the process easier for you please let us know. Click here to access the HEDIS Quick Reference Guide for your reference; you may also access the guide by visiting www.ct.gov/husky, clicking “For Providers,” then “Provider News, Trainings & Events.” This guide describes the scope of data and coding guidelines associated with each HEDIS measure.

Thank you for working with CHNCT to improve the health of the individuals, families, and communities we serve together. Your cooperation and timeliness in submitting the requested clinical information in the coming months would be greatly appreciated.

ICM Partnering Efforts to End Homelessness and Improve Access to Care

The State of Connecticut has embraced the Zero: 2016 initiative, an effort to end homelessness among veterans and the chronically homeless by the end of 2016. How is CHNCT’S Intensive Care Management program (ICM) helping the state’s efforts to reach this goal?. . . read more

We conduct targeted outreach to members who may be homeless, attend community meetings to learn more about the homeless community, and work together with agencies that serve the homeless to connect them to medical care.

ICM takes a comprehensive, person-centered approach to address current medical issues and social determinants of health needs of HUSKY members referred to the program. HUSKY members with identified social determinants of health needs are referred to a CHNCT Community Health Worker (CHW) formerly know as Human Services Specialist. ICM nurses help coordinate members care needs while collaborating with CHW staff.

Together CHWs and ICM nurses foster community connections for members and providers with organizations that help with needs such as but not limited to:

  • Housing
  • Employment
  • Veterans aid
  • Criminal justice
  • Education
  • Behavioral health
  • Child welfare

The most recent data on the number of homeless in the state (February 2015 Connecticut Counts Initiative) is 4,000 plus individuals. As many as 3,000 of these are homeless youths age 24 and under. Intensive Care Managers, Community Health Workers, and Utilization Management staff participates in forums across the state that aims to address the special needs of our homeless population. At hospital-based community care and other community-based collaborative meetings, ICM nurses and CHW staff share pertinent clinical and psycho-social information; HUSKY members sign a release before their cases are discussed.

The goal of these meetings is to connect HUSKY members to needed health care, shelter, and community resources. Connection to care services includes attribution to primary care providers and referrals to other providers and community resources. Our healthcare partners include the Connecticut Behavioral Health Partnership, the Connecticut Dental Health Partnership, and the Department of Mental Health and Addiction Services; and we maintain contacts with many home care agencies and area shelters for member referrals. Providers can contact ICM for community services by CHWs whenever they have members with these concerns; call 1.800.859.9889, extension 2024.

CHNCT Community Health Workers advocate for HUSKY members by accompanying them to housing meetings and other applicable appointments. CHWs also work with the Coordinated Access Network in the Greater Hartford Region to complete universal housing applications and administer the VI-SPDAT9, a tool to identify an individual’s vulnerability index and the best type of support and housing intervention.

CHNCT staff will continue to participate in hospital- and community-based collaborative meetings, and will partner with providers to ensure that our most vulnerable and long-term homeless members are placed into appropriate housing and have access to needed health care. If you have questions about the services provided by ICM and CHNCT’s Community Health Workers, please call 1.800.859.9889, extension 2024.

Enhanced Rates for Glide Path & PCMH Recognized Practices

The Department of Social Services (DSS) invests significant resources to help primary care practices obtain Person-Centered Medical Home (PCMH) recognition from the National Committee for Quality Assurance (NCQA). Practices which have attained PCMH recognition and practices working toward recognition are both eligible for enhanced fee-for-service payments; practices which have attained PCMH recognition are eligible for additional incentive payments for meeting identified quality measures. . . read more

Practices on the Glide Path receive comprehensive program support and guidance from CHNCT in addition to their financial incentive for pursuing PCMH recognition. Connecticut’s PCMH program is unique in providing financial incentives to both practices which have achieved recognition as well as those working towards becoming PCMH recognized.

Key features of practice transformation to a PCMH include:

  • Embedding limited medical care coordination functions within primary care practices
  • Implementing non-face-to-face and after hours support for patients
  • Using interoperable electronic health records (EHR)

Enhanced fee-for-service payments are applied to the current Medicaid fee schedule and are limited to primary care services. Click here to view a list of the primary care codes for enhanced reimbursement. Enhanced payments vary based on whether a practice is on the Glide Path or the level of PCMH recognition a practice has attained. Depending on a practice’s status in the PCMH program, a 14, 20, or 24 percent increase is applied to the current Medicaid fee for applicable CPT codes. The chart below provides an estimate of a practice’s increased revenue at the various levels of PCMH program participation based on their annual Medicaid reimbursement.

  Annual Medicaid Reimbursement by PCMH Program Status*
Annual Medicaid
Reimbursement*
Glide Path
14% Increase
PCMH Level 2
20% Increase
PCMH Level 3
24% Increase
$200,000 $228,000 $240,000 $248,000
$1,000,000 $1,140,000 $1,200,000 $1,240,000
$2,500,000 $2,850,000 $3,000,000 $3,100,000

* Annual Medicaid reimbursement figure is based on potential reimbursement for applicable CPT codes for primary care services only.

In addition to the enhanced fee reimbursement, there are two types of ongoing performance payments available to practices after they have achieved PCMH recognition. The incentive performance-based payment compares a practice’s quality performance measures to other practices and the second is based on the amount of improvement the practice demonstrates over time. Click here for details on how performance payments are calculated.

Primary care practices interested in pursuing PCMH recognition through DSS’s Glide Path program and receiving their additional financial incentive payments should contact the PCMH administrator at 203.949.4194, or by e-mail at pcmhapplication@chnct.org. Practices which have achieved PCMH recognition and may not be receiving all of their available incentives should also contact the PCMH administrator.

Follow-Up Appointments are Crucial after Hospital Discharges

The days immediately following hospital inpatient discharge are a vulnerable period for members. Members may have complex care needs that require coordination and oversight, so they must have a follow-up appointment with a primary care provider within seven days of hospital discharge. . . read more

The follow-up visit with the member’s primary care provider is key to preventing an unnecessary hospital readmission. This appointment serves several important functions including addressing the conditions that precipitated the hospitalization, ensuring continuity of care, and evaluating patient progress with the plan of care in the community.

Recently, a sample of HUSKY members from the CHNCT Member Advisory Workgroup shared insightful information about the barriers to receiving post-discharge follow-up care. The participants advised that while members are in the hospital they primarily focus on returning home, finding transportation, and ensuring they have their prescriptions. They also shared that the packet of information given to members at the time of discharge is voluminous and difficult to understand. Finally, the participants felt that members do not consider follow-up care an essential part of getting and staying well; they may think that the medical crisis is over and there is no need for continued care.

During the inpatient stay, CHNCT assists hospitals with discharge planning and coordination of care for all HUSKY members. Select hospitals have a CHNCT Inpatient Discharge Care Manager (IDCM) who collaborates with members, their caregivers, hospital care coordinators, and social workers to provide onsite or telephonic transitional care support for members with select chronic conditions, such as:

  • Asthma
  • Diabetes
  • Congestive heart failure
  • Coronary artery disease
  • Sickle cell disease

The IDCM also assists members with complex needs who are at risk for hospital readmission. As advocates for these members, the IDCM collaborates with hospital care coordinators, primary care physicians, specialists, members, caregivers, community-based providers, and CHNCT Intensive Care Management (ICM) nurses to identify and address medical and psychosocial gaps that contribute to readmission. The IDCM then develops a comprehensive discharge plan that promotes safe and effective transition of care to an alternate setting. A post-discharge follow-up appointment is scheduled prior to discharge.

Within the first days following discharge, CHNCT Transitional Care nurses call all members and their providers to conduct medication reconciliation, assess for outstanding healthcare and educational needs, promote care coordination, and assist with scheduling transportation; for members who did not have an assigned IDCM during their hospital stay, Transitional Care nurses will also help schedule their post discharge follow-up appointments. CHNCT encourages primary care providers to contact the CHNCT dedicated Transitional Care phone line at 203.949.4000, extension 2010, to advise us of a preferred contact in your office for appointment scheduling.

Primary care providers can access a census of their inpatient HUSKY members through the HUSKY Health Provider Portal by going to www.ct.gov/husky, clicking “For Providers,” then “Provider Login.” The portal provides secure access to the Daily Admission and Discharge Report as well as other useful reports, including monthly inpatient claims and ED utilization.

Reach for Escalation!

The HUSKY Health Member Services Escalation Unit (EU) is available to help when your HUSKY patients have complex access-to-care issues such as locating providers, making appointments, or coordinating services with multiple providers. . . read more

The services the EU provides include:

  • Locating a hard-to-find provider or specialist your HUSKY patient may need
  • Helping patients who need multiple providers and appointments
  • Transitioning a patient to an alternative provider when indicated
  • Connecting your patients with community resources for shelter, food clothing, utilities as well as with other free or low-cost services not covered by HUSKY Health
  • Assisting with getting patient medical records and any other documentation for a visit to a new provider

If you have HUSKY patients who would benefit from the help of the EU, Reach for Escalation by contacting Provider Services at 1.800.440.5071 and asking for the Escalation Unit. You can also complete and return the Escalation Referral Form by clicking here or visiting www.ct.gov/husky, clicking “For Providers,” “Provider Bulletins & Forms” then “Escalation Referral Form” located on the right hand side of the page. Email the completed form to reachforescalation@chnct.org or fax it to 203.265.3197.

Once the referral is received, the EU will contact the member and begin to work on the request. We will keep in touch to keep you informed as your patient’s issue is addressed by the EU.

Member Missed Appointment Assistance

Provider Relations and Member Services collaborate in an outreach program to contact members who have missed an appointment in the last 90 days. But we need your help. We have only one way of knowing that a member has missed an appointment–if you tell us. So, please do!. . . read more

There are two ways you can submit missed appointment information to us: you can complete and return the Member Missed Appointments Form or you can use the new online Member Missed Appointments web form to submit your information through the secure Provider Portal. We use the information you provide to contact the member and discuss the importance of their keeping an appointment or calling within an adequate time to cancel their appointment, if necessary.

You can access both forms by visiting www.ct.gov/husky, clicking “For Providers,” “Provider Bulletins & Forms,” then selecting the type of form you’d like to use from the Member Missed Appointment links on the right hand side of the page.

Important Provider Profile Update Reminder

Have you updated your profile lately? All demographic changes for you and your practice, including additions and terminations of physicians, nurse practitioners, and physician assistants, need to be made in a timely fashion to ensure the integrity of the provider directory. These updates assist physicians and clinical staff, call center staff, and members when searching for or referring to a provider to access and coordinate care. . . read more

The accuracy of your profile may impact the payment of claims and can also affect misdirected payments, the loss of provider eligibility or the recoupment of previously paid claims.

Any changes in address, licensure, provider specialty, certification, business name or ownership, group/clinic affiliation, and Federal Employer Identification Number (FEIN) of all National Provider Identifier (NPI)/non-medical providers must be communicated to DXC Technology.

The Provider Manual is located on the DSS website and provides more information about managing and updating your provider profile. You can access the DSS Provider Manual by clicking here or visiting www.ctdssmap.com, clicking “Information,” then “publications.”

Please review and update your profile by logging into the DSS Provider Portal by clicking here or by going to www.ctdssmap.com and clicking “Secure Site” on the left hand navigation menu.

You may also submit any changes, on your letterhead, by mail to:

DXC Technology
P.O. Box 5007
Hartford, CT 06104

The Provider Call Center Is Here to Help You!

Call us at 1.800.440.5071 Monday-Friday from 8 a.m.–6 p.m.

Some of the things we can help with include:

  • Explaining HUSKY benefits and services
  • Locating a CMAP-enrolled specialist, sub-specialist, or ancillary provider for your HUSKY patients
  • Contacting patients with a history of missed appointments
  • Assisting when other insurance is no longer active but threatens to prevent or interrupt services, including filling prescriptions or claims payment
  • Coordinating with other services, such as behavioral health, transportation, or dental
  • Working with DSS when eligibility issues create a barrier to care

Get to Know Your Provider Relations Representative – We Can Help!

CHNCT's Provider Relations staff is dedicated to working personally with your practice onsite and by phone. Our staff is on the road 4-5 days a week, visiting provider offices to discuss topics such as enrollment/attestation processes, DSS Bulletins and Policies, CHNCT policies and programs, and other important matters. . . read more

Our goal is to establish an open dialogue with you and your practice to promote positive relationships through communication, problem resolution, and education. CHNCT collaborates with our partners at DSS and DXC Technology to address any and all inquiries as quickly as possible and facilitate resolutions when necessary.

The CHNCT Provider Relations staff supports and attends a number of provider conferences held throughout the state each year. When you see us at an event, please stop by to introduce yourself and we will do the same!

To set up an appointment with us or to speak with your local Provider Relations representative, please call your regional contact listed below:

Nancy Esposito

203.949.4163

nesposito@chnct.org

New Haven

Richard Genden

203.949.4064

rgenden@chnct.org

Fairfield

Kimberly Martin

203.949.4106

kmartin@chnct.org

Greater Hartford/Tolland

David Miller

203.949.4141

dmiller@chnct.org

Hartford/Litchfield

Jennie Pinette

203.949.6140

jpinette@chnct.org

Middlesex/New London/Windham

Important Contact Information

  • Behavioral Health1.877.552.8247

Monday - Friday; 8:00 a.m. - 7:00 p.m.
www.ctbhp.com

  • Dental1.888.445.6665

Monday - Friday; 8:00 a.m. - 5:00 p.m.
www.ctdhp.com

Non-Emergency

  • Medical Transportation1.888.248.9895

Monday - Friday; 7:00 a.m. - 6:00 p.m.
www.logisticare.com

  • Medical1.800.440.5071

Monday - Friday; 8:00 a.m. - 6:00 p.m.
www.ct.gov/husky

  • Member Eligibility1.800.440.5071

Monday - Friday; 8:00 a.m. - 6:00 p.m.
www.ctdssmap.com

  • Pharmacy1.800.842.8440

Monday - Friday; 8:00 a.m. - 5:00 p.m.
www.ctdssmap.com