MARYLAND PHYSICIANS CARE MCO



Delaware Health and Social Services

Medical Care Advisory Council (MCAC)

Meeting Minutes

|Date: May 9, 200October 18, 2007 |Members Present: Richard Cherrin (chair), William Adami, William Adami, Kristin Bennett (for Dr. Herman Ellis),|

|P7 |Judy Chaconas, Penny Chelucci, Michael Duva, Susan Ebner, George English, Wendy Gainor, Rita Marocco, Dr. |

|Place: Hideaway Café, Herman Holloway Campus |Leonard Nitowski, Dr. Julia Pillsbury, Olga Ramirez, PPaula Roy |

|Time: 9:00 am to 10:35 am |Members Absent: Rita Marocco, Judy Chaconas, Wendy L. Gainor, Brandi Niezgoda, Dr. Julia Pillsbury, Olga |

|Presiding: Richard Cherrin |Ramirez, Yrene Waldron |

| |Staff Present: Harry Hill (DMMA), Rosanne MahaneyPam Tyranski (DMMA), Dr. Anthony Brazen (DMMA), Cynthia |

| |Denemark (EDS), Mollie Daughtrey (DMMA), Mary Marinari (DMMA)Steve Groff (DMMA), Jim Wilton (DMMA) |

| |Guests: Jim Cannon (Johnson & Johnson), Jeanne Chiquoine (ACS), Debbie Hamilton, Paul Hughes (CMS), Nancy |

| |Rapport (CMS), Raj Verma (CMS), Mark DiMaio (Astra Zeneca), Kim Whitelock (Meadowwood) |

| | | | |

|TOPIC FOR DISCUSSION |DISCUSSION / ISSUE |ACTIONS |FOLLOW-UP |

| | | |RESPONSIBILITY |

|Approval of Minutes: |Olga Ramirez moved for the acceptance of the minutes as written, Paula Roy seconded. | | |

| |The motion was approved.Richard moved for the acceptance of the minutes as written. | | |

| |Hearing no objections, the motion was approved. | | |

|Old Business: | Cindy Denemark reported that the Pharmaceutical & Therapeutics (P&T) Committee met | | |

|Pharmacy Update |in August and implemented a revised Preferred Drug List (PDL) for the first time in | | |

|by Cindy Denemark |two and a half years. Instead of sending a hard copy of the PDL to doctors’ offices,| | |

| |the PDL will be placed on the DMMA website. EDS has also stopped faxing the 22-page | | |

| |document. Cindy noted that some manufacturers are not covered because they do not | | |

| |participate in the Delaware Healthy Children Program. | | |

| |Cindy Denemark noted that the Drug Utilization Review (DUR) Board met on Monday, May | | |

| |7, 2007. | | |

| |The DUR Board is eliminating first line therapy products (i.e., non-nicotine | | |

| |products). The board is working with the Delaware Quit Line, and sending more | | |

|Old Business: |information to clinicians about what Delaware Medicaid can offer. The board realizes| | |

|Pharmacy Update (continued) |that primary attempts at smoking cessation may not work. Counseling is recommended | | |

|by Cindy Denemark |as a second option. | | |

| |The DUR Board created a different drug letter with the assistance of the Division of | | |

| |Substance Abuse and Mental Health (DSAMH). As of September 2007, they will eliminate| | |

| |Heritage and move to health intervention design. | | |

| |The Preferred Drug List (PDL) was refreshed in April 2007. No major changes |Division of Public Health smoking cessation |Kris Bennett/ statistics |

| |occurred. |report to be presented at July 11, 2007 |courtesy of Fred Gatto (DPH) |

| |Richard inquired as to the success of the smoking cessation program. Cindy reported |meeting. | |

| |that the Drug Utilization Review Board (DUR) met in September, and the group is | | |

| |making nice progress. Dr. Borer is developing sleep guidelines. Cindy stated that | | |

| |monitoring the use of sedatives is not the best method to properly address this | | |

| |issue. A two-page document and one-page table were developed. Another issue | | |

| |addressed during the DUR Board meeting was the “relative cost” of prescriptions. A | | |

| |discussion occurred on this very issue, on the DMAP webpage last month. Cindy | | |

| |encouraged committee members to register with the listserv. Listserv subscribers | | |

| |will receive an overview of all topics, and can also sign up for updates on specific | | |

| |areas of interest. To register with the listserv, either visit: | | |

| |, or follow the directions, attached| | |

| |to the meeting minutes (Adobe document 10-18-07 DMAP Notification.pdf). | | |

|Old Business: | Harry noted that at the Federal level, there are several policy and financial | | |

|Medicaid Overview |questions with regard to future financial eligibility levels for the Children’s | | |

|by Pam Tyranski for Harry Hill |Health Insurance Program (CHIP). However, the Delaware Healthy Children Program is | | |

| |in an advantageous position because the state has sufficient Federal financial | | |

| |resources. Delaware will have no coverage gap, and will be able to serve all the | | |

| |enrolled children within the State. The University of Delaware reports that | | |

| |13,000 children would quality for the Delaware Healthy Children Program. DMMA has | | |

| |10,700 enrolled during a year. George English pointed out if a parent is not | | |

| |actively pursuing an application, the state will not know of the child, nor will know| | |

| |a monthly income for the parent. Steve Groff and Rosanne Mahaney responded that | | |

| |income is checked annually, and Steve added that all CHIP kids are enrolled in | | |

| |managed care. Richard asked about the age limit for the program and Rosanne | | |

| |responded that children are eligible up to their nineteenth birthday. Richard | | |

| |Cherrin heard of legislation that proposed raising the eligibility age to | | |

| |twenty-four, but Paula Roy noted this was for private insurance only. Richard | | |

| |Cherrin inquired about the private industry impact. George English responded that in| | |

| |order to cover the underinsured and uninsured, insurance rates and premiums would | | |

|Old Business: |indeed rise, for all. Dr. Nitowski noted this is due to the low number of | | |

|Medicaid Overview (continued) |public/non-profit hospitals in Delaware. | | |

|by Harry Hill | |Stress unborn child-maternal health plan link|Pam Tyranski |

| |Harry stated on May 25, 2007 Federal legislation was approved which mandated that |to EDS’ Health Benefit Manager (HBM) and the | |

| |tamper-resistant prescription pads must be used for Medicaid clients (effective |Division of Social Services (DSS). | |

| |October 1, 2007). A more detailed directive was sent to states on August 17, 2007 |Follow up with Mike McGarrigle of DCPI and | |

| |and DMMA began working with pharmacies, doctors, and the Medical Society of Delaware |Diamond State Partners (DSP) as to what can | |

| |to develop a strategy. Cindy noted that the State was prepared, made contingency |be done to perform outreach to pregnant | |

| |plans, and even ordered extra prescription pads. On September 29, 2007 President |women. |Mary Marinari |

| |Bush delayed the effective implementation date until April 1, 2008 (at which point | | |

| |DMMA had already made the decision to move forward with the existing implementation |Brainstorm with DPCI & Unison. | |

| |date. It was then decided that October 1, 2007 would be a “soft start” date. For | | |

| |Delaware providers, the State mandated that at minimum, one tamper resistant quality | | |

| |of three be implemented for written prescriptions, effective October 1, 2007. All | | |

| |tamper resistant qualities must be met by October 1, 2008 (including tamper resistant| | |

| |paper). Harry reported that a town meeting was held on October 9, 2007. | |Pam Tyranski and DMMA Medical |

| |Approximately two hundred people were in attendance (including Christiana Care, the | |Management team |

| |Office of the Attorney General, Delaware State Police, and the Medical Society of | | |

| |Delaware). Harry noted the main concern was over the timing of implementation, not | | |

| |the policy. The State will continue to work with physicians and pharmacists to | | |

| |address any issues that may arise and no client will go without their needed | | |

| |medications. As a pharmacist, Susan Ebner expressed concern that oftentimes a nurse | | |

| |or technician will write a doctor’s prescription, and the doctor will sign off on it.| | |

| |In calling for clarification, pharmacists find it difficult to get in touch with the | | |

| |doctors. Harry reminded the group this is the precise reason for switching to | | |

| |E-prescribing. Susan also noted that the E-prescribing system will contain NPI and | | |

| |DEA numbers. Harry asked if committee members hear of problems (which should not be | | |

| |happening), to please let him know. Harry stated that the leading fraud prevention | | |

| |method currently in place are pharmacists—indicating that a suspected illegal | | |

| |activity is taking place. Wendy added that oftentimes clients will obtain a | | |

| |legitimate prescription, and then sell it. Cindy replied that yes, there is an | | |

| |entire market for this. Susan Ebner asked if the doctors must buy their own | | |

|Old Business: |tamper-resistant prescription pads, to which Harry responded yes. The | | |

|Medicaid Overview (continued) |tamper-resistant prescription pads will cost an additional $.04 more, per sheet. | | |

|by Harry Hill |These pads only apply to Medicaid clients, and doctors can even go electronic to | | |

| |prevent this cost. Harry noted that fulfilling current tamper-resistant requirements| | |

| |can be as simple as spelling out the dosage amount (an action which Christiana Care | | |

| |is taking). Richard reminded the committee of one camp of economists’ argument that | | |

| |removing illegal drugs from the environment will only increase violence. Richard | | |

| |asked if we are truly addressing the core problem—the drug habit/addiction. Cindy | | |

| |responded that because of the heightened Federal regulations for tamper-resistant | | |

| |prescriptions, Delaware is working even closer with prescription monitoring offices | | |

| |(the Office of Narcotics and Dangerous Drugs) to address the following problems: | | |

| |street and recreational drug use, and legitimate pain/addiction. | | |

| |Harry stated that DMMA was awarded $1 million (to be used over 18 months) for | | |

| |E-Prescribing, for Medicaid providers. Steve thanked Cindy and EDS for writing the | | |

| |technical component of the proposal and noted that E-prescribing will decrease the | | |

| |number of adverse medical events/drug interactions. Fifty prescribers will be chosen| | |

| |for a pilot study and will receive a handheld device (PDA; personal digital | | |

| |assistant) software and training. Wendy noted that the Medical Society of Delaware | | |

| |would be glad to assist the State with any efforts. Susan expressed concern over | | |

| |security issues, and who could enter prescriptions in the PDAs. Cindy reminded Susan| | |

| |that for security, no Class II medications (such as Oxycontin) can be prescribed | | |

| |electronically. Security features also include encryption and password protection. | | |

| |Susan still expressed concern over a nurse or administrative staff having access to | | |

| |the PDA. Cindy noted that this situation would be no different than some physicians | | |

| |signing blank prescriptions. Kristen Bennett asked about state clinic staff, and | | |

| |stated that they will most likely not purchase the PDAs. Cindy noted that | | |

| |E-prescribing should simply be a matter of installing the correct software. If an | | |

| |office is already using software, we can feed/route this into the E-prescribing | | |

| |system. Dr. Nitowski asked if we could try to work E-prescribing in electronic | | |

| |medical records (EMR) or the Delaware Health Information Network (DHIN). Dr. | | |

| |Nitowski further explained that with the barrage of medical technology initiatives, | | |

| |he would request the State keep systems simple (i.e. one platform). Steve noted that| | |

|Old Business: |DMMA would like to integrate with the DHIN. Harry recognized that the transition | | |

|Medicaid Overview (continued) |will have challenges. | | |

|by Harry Hill |Harry reminded the MCAC that Secretary Meconi will present the DHSS budget to the | | |

| |Legislature on November 13, 2007. The Delaware Economic and Financial Advisory | | |

| |Council (DEFAC) continues to report very tight finances for the State. DMMA will | | |

| |most likely only be allowed “door openers”, but we can still offer input. Harry | | |

| |noted that we have requested full year funding for Money Follows the Person (MFP) and| | |

| |Medicaid Buy-In (MBI). DMMA has asked for additional staff positions, and is adding | | |

| |positions to our Surveillance and Utilization Review (SUR) Unit this year. Richard | | |

| |inquired as to the dollar value of our budget. Harry responded the DMMA’s budget is | | |

| |now over $500 million of general funds. The Centers for Medicare and Medicaid | | |

| |Services (CMS) matches these funds at 50/50.Pam Tyranski reported that the newest | | |

| |managed care organization (MCO), Unison Health Plan, will “go live” on July 1, 2007. | | |

| |All computer system interfaces are nearly complete. The Division of Medicaid & | | |

| |Medical Assistance (DMMA), Electronic Data Systems (EDS), Delaware Physicians Care, | | |

| |Inc. (DPCI), and Unison Health Plan staff have all been working together on | | |

| |collaborative strategies, especially in the area of medical management. Unison | | |

| |continues to build their local team by hiring provider and community relations staff.| | |

| |Unison has also secured temporary office space on Route 202. | | |

| |Pam noted that DMMA staff are currently working on budgetary analysis and answering | | |

| |questions for the legislature. | | |

| |DMMA has partnered with the Insurance Commission regarding Children’s Health | | |

| |Insurance Plan (CHIP). Delaware has not been drawing its federal share of dollars; | | |

| |therefore, the state is offering additional resources to touch the children who have | | |

| |been missed. | | |

| |Julia Pillsbury expressed concerns with maternal health issues in regard to health | | |

| |plan coverage. Julia noted that very few pregnant mothers realize their unborn child| | |

| |will be placed into the very same health plan as they choose. Julia is paid for the | | |

| |actual birth/hospitalization, but does not get paid for the first thirty days of | | |

| |life if the mother has not chosen a primary care physician (PCP) for the baby. Mary | | |

| |Marinari noted that for the first thirty days the baby’s eligibility is tied to the | | |

| |mother. Susan Ebner then inquired why a managed care organization is not responsible| | |

|Old Business: |for the first thirty days of any baby (whether the baby is enrolled or not, when the | | |

|Medicaid Overview (continued) |mother is enrolled). George English responded that this would affect the | | |

|by Harry Hill |capitation/risk factor. Pam noted that the “kick payment” Medicaid reimburses is a | | |

| |global payment for an MCO, thus covering the entire pregnancy and the first thirty | | |

| |days of the child. George wondered ifsuggested DPCI could pay an out of network | | |

| |benefit to Dr. Pillsbury (to cover her for only the first thirty-day services). Pam | | |

| |noted that this is doable, but perhaps not feasible, given the medical home model in | | |

| |place. Susan added that Dr. Pillsbury could then convey that she is not able to see | | |

| |the patient after thirty days; the mother must choose an in-network physician. Julia| | |

| |thought that obstetricians have a responsibility as well, to educate mothers on | | |

| |health plan coverage and selecting a pediatrician. Additionally, Julia thought that| | |

| |nursing staffs could be educated to assign the baby to either the PCP of the mother, | | |

| |or the PCP of alternate children in the family. Cindy noted that the true problem is| | |

| |a mother failing to choose a primary care physician for her unborn child during | | |

| |prenatal visits. | | |

| |Leonard Dr. Nitowski inquired as to the strength of Unison’s network. Pam responded | | |

| |that Unison’s contracted network closely matches DPCI. In some cases, Unison has | | |

| |contracted with doctors not in DPCI’s network. | | |

|Old Business: | Mary Marinari reported that Delaware is the first state in the country to fully | | |

|HIPAA/ NPI Update |implement National Provider Identifier (NPI). | | |

|by Pam Tyranski/ Mary Marinari |Cindy stated that the process has run smoother than expected. One of the most trying| | |

| |issues were health systems needing to collapse their identifiers, such as Christiana | | |

| |Care. At the DUR Board meeting, Walgreen’s pharmacists spoke positively about the | | |

| |process, and noted the largest problem to be out-of-state physicians (who are not yet| | |

| |using NPI). | | |

| |George asked whether NPI implementation was mandatory, as the federal government has | | |

| |now extended dates for compliancy. Mary responded that the federal government | | |

| |extended the deadline a mere two weeks before our implementation, at which point | | |

| |Delaware was already in the final stages of implementation. Additionally, Pam noted | | |

| |that Delaware moved forward per federal instruction to complete implementation of NPI| | |

| |if states were in the final stages. | | |

| |Dr. NitowskiLeonard touched on the problem that Medicaid carriers are backlogged with| | |

| |assigning numbers. George corrected Leonard in saying he though national billers and| | |

| |payers have not been able to accommodate the new numbers. | | |

| |Susan mentioned a problem with the Pharmacy Benefit Manager (PBM), Express Scripts. | | |

| |Cindy noted that this was a personal software issue at Susan’s particular pharmacy. | | |

| |Julia questioned why UPIN numbers were still requested on a portion of her billing. | | |

| |George noted that NPI replaces UPIN, but perhaps a company does not yet recognize | | |

| |NPI. | | |

| |Susan asked for the extended date for NPI implementation. Cindy responded, May 23, | | |

| |2008. | | |

| |Cindy does not know when Express Scripts or Medco will be transitioning to NPI. | | |

| |Leonard Dr. Nitkowski informed the committee he had heard of difficulties in third | | |

| |party administrators processing claims. |Determine who requests UPIN and does not take|Julia Pillsbury |

| | |NPI. | |

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|New Business: Unison Implementation Update by |Rita Marocco introduced her invited guest, Kim Whitelock, CEO of Meadowwood. | | |

|Harry Hill/Rosanne MahaneyOld Business: |National Alliance on Mental Illness in Delaware (NAMIDE) will sponsor Pulitzer Prize | | |

|Mental Health Issues |finalist Pete Earley on May 11, 2007 at DuPont Country Club. Mr. Earley will speak | | |

|by Rita Marocco |on his novel “Crazy: A Father's Search Through America's Mental Health Madness”. If | | |

| |an MCAC member wishes to attend, please contact Rita directly, as the event is sold | | |

| |out. | | |

| |Rita expressed concern over Delaware Senate Bill 84. Richard inquired on the details| | |

| |of the legislation. Cindy responded that this was part of the sunset | | |

| |revision/regulation, in which there can be therapeutic interchange between | | |

| |medications if a previously established contract exists between a specific pharmacist|Contact Dave ___, Executive Secretary for the|Cindy Denemark |

| |and physician. Cindy noted that the legislation is supported by the Board of |Delaware State Assembly’s ____ Committee and | |

| |Pharmacy and the Medical Society of Delaware and promotes therapeutic interchange. |his Attorney General. Express the MCAC’s | |

| |Rita stated that the mental health community does not support the legislation. Cindy|concern in regard to language of Delaware | |

| |reassured Rita that it is unlikely there will be interchange between mental health |S.B. 84. | |

| |drugs. Additionally, Julia noted a key safety feature—currently, physicians must | | |

| |specifically dictate “brand not medically necessary”. Mark DiMaio, Astra Zeneca’s |Write resolution on behalf of the MCAC. | |

| |lobbyist, stated that the committee was incorrect in their interpretation of the | | |

| |legal language of the bill. Mark stated that there is no legal language clarifying | | |

| |the agreement takes place between the prescribing physician and pharmacy. Cindy and | |Mollie Daughtrey |

| |Dr. PillsburyJulia agreed that this would be the legislative intent. Cindy noted | | |

| |that the bill is presently in committee. Dr. NitkowskiLeonard reminded the committee| | |

| |that we should perhaps act now, as the legislative session will be finished by the | | |

| |July 11 MCAC meeting. Dr. Nitkowski Leonard motioned that the committee go on record| | |

| |and offer a resolution that the bill be modified to read “prescribing practitioner”. | | |

| |Rita seconded the motion. The committee voted in favor of the motion. | | |

| |Rita reminded the committee that May is mental health month. Celebratory events | | |

| |include a walk on Saturday, May 12, 2007 along with receiving a proclamation from the| | |

| |Delaware State Legislature and City of Wilmington. Rosanne stated that the overall | | |

| |implementation for Unison went very smoothly. Monthly meetings now occur with Unison| | |

| |and Delaware Physicians Care Incorporated (DPCI). Wendy Gainor noted that Unison | | |

| |contracted through Med Net (similar to the action which DPCI took, when first opening| | |

| |in Delaware). While all rates are not the same, being in Med Net and working with | | |

| |the four PO’s, a provider sees better reimbursement. | | |

|New Business: Review of Quality Assurance Reports |Mary noted that DMMA is tasked by CMS to monitor Medicaid managed care programs and | | |

|by Mary Marinari |waivers, stressing annual validation. | | |

| |Mary distributed three reports: Quarterly Report January-March 2007, Year End Quality| | |

| |Report January-December 2006, and Quarterly Report October-December 2006. Page six | | |

| |of the Quarterly Report January-March 2007 outlines the goal of regular quality | | |

| |reporting, and develops a reporting schedule for 2007. Mary plans to have various | | |

| |agencies attend Quality Assurance meetings throughout 2007 and bring their various | | |

| |work plans for development, adjustment, and/or review. | | |

| |Recent accomplishments in the field of Quality Assurance include: producing goals for| | |

| |2007; reviewing Medicaid funded waiver documents; Smart Start and emergency room | | |

| |reporting. | | |

| |Julia questioned why the encounter form to document well-child care was necessary | | |

| |(page 11 of the Quarterly Report January-March 2007). Julia thought these answers | | |

| |were automatically generated. Mary answered that the reviewers were not obtaining | | |

| |the information they need via chart review. Therefore, the form serves as a | | |

| |correction tool. Mary noted the positives in a form—reviewers would be able to | | |

| |obtain a HEDIS measure. Julia said we should not recreate the wheel—The American | | |

| |Academy of Pediatrics has an existing form. Mary noted that managed care plans are | | |

| |offering money to physicians who complete the forms. Our professional community will| | |

| |most likely see more of this payout in the future, as we are required to report to | | |

| |CMS. Julia expressed her opinion that companies should not pay for the information, | | |

| |as the provider is expected to compute this information anyway. | | |

| |Mary reported that DSAMH held a graduation for their high-end emergency services | | |

| |users (if the client did not use emergency services within a specified time period). | | |

| |Mary distributed the Quality Courier. | | |

| |The next Quality Initiatives meeting will be held on May 24, 10:00-12:00. The | | |

| |10:00-11:00 hour is for state agency staff. The 11:00-12:00 hour is open to all | | |

| |external parties. If you would like to attend, please contact Mary Marinari at | | |

| |mary.marinari@state.de.us or 302-255-9548. | | |

|New Business: |The Deficit Reduction Act (DRA) of 2006 enacted major pharmacy changes. Cindy noted | | |

|Pharmacy Reimbursement Methods Overview |that cheaper prescriptions found in Canada and Mexico were areas which the MCAC | | |

|by Cindy Denmark |thought should be explored as options for the Delaware programs. This poses the | | |

| |question of what our country can do to make prescription costs lower. This issue has| | |

| |subsided in recent years, with the advent of $4 generic prescriptions. Cindy noted | | |

| |that most pharmacy programs are based on Average Wholesale Price (AWP); a few | | |

| |programs are based on Wholesale Acquisition Cost (WAC). In the 1990’s a Federal | | |

| |Upper Limit (FUL) was established. However, in 2006 the DRA stated that this | | |

| |reimbursement rate was too high. The DRA requires CMS to create new Federal Upper | | |

| |Limits (FUL) reimbursement rate to the AMP of the lowest prescription, times 250% | | |

| |(i.e. the lowest price of aspirin x 250= the dollar amount which Medicaid will | | |

| |reimburse). The AMP (price at which the manufacturer sells to the wholesale | | |

| |distributor) has normally not been available to the public. Beginning in July 2006, | | |

| |states now receive this information. | | |

| |A new FUL will be announced in December, 2007, which states will have one month to | | |

| |implement. Cindy noted this change will effect commercial payors, and she believes | | |

| |lower reimbursement rebates are coming. | | |

|New Business: |A state report card is forthcoming with the top 50 drugs covered by Medicaid programs| | |

|Pharmacy Reimbursement Methods Overview |listed by reimbursement to providers. | | |

|(continued) |Richard asked if the FUL encompasses AMP. Cindy responded that FUL is based on AMP. | | |

|by Cindy Denmark |Richard then asked if this information was available through the Freedom of | | |

| |Information Act (FOIA). Cindy said yes, it should be available through FOIA. | | |

| |Deferred until July 11, 2007. | | |

|New Business: |Cindy reported that Delaware is interested in taking advantage of specialized | | |

|Specialized Pharmacy Pricing |pharmacy pricing (i.e. injectable specialty drugs such as oncology medications or | | |

|by Cindy Denemark |like SYnagis®). | | |

| |We want to negotiate down as far as possible. It would be great to keep margins low.| | |

| |Specialized pharmacy is willing to work with various entities. | | |

| |Pennsylvania has worked through these issues, received many proposals and selected | | |

| |two which work at better prices. | | |

| |We will look at this once it fits in.Deferred until July 11, 2007. | | |

|New Business: |Kristin Bennett presented information on the Smoking Cessation Program by the | | |

|Division of Public Health Smoking Cessation Update|Division of Public Health (DPH). This information will be attached to the meeting | | |

|by Kristin Bennett |minutes. | | |

| |Kristin noted that the Quitline began in February, 2002. | | |

| |At first, DPH used programs previously developed by the Centers for Disease Control | | |

| |and Prevention (CDC). Delaware eventually began using test programs, and thereafter | | |

| |changed the entire program in 2005. 2006 statistics indicated that 25% of those who | | |

| |received counseling remained smoke-free for three months. 2007 showed a surge in | | |

| |enrollment, with free nicotine replacement therapy. Richard wondered how the new | | |

|New Business: |cigarette tax impacts the Quitline. Paula Roy indicated that price sensitivity | | |

|Division of Public Health Smoking Cessation Update|impacts teens more than adults. Susan asked if people must be eighteen to enroll in | | |

|(continued) |the Quitline, and Kristin responded, yes. Paula noted that this is unfortunate, but | | |

|by Kristin Bennett |understood. Richard stated that the previously noted statistic of 25% of the | | |

| |respondents remaining smoke-free for three months is not indicative of a lifetime | | |

| |without smoking. Bill suggested more detailed ways to correlate smoking cessation. | | |

| |Kristin will ask the research group if these statistics are possible, but also noted | | |

| |it is difficult to calculate when cessation programs have changed over the years. | | |

| |If any members or guests have additional questions, please contact Kristin Bennett, | | |

| |directly. | | |

|New Business: |Jim Wilton distributed the Quarterly Quality Assurance (Second Quarter) Report. |Rosanne suggested that Quality Improvement |Jim Wilton and DMMA’s QII |

|Review of Quarterly Quality Assurance Report |Jim noted that page six contains the meeting schedule for the group. |Initiatives (QII) report back to the MCAC | |

|by Jim Wilton |Taskforce meetings will be held once per month, include all stakeholders at-large, |2007 goals/accomplishments, and 2008 goals. | |

| |and will be the central means of communication and education for the group. | | |

| |In 2008 the group will implement quality improvements, use data to analyze trends and| | |

| |effects, and discuss findings. |The next Quality Improvement Initiatives | |

| |Kristin noted that as a member of the group, she had positive experiences working |(QII) meeting will be held on October 25, | |

| |with the other stakeholders to solve problems and serve clients. |2007 at 9:00 AM to 12:00 PM in Lewis 258. | |

| |Richard inquired whether establishing 2008 goals would be discussed at the December |Report presentations will be made by DSAMH, | |

| |6, 2007 meeting. Jim responded that yes, the External Quality Review Organization |and EDS Pharmacy. | |

| |(EQRO) works closely with DMMA and he would like benchmarks to be set at the December|A final QII meeting will be held on December | |

| |meeting. Richard asked what role the MCAC can have. Jim responded that members can |6, 2007, 9:00 AM to 12:00 PM in Lewis 258 to | |

| |help identify issues and areas that might need investigating. Richard asked about |address follow-up questions, review 2007 | |

| |the group’s approval process to which Jim responded that all the work of the group |goals, and set 2008 goals. | |

| |must fit into the quality management structure, as required by CMS. Richard asked if| | |

| |MCAC members could attend the meeting. Jim welcomed Richard and others to attend. | | |

| |Richard asked if any additional MCAC members would like to attend. No response was | | |

| |heard. | | |

|New Business: | | | |

|Review of Quarterly Quality Assurance Report | | | |

|(continued) | | | |

|by Jim Wilton | | | |

|New Business: |The following members have indicated interest in |Forward the names of those MCAC members |Mollie Daughtrey |

|Membership Reappointment Commitment by Select |serving another term on the Medical Care Advisory Committee: Richard |interested in serving another term to | |

|Members of the Committee |Cherrin, William (Bill) Adami, Susan Ebner, Dr. Herman Ellis, George English, Wendy |Secretary Meconi’s office. | |

| |Gainor, Brandi Niezgoda, Dr. Leonard Nitowski, Dr. Julia Pillsbury, Olga Ramirez, and| | |

| |Yrene Waldron. | | |

| |Richard asked for additional names to be brought forward. No additional names were | | |

| |brought forward. | | |

| |Since the present meeting is scheduled in such close proximity to the November 7, | | |

| |2007, meeting Richard moved that the November meeting be moved to December 6, 2007. | | |

| |Hearing no objections, the November meeting will be rescheduled to December 6, 2007. | | |

|Miscellaneous: |Pam requested that committee membership reappointment voting be deferred until the | | |

| |July 11, 2007 meeting so that Harry Hill may be present to vote. | | |

| |Kris Bennett detailed House Bill 106, which touts more access to care for | | |

| |professional midwives. The Department of Public Health and The Medical Society of | | |

| |Delaware oppose this legislation because there is no collaboration between midwife | | |

| |and physician. A meeting will be held Tuesday, May 15, 2007 from 9:00AM-12:00PM, | | |

| |hosted by Representatives Maier and Hall-Long. Rita inquired as to the future of the| | |

| |legislation. Kris noted that the bill may not go far. It is presently in committee | | |

| |and faces opposition. | | |

| |Olga Ramirez questioned the status of Medicaid dental coverage for pregnant women. | | |

| |Kris informed the committee that the Children’s Caucus brought this issue forward. | | |

| |Pam added that the idea did not make it past discussion. This is identified in | | |

| |women’s health initiatives under expanded Medicaid benefits. At present, Medicaid | | |

| |does not offer dental coverage for pregnant women, and this initiative would need | | |

| |more than a legislative change in order to be offered. Olga asked about CHIP adult | | |

| |coverage. Pam responded that there are several competing proposals. Proposal A | | |

| |calls for expanded coverage for adult parents of CHIP children. Proposal B calls for| | |

| |an expanded poverty level for all adults. Current outreach and discussion ensues. | | |

| |The meeting was adjourned at 10:35 AM. | | |

| |The November 7, 2007 meeting is rescheduled to December 5, 2007. Each member must | | |

|IMPORTANT NOTES: |let Mollie Daughtrey know if they will attend the December 5 July 11 , 2007 meeting. | | |

| |Mollie can be reached at 302-255-9658 or via email, at mollie.daughtrey@state.de.us. | | |

| |DMMA requests an accurate head count for preparation of the room and all materials. | | |

Respectfully submitted,

Mollie Daughtrey October 31, 2007_____ __ Richard Cherrin

Recorder Date approved Chairperson

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