MARYLAND PHYSICIANS CARE MCO



Delaware Health and Social Services

Medical Care Advisory Council (MCAC)

Meeting Minutes

|Date: May 9, 200December 5, 2007 |Members Present: Richard Cherrin (chair), William Adami, Kristin Bennett (for Dr. Herman Ellis), Judy Chaconas,|

|P7 |Penny Chelucci, Michael Duva, Susan Ebner, George English, Wendy Gainor, Brandi Niezgoda, Dr. Julia Pillsbury, |

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

|Time: 9:00 am to 10:40 am10:35 am |Members Absent: William Adami, Penny Chelucci, Susan Ebner, Dr. Leonard Nitowski,Judy Chaconas, Wendy L. |

|Presiding: Richard Cherrin |Gainor, Brandi Niezgoda, Olga Ramirez Yrene Waldron |

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

| |Brazen (DMMA), Cynthia Denemark (EDS), Mollie Daughtrey (DMMA), Mary Marinari (DMMA)Sheila Nutter (EDS), Jim |

| |Wilton (DMMA) |

| |Guests: Paul Hughes (CMS), Mark DiMaio (Astra Zeneca), Kim Whitelock (Meadowwood) |

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|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. | | |

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

| |written. | | |

| |Wendy Gainor noted that while Rita Marocco was on the previous meeting’s minutes, she| | |

| |no longer serves as the Executive Director of NAMIDE (National Alliance on Mental | | |

| |Illness in Delaware). A replacement will be confirmed by the close of the week. | | |

| |Some discussion ensued about the new Executive Director, and it was gathered that a | | |

| |final decision had already been made. Both Harry Hill and Wendy Gainor noted that | | |

| |Carlyle Hooff will serve as the Executive Director of NAMIDE. Richard reminded the | | |

| |Committee that Ms. Hooff is not automatically included as a Committee member. | | |

| |Secretary Meconi must first confirm her appointment. Richard stated that the | | |

| |Committee is asking for nominations, subject to approval by the Secretary. Harry | | |

| |nominated Jim Lafferty, and noted he is willing to serve. Wendy thought that Jim | | |

| |would serve as an excellent candidate, as he is involved with the mental health | | |

| |taskforce. | | |

| |Richard moved for the acceptance of the minutes as written. Paula Roy seconded, and | | |

|Approval of Minutes (continued): |the motion was approved. |Contact Jim Lafferty to confirm he is willing|Harry Hill |

|by Richard Cherrin | |to serve as a member of the MCAC | |

|New Business: |Richard brought the issue of meeting frequency to the table. Richard reminded the | | |

|Frequency of Committee Meetings |Committee that the group has the possibility of meeting quarterly. | | |

|by Richard Cherrin and Committee |Mollie Daughtrey prepared a tentative 2008 meeting schedule as follows: (bi-monthly) | | |

| |1/9/08, 3/12/08, 5/14/08, 7/9/08, 9/10/08, 11/12/08 and (quarterly) 2/13/08, 5/14/08,| | |

| |8/13/08, 11/12/08. | | |

| |Yrene Waldron thought that quarterly meetings would be a good idea as many members | | |

| |hold a tight schedule. She added that should an urgent matter arise, the Committee | | |

| |could perhaps agree to a conference call on the issue at hand. Wendy Gainor and | | |

| |George English both agreed this was a good idea. | | |

| |Kris Bennett suggested that the Committee take unexpected cancellations into account,| | |

| |and schedule a bi-monthly meeting with the intention of canceling some meetings | | |

| |(perhaps canceling a July meeting as well as another date). | | |

| |Yrene and Richard did express one concern with quarterly meetings—if an unexpected | | |

| |cancellation arose there would be a large space of time between meetings. | | |

| |Dr. Brazen suggested moving the proposed August 13, 2008 meeting to September, and | | |

| |the November meeting to December. | | |

| |Yrene proposed a conference call instead of a live meeting every other month. Yrene | | |

| |noted that conference calls work well for her and her business associates. | | |

| |Paula Roy also proposed canceling a meeting depending on tentative attendance | | |

| |numbers. | | |

| |Richard proposed the next meeting occur in March 2008, followed by one meeting each | | |

| |quarter – June 2008, September 2008, and December 2008. This schedule would avoid | | |

| |August vacations. The Committee would still meet on the second Wednesday of the | | |

| |designated month. Harry agreed that he liked this option. And, to further support | | |

| |the meeting dates, Harry noted the September meeting would fall nicely before the | | |

| |Office of Management and Budget (OMB) Hearings and the December meeting would fall | | |

|New Business: |nicely before the Joint Finance Committee (JFC) meeting. The Committee was in | | |

|Frequency of Committee Meetings (continued) |consensus, agreeing to the above quarterly meeting schedule. | | |

|by Richard Cherrin and Committee |Harry noted that in the event a quarterly meeting must be canceled, the Division of | | |

| |Medicaid and Medical Assistance (DMMA) would quickly reschedule the meeting so that | | |

| |it would fall shortly after the original date. | | |

| |Richard moved for the acceptance of the quarterly meeting schedule (3/12/08, 6/11/08,| | |

| |9/10/08, 12/10/08). Paula Roy seconded, and the motion was approved. | | |

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| | |Distribute and post the 2008 meeting |Mollie Daughtrey |

| | |schedule, make accommodations for the | |

| | |meetings. | |

|Old Business: |Cindy Denemark reminded the Committee that the Drug Utilization Review (DUR) Board | | |

|Pharmacy Update |met on November 19, 2007. The Board is waiting on several items: | | |

|by Cindy Denemark |The December release of the Federal Upper Limit (FUL) from the Centers for Medicare | | |

| |and Medicaid Services (CMS) | | |

| |Provider feedback on the new FUL. | | |

| |Cindy stated that the National Association of Chain Drug Stores has filed a lawsuit | | |

| |against CMS for an inequitable definition of Average Manufacturing Price (AMP). | | |

| |Cindy also noted that many drugs are losing their patents, shortly. Companies must | | |

| |be creative with formularies. | | |

| |The next DUR Board meeting will be held on January 14, 2008. | | |

| |The Pharmaceutical and Therapeutics (P&T) Committee will meet on February 14, 2008. | | |

| |Richard asked if there were any questions from the Committee. No response was heard.| | |

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

|Old Business: |7, 2007. | | |

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

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

| |information to clinicians about what Delaware Medicaid can offer. The board realizes|Division of Public Health smoking cessation |Kris Bennett/ statistics |

| |that primary attempts at smoking cessation may not work. Counseling is recommended |report to be presented at July 11, 2007 |courtesy of Fred Gatto (DPH) |

| |as a second option. |meeting. | |

| |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 | | |

| |occurred. | | |

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

|Old Business: | | | |

|Medicaid Overview |Pam Tyranski reported that the newest managed care organization (MCO), Unison Health | | |

|by Pam Tyranski for Harry Hill |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| | |

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

|Old Business: |mother is enrolled). George English responded that this would affect the | | |

|Medicaid Overview (continued) |capitation/risk factor. Pam noted that the “kick payment” Medicaid reimburses is a | | |

|by Harry Hill |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. | | |

| |Harry reminded the Committee that the fiscal year 2009 budget will be very tight. | | |

| |In fiscal year 2009, DMMA is requesting $558 million in general funds (which totals | | |

| |$1.2 billion with federal matching funds). | | |

| |Harry thanked DMMA’s budget staff. The staff perform an amazing job, in that their | | |

| |fiscal projections cannot be off by even 1% as this would mean DMMA would need an | | |

| |additional $5.6 million which was not in the State budget. | | |

| |The OMB Hearings took place last week, before Budget Director Jennifer Davis. | | |

| |Secretary Meconi spoke for DHSS and all the divisions. | | |

| |Harry reminded the Committee that MCAC supported Medicaid Buy-In (MBI). DMMA | | |

| |requested approximately $928,600 for full-year funding in fiscal year 2009. | | |

| |Harry stated that DMMA has requested an additional $41 million for Medicaid inflation| | |

| |in fiscal year 2009. Medicaid inflation involves an increase in the number of | | |

| |clients (which has seen approximately a 4% growth), and an increase in the cost of | | |

| |services and changes in the mix of services. | | |

| |Richard inquired about the total number of Medicaid clients. Harry responded that | | |

| |157,000 total citizens are currently funded by Medicaid in Delaware (146,000 strictly| | |

|Old Business: |receive Medicaid only while the remaining 11,000 received various ancillary | | |

|Medicaid Overview (continued) |services). | | |

|by Harry Hill |Funding for Money Follows the Person (MFP) is drawn from tobacco funds (approximately| | |

| |$691,000). The MFP goal is to shift the balance from institutions to community-based| | |

| |placements. Twenty-five individuals per year (for five years) will be placed in a | | |

| |less-restrictive, community-based environment. Yrene noted that the cost for elderly| | |

| |care will only grow, as our aging population is increasing. | | |

| |A lengthy discussion ensued over the issue of the Children’s Health Insurance Program| | |

| |(CHIP). | | |

| |POVERTY LIMIT: Harry reported that CHIP has sufficient funding in the State of | | |

| |Delaware. At present, the State covers those at 200% of the poverty limit (not | | |

| |including adults without children). Paula Roy noted that states requesting a higher | | |

| |poverty limit are oftentimes not receiving approval from CMS (as the states must | | |

| |demonstrate they are first serving 95% of their eligible children before expanding | | |

| |the eligibility population). | | |

| |PARTICIPATION: Harry stated that the University of Delaware reports approximately | | |

| |13,000 children in our state are eligible for CHIP. We provide services to about | | |

| |10,000 per year, with 5,000 receiving care at any given time. Paula noted that the | | |

| |program experiences some churn. Harry responded, yes, children go on and off the | | |

| |program. Many children go back and forth between CHIP and Medicaid. | | |

| |ELIGIBILTY: Yrene inquired what 200% of the poverty limit was, and Paula responded | | |

| |$41,000 annually, for a family of four. George English asked if CHIP eligibility was| | |

| |determined on a monthly basis and Harry responded yes. Shelia Nutter added that if | | |

| |parents pay for three months, they receive one month at no charge. George noted that| | |

| |the burden of compliance falls on the parent. Oftentimes, this issue is hard for the| | |

| |parent to manage. | | |

| |BARRIERS: Yrene asked what barriers prevent children from enrolling in CHIP. Dr. | | |

| |Pillsbury responded that a barrier was reoccurring recertification. She stated that | | |

| |if parents are turned down or loose eligibility, they are oftentimes too discouraged | | |

| |to apply again. Additionally, Dr. Pillsbury commented that children do not see the | | |

| |doctor for well visits; parents wait until the child is sick before visiting the | | |

| |doctor (and immunizations are free for children without insurance). | | |

|Old Business: |ENROLLMENT: Dr. Pillsbury thought that CHIP was first established for children whose | | |

|Medicaid Overview (continued) |parents’ employer did not offer child health insurance. Even if the employer offers | | |

|by Harry Hill |this insurance, it is often too expensive. Paul Hughes questioned whether there is a| | |

| |waiting period for CHIP. Big changes are forthcoming for this program, he noted. | | |

| |Paul also referenced the “crowd out” effect, whereby employers such as Wal-Mart, | | |

| |offer insurance to their employees, and hand out applications for CHIP as a solution | | |

| |to dealing with children’s health insurance coverage. George asked how the average | | |

| |person would be able to navigate CHIP enrollment. Rosanne noted this was a good | | |

| |point. She stated that CHIP eligibility is determined by the Division of Social | | |

| |Services (DSS). There is an online application and a screening tool. Brandi | | |

| |Niezgoda and Yrene both asked if the poor or disadvantaged would have access to the | | |

| |Internet. Cindy Denemark reminded the Committee that the paper application is only | | |

| |one page. | | |

| |PREMIUMS: George understood why parents making $41,000 are on the cusp of bouncing | | |

| |their child in, and out of CHIP. Sheila Nutter stated that CHIP premiums are $10-$25| | |

| |per household, per month. If a family is in dire straights, they may be unable to | | |

| |pay this amount. A family may now want to pay for preventative/well care when a | | |

| |child is visibly healthy. Sheila stated that many children leave the program due to | | |

| |lack of premium payment. Efforts in the past have included waiving premiums, for six| | |

| |months. This did result in a higher number of children staying in the program. | | |

| |Premiums are not a federal requirement. However, without a premium payment, it | | |

| |becomes difficult to track clients when they leave the state. Paula suggested a | | |

| |slight buy-in. Yrene suggested a deductible instead of a premium. Dr. Pillsbury | | |

| |responded that providers often end up paying the deductible. Richard asked what the | | |

| |State would you loose if there were no premiums. Paula surmised that the State would| | |

| |need to recoup the cost of the premium plus account for a significant increase in the| | |

| |participating population. Richard thought the elimination of premiums would solve | | |

| |two issues: 1.) the issue of trying to increase the 5,000 clients participating at | | |

| |any given time, and 2.) remove the barrier of cost for enrolling a child. Paula | | |

| |estimated the cost to the State for eliminating premiums to be $25 multiplied by 12 | | |

| |months, multiplied by roughly 10,000 clients (for a total of $3 million). | | |

| |THOUGHTS FOR THE FUTURE: Paula asked if anyone had seen results from the (Insurance | | |

| |Commissioner) Matt Denn outreach effort. Sheila responded that Matt Denn worked with | | |

|Old Business: |DMMA for CHIP causes and produced a 1-page flyer, but no enrollment changes are | | |

|Medicaid Overview (continued) |discernable. Richard inquired about the maximum age of eligibility to which Rosanne | | |

|by Harry Hill |responded eighteen. Richard then inquired about potential federal legislation to | | |

| |change the age. Harry responded that no federal legislation is proposed to change | | |

| |the age limit. Dr. Pillsbury stated that the number of employers who offer family | | |

| |health coverage are in the minority. If these select employers do offer coverage, it| | |

| |is expensive ($600-700 per month). George asked how the premiums are collected. | | |

| |Sheila responded that EDS collects premiums by working with Walgreen’s/Happy Harry’s,| | |

| |collecting monthly invoices, and billing credit cards. George suggested automatic | | |

| |withdrawal for CHIP from the parents’ paycheck (authorization to do so on behalf of | | |

| |the employee is all that is required). Many companies are already familiar with | | |

| |practices as such. Harry responded that this proposal might alleviate the problem of| | |

| |children bouncing in and out of the program. Yrene still expressed concerns with the| | |

| |escalating cost of living (e.g. the price of gas). George expanded on his initial | | |

| |proposal: premiums could be reduced (as some administrative management of the program| | |

| |would shift to employers). Sheila reminded the Committee that premiums are based on | | |

| |income (families at 110% of the poverty limit pay $10 per month, families at 199% of | | |

| |the poverty limit pay $25 per month). George noted that with the premium deducted | | |

| |from an employee’s paycheck the family will start getting used to living on less. | | |

| |Troubles still lie for those families making close to $41,000 as an annual raise of | | |

| |2% to 3% would eliminate their participation in the program. Touching on an earlier | | |

| |point, Wendy noted that CHIP premium payments via credit cards come at a detriment to| | |

| |the parent with potential accrued interest on their card. Yrene asked if there was | | |

| |ever a small focus group study relating to CHIP premiums. Rosanne and Dr. Pillsbury | | |

| |both responded, yes, but a long time ago. Rosanne detailed that the State received | | |

| |$500,000 in grant money to review premiums and create brochures in the past. Yrene | | |

| |asked if we could try to obtain grant money again. Employers would also benefit in | | |

| |knowing when a client moves out of the state. Richard inquired how the group could | | |

| |move this issue along. Harry responded that the Committee should wait for now, as | | |

| |the immediate future holds many changes for CHIP. Harry noted that both Lieutenant | | |

| |Governor Carney and Secretary Meconi have focused on this issue. Richard stated that| | |

| |he was in favor of $1 premiums (to be charged for the reason of tracking clients). | | |

|Old Business: |Dr. Brazen noted that George’s idea of the premium being deducted from the paycheck | | |

|Medicaid Overview (continued) |is difficult because a lot of the uninsured are self-employed (i.e., electricians, | | |

|by Harry Hill |plumbers). Dr. Pillsbury stated that the individuals must fill out required | | |

| |paperwork with the state now, and this would simply be another form. Richard asked | | |

| |about the timing of federal legislation. Harry anticipated hearing some discussion | | |

| |on this issue by December 14, 2007. Paula reminded the Committee of all previous | | |

| |delays. A decision was supposed to be made back in September 2007. Yrene heard | | |

| |discussion of a Presidential veto on the issue. | | |

| |Harry detailed the Division’s accomplishments in the past year: | | |

| |DRA – Required changes were completed which included specialty Long Term Care | | |

| |modifications; | | |

| |Managed Care Organization (MCO) Bids – The managed care bid process saved the State | | |

| |of Delaware approximately $10 million due to competition and offered more options for| | |

| |clients; | | |

| |New Eligibility Unit Location – DMMA received funding for a Long Term Care | | |

| |eligibility unit in Smyrna, Delaware with seven new employees; | | |

| |National Provider Identifier (NPI) – Delaware was the first state in the country to | | |

| |complete this task due to the dedicated work of EDS and DMMA staff; | | |

| |Part D implementation – Delaware implemented changes and was ranked #1 in the country| | |

| |for effectiveness; | | |

| |Tamper-resistant prescription pads – DMMA faced implementation challenges and | | |

| |questions, participated in town meetings, supported a soft start and did extensive | | |

| |research, received a positive editorial in the Delaware News Journal; and | | |

| |The Delaware Information Network (DHIN) – Health record databases have been | | |

| |established, ensuring an easier implementation for E-prescribing. | | |

| |Wendy and Dr. Brazen have spent a lot of time on telemedicine. Telemedicine, though | | |

| |not a Medicaid covered service, would be useful to treat the prison population. | | |

| |Richard asked for an executive summary on the issue. Richard also asked about using | | |

| |this in nursing homes. Dr. Pillsbury noted that the development of this issue has | | |

| |progressed so far as to establish billing codes. CMS now supports billing codes when| | |

| |a doctor consults via telephone, email, or online. Wendy noted that this technology | | |

| |includes robots and various equipment, and would even work well for psychiatrists. | | |

| |Dr. Brazen suggested building on current infrastructure, as some providers already |Per Richard’s request, provide a list of DMMA| |

|Old Business: |have compatible technology. |accomplishments in 2007 | |

|Medicaid Overview (continued) |Dr. Pillsbury would like follow up regarding newborns who do not yet have an assigned| |Harry Hill |

|by Harry Hill |pediatrician. For the initial months of the MCO transition, the managed care | | |

| |companies were good about paying out-of-network providers. Now the MCOs will pay | | |

| |them for the birth, but will not pay for follow-up care provided after their release | | |

| |from the hospital. When the baby is born, they are covered on the mother’s plan. | | |

| |The mother has 90 days to move the baby to another plan. Yrene stated that this | | |

| |transition should be seamless. DMMA will follow up. | | |

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| | |Follow up: If a parent is working and has |Harry/Rosanne |

| | |health insurance, when is the child eligible | |

| | |for CHIP? | |

| | |Follow up on Dr. Pillsbury’s 30-day gap |Pam Tyranski |

| | |concern. | |

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| | | |Mary Marinari |

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| | |Stress unborn child-maternal health plan link| |

| | |to EDS’ Health Benefit Manager (HBM) and the | |

| | |Division of Social Services (DSS). | |

| | |Follow up with Mike McGarrigle of DCPI and | |

| | |Diamond State Partners (DSP) as to what can |Pam Tyranski and DMMA Medical |

| | |be done to perform outreach to pregnant |Management team |

| | |women. | |

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| | |Brainstorm with DPCI & Unison. | |

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|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 |Rosanne expressed her excitement in having two MCOs for healthy market competition. | | |

|Harry Hill/Rosanne MahaneyOld Business: |Richard inquired about representatives from Unison and Delaware Physicians Care | | |

|Mental Health Issues |(DPCI) making a presentation to the Committee. Harry stated that this would be | | |

|by Rita Marocco |possible, but Richard decided against the idea. | | |

| |Rita Marocco introduced her invited guest, Kim Whitelock, CEO of Meadowwood. | | |

| |National Alliance on Mental Illness in Delaware (NAMIDE) will sponsor Pulitzer Prize | | |

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

| |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. |Contact Dave ___, Executive Secretary for the|Cindy Denemark |

| |Rita expressed concern over Delaware Senate Bill 84. Richard inquired on the details|Delaware State Assembly’s ____ Committee and | |

| |of the legislation. Cindy responded that this was part of the sunset |his Attorney General. Express the MCAC’s | |

| |revision/regulation, in which there can be therapeutic interchange between |concern in regard to language of Delaware | |

| |medications if a previously established contract exists between a specific pharmacist|S.B. 84. | |

| |and physician. Cindy noted that the legislation is supported by the Board of | | |

| |Pharmacy and the Medical Society of Delaware and promotes therapeutic interchange. |Write resolution on behalf of the MCAC. | |

| |Rita stated that the mental health community does not support the legislation. Cindy| | |

| |reassured Rita that it is unlikely there will be interchange between mental health | | |

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

| |specifically dictate “brand not medically necessary”. Mark DiMaio, Astra Zeneca’s | | |

| |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 | | |

| |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. | | |

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

|Pharmacy Reimbursement Methods Overview | | | |

|by Cindy Denmark | | | |

|New Business: |Deferred until July 11, 2007. | | |

|Specialized Pharmacy Pricing | | | |

|by Cindy Denemark | | | |

|New Business: |Jim Wilton noted the August and September 2007 Quality Initiatives Improvement | | |

|Review of Quarterly Quality Assurance Report |Taskforce meetings (QII) went well and were well-attended. A quality management | | |

|by Jim Wilton |strategy was developed. | | |

| |In the July meeting, DMMA presented the quality strategy which CMS used in their best| | |

| |practices. Dr. Pillsbury inquired about a medical home grant. Yrene stated that you|Research medical home grant |Paul |

| |want to be in the home. Dr. Pillsbury noted she heard of this in September at an | | |

| |American College of Physicians meeting. Dr. Pillsbury noted the CMS grant would | | |

| |chose 50 to 100 practices from around the country (rural to inner city) for the paid | | |

| |model study. Dr. Pillsbury noted that the CMS representatives noted this was limited| | |

| |to Medicare. Paul said nothing was sent to states. No members of the Committee were| | |

| |aware of this grant. | | |

| |In September, Unison presented their quality strategy including discussion of disease| | |

| |management, high-risk pregnancies, and diabetes management. | | |

| |Jim noted that DMMA’s actions drive the MCOs as we require certain measureables | | |

| |(which DMMA is also working to refine). Now that two MCOs are on board, we have | | |

| |better cumulative data with both plans. | | |

| |DMMA is working on an MCO satisfaction survey. | | |

| |DMMA is upgrading case management software in January 2008, to the web-based Atlantes| | |

| |system. This will allow staff a better opportunity for case management. | | |

| | | | |

| | | | |

| | | | |

| | |Per Richard’s request, present results of the| |

| | |MCO satisfaction surveys | |

| | | |Jim |

•

|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. | | |

| |Each member must let Mollie Daughtrey know if they will attend the March 12, 2008 | | |

|IMPORTANT NOTES: |July 11, 2007 meeting. Mollie ( can be reached at 302-255-9658 or via email, at | | |

| |mollie.daughtrey@state.de.us or 302-255-9658). DMMA requests an accurate head count | | |

| |for preparation of the room and all materials. | | |

Respectfully submitted,

Mollie Daughtrey December 20, 2007_____ __ Richard Cherrin

Recorder Date approved Chairperson

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