OLR Research Report


October 11, 2013

 

2013-R-0391

COMMUNITY HEALTH NETWORK OF CONNECTICUT, INC.

By: Katherine Dwyer, Legislative Analyst II

You asked for an overview of the Community Health Network of Connecticut, Inc. (CHNCT), the state's administrative service organization (ASO) for the HUSKY Health program.

SUMMARY

CHNCT is a Wallingford-based nonprofit consortium of federally qualified health centers (FQHC). While it previously acted as one of three managed care organizations (MCOs) serving HUSKY A and B and Charter Oak Health Plan (COHP) recipients, since 2012, its role has been to provide administrative functions for program beneficiaries who receive services from any medical providers enrolled with the Department of Social Services (DSS). DSS pays CHNCT a monthly amount to: (1) make referrals, (2) help with appointments, (3) provide intensive care management for clients with exceptional health challenges, (4) obtain prior authorizations, and (5) provide quality management.

CHNCT HISTORY

According to its website, CHNCT was founded in 1995 by FQHCs “who sought to bring non-profit oversight to Medicaid managed care in Connecticut.” From 1995 – 2007, CHNCT acted as one of three managed care organizations (MCO) for the state's HUSKY A and B programs. (DSS also contracted CHNCT as the ASO for the State Administered General Assistance (SAGA) Program from 2004 until the program's end in 2010.)

To respond to ongoing concerns with the MCO model, such as access to care and MCOs' unwillingness to share information, the legislature in 2010 authorized DSS to contract with one or more ASOs to provide, among other things, care coordination, provider credentialing, customer service, and grievance remedies for individuals enrolled in Medicaid, HUSKY B, and COHP (PA 10-179 20, codified in CGS 17b-261m). Thus began the process of converting oversight of DSS' medical assistance programs to a modified fee-for-service model wherein the ASO provides a number of administrative functions, including care coordination, operating a centralized customer call center, provider profiling, and enrollee referrals and appointment scheduling.

In April 2011, DSS issued an RFP to entities interested in serving as ASOs to run DSS' medical assistance programs (including Medicaid, HUSKY B, and COHP). (COHP will no longer exist after December 31, 2013, see PA 13-234.) As the result of a competitive bidding process, DSS awarded a contract to CHNCT to serve as the single DSS ASO, starting in January 2012.

CHNCT FUNCTIONS

Table 1 lists the structure and some of the major functions of DSS' ASO model of delivering health care to its clients. Unless otherwise noted, CHNCT performs these functions.

TABLE 1: ASO MODEL OF DSS

Function

Summary

Structure

One managed fee-for-service entity

Outcome Incentive

DSS withholds 7.5% of each quarterly administrative payment contingent upon ASO's success in meeting performance targets related to beneficiary health outcomes, experience of care, and provider satisfaction

Payment Model

Managed fee-for-service

Care Delivery Model

Utilization management standardized and intensive care management available for all “Medicaid” beneficiaries

Data

One integrated data set immediately available to DSS, providing greater detail and transparency

Provider Enrollment

A separate DSS contractor, Hewlett Packard (HP), handles enrollment through an online process

Provider rates

DSS uses a standard rate schedule and common definitions for all services

Provider payment

HP issues payments on a two-week claims cycle

Source: DSS presentation, September 13, 2013 Commission on Medical Assistance Program Oversight (MAPOC) meeting.

According to CHNCT, it is also responsible for:

1. operating a call center for members and providers,

2. providing various services for members including provider selection and appointment scheduling assistance,

3. providing intensive care management,

4. providing various supports to provider practices who are becoming person-centered medical homes,

5. administering the member and provider appeals process,

6. assisting in retaining and expanding the provider network, and

7. conducting data analytics and various reporting.

HYPERLINKS

Community Health Network of Connecticut, Inc. website, http://www.chnct.org/, last visited October 4, 2013.

Lt. Gov. Nancy Wyman September 29, 2011 press release, http://www.ct.gov/dss/lib/dss/pdfs/2011pressrelease/chnrel9.29.11.pdf, last visited October 7, 2013.

DSS presentation, September 13, 2013 MAPOC meeting, http://www.cga.ct.gov/med/mh-meetings.asp?sYear=2013, last visited October 9, 2013.

Connecticut Mirror, Community Health Network selected for Medicaid ASO,” September 29, 2011, http://www.ctmirror.org/node/59281, last visited October 8, 2013.

KD:ts