UTILIZATION MANAGEMENTFORYOUTH MEMBERS

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1 UTILIZATION MANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare CalendarYear216:January-December216-SubmitedMarch1,217

2 ByRobertPlant,PhD,withAnnPhelan,BonniHopkins,PhD, LaurieVanDerHeide,PhD,SherieSharp,MD, LynneRinger,HeidiPugliese,CarieBourdon, JennfierKrom,JoeBernardi,StelaNtate, StephanieShorey-Roca,WalaceFarel,andLindsayBetzendahl, aswelastheentirereporting,clinical,andqualitydepartments. Foranyinquiries,comments,orquestionsrelatedtotheuseofTableau,ortheinteractivefeatureswithinthisreport, ThisreportwascreatedbyBeaconHealthOptionsonbehalfoftheCTBehavioralHealthPartnership.Howevertheopinions,conclusions,andrecommendationscontainedhereinare solelythoseofbeaconhealthoptions,andmaynotrepresentthoseofdss,dmhas,anddcf.

3 UTILIZATION REPORTFORYOUTH MEMBERS CalendarYear216:January-December216 GeneralOverview Onatleastasemiannualbasis,thereportsmutualyagreeduponinExhibitEoftheCTBHPcontractaresubmitedtotheStateforreview.Theshifttosemiannual reportswasdesignedtominimizenoisecreatedbyquarter-to-quarterfluctuationsthatdonotreflectatruetrendinthedata.themarchdeliverableservesasthe annualreportandcoversfourconsecutiveyearsofutilizationdata.theseptemberdeliverablecovers1consecutivequarterswithafocusedanalysisonthemost recenttwoquarters,butmayincludethepastfourifthereisinformationnecessarytoreviewthathadnotbeenanalyzedpreviously. Thisreportfocusesontheutilizationmanagementportionofthesereports,evidencedinthe4Aseries,whichreviewsutilizationstatisticssuchasadmissionsper 1,members(Admits/1,),daysper1,members(Days/1,),andaveragelengthofstay(ALOS). Withinthisinteractivereport,alutilizationdataisavailableviadrop-downfilters,butthenarativehighlightstheareasofinterestrelatedtocertainutilizationtrends. Insomecases,demographicbreakoutsareavailabletoenhancetheunderstandingofutilization.Additionaly,thenarativeidentifiestheunderlyingfactors,which drivethetrendsandassociatedprogrammaticresponsestakenbybeaconhealthoptionstoimpact/mitigateorsupportthetrend.beaconalsopresents recommendationstoaddressremainingchalengesandreportsprogressrelatedtotheseplannedrecommendations.theareasoffocusforthisdeliverableare listedonthefolowingpage. Methodology Thedatacontainedinthisreportarebasedonauthorizationadmissionsandarerefreshedforeachsubsequentsetofupdatesduringtheyear.Duetochangesin eligibility,theresultsforeachquarteroryearmaychangefrom thepreviouslyreportedvalues.thereportsandanalysesforallevelsofcareareafectedbythis change.pleasenotethatutilizationmetricsmaychangewiththerefreshofthedata.therefore,thereadershouldbecautiouswheninterpretingthelatestquarter ofdata.thecontractorwilmonitorthepost-refreshchangesclosely.ifwaranted,methodologywilberevisited. Themethodologyformembershiptotalsremainsunchanged.FortheTotalMembershipcounts,eachmemberisonlycountedonceperquarter,evenifhe/she changeseligibilitygroupsorexperiencesgapsineligibility.forinstance,ifamemberchangesbenefitgroupswithinthequarter,thatmemberisincludedinthe totalsforeachbenefitgroup,butonlyonceforthetotalmembership.thismethodologyisreferedtointhegraphsas UniqueMembership".Forthebenefit groups,membersarecountedineachgroupinwhichtheywereeligibleduringthetimeperiod(quarteroryear).thismeansthattheindividualbenefitgroup membershipcountscannotbeaddedtoobtainanoveraltotalsincememberscanshiftbetweenbenefitgroups. Themethodologyforcalculatingagehaschanged,resultinginaslightshiftinadultandyouthmembershiptotals.Previoustothisreport,countsforadultsand youthwerebasedonifamembermetthatagecriteriaduringthetimeperiod.thismeantthatyouthwhowereboth17and18yearsoldinaquarterwerecounted inboththeadultandyouthtotals.inordertoalowforthedril-downofdemographicandageinformation,itwasrequiredthatmembersbecountedinonlyone groupduringatimeperiod.agegroupisnowbasedontheagethatamemberwasforthemajorityofthetimeperiod(quarteroryear).otherdemographicssuch asgenderandrace/ethnicityarebasedonthemostrecentlyupdatedeligibility.thesedemographicswilupdateasneededaswewanttoreportonthemost accurategenderorrace/ethnicitythatamemberidentifieswith. Additionaly,whileunchangedfrom previousreportingperiods,itisworthnotingthattheper1,measurescomparetheutilizationratesofthepopulationtothe population s membermonths.thismeansthatwhenviewingtheadmits/1,ofhuskydmemberstherateisbasedonthenumberofadmissionswithinthe HUSKYDpopulation,nottheentireadultpopulation.Thishelpstoanalyzewhichpopulationsarepotentialymorechronic,acute,orinneed.

4 UTILIZATION MANAGEMENTFORYOUTH MEMBERS ExecutiveSummary& AnalysisbyLevelofCare CalendarYear216:January-December216-SubmitedMarch1,217 AreasofFocus Membership TotalUnique DCF&Non-DCF CompositionofDCFMembership Demographics TableofContents SelectBookmarkIcontoView"AreasofFocus" AndGoDirectlytoSelectedPage InpatientFacilities Admits/1,&Days/1, AverageLengthofStay In-StatePARHospitalAverageLengthofStay PercentofDaysDelayed&DischargeDelayReasonCode(s) InpatientSolnitCenter AverageLengthofStay NumberofDaysDelayed DischargeDelayReasonCode(s) Community&SolnitPRTF &Days/1, AverageLengthofStay TotalOverstayDays&OverstayReasonCode(s) Autism Spectrum DisorderServices &Admits/1, UtilizationProfile ProviderVolume OutpatientEnhancedCareClinics(ECC) RegistrationVolume AccessStandards Forthisreport,thefolowingutilizationdatapointshavebeenplaced intheappendixandarenotdiscussed: RTC & ALOS PHP,IOP,& EDT Admits/1, ICAPS Admits/1, Outpatient (OTP) Admits/1,

5 PG1 YouthMedicaidMembership TotalMembershipVolume 5K 4K TotalUniqueMembership AdultMemberswithoutDuals YouthMemberswithoutDuals DCF Non-DCF SelecttoView Totals Multiplevalues Members 3K 2K SelecttoShowTableorText 1K MembershipCount Methodology DualEligibility Information K TotalMembership TheYouthMemberswithoutDualsdecreasedinCY216;thefirstannualdecreaseinthelastfiveyears.YouthMemberswithoutDualsrepresents4.1% ofthe totalmedicaidmembershipforcy216.likethetotalyouthmemberswithoutdualsthenon-dcfmembershipdecreasedincy216.thedcfmembership increasedby14.83% incy216to14,116;thisisthehighestlevelsincecy211(14,966). DataRefresh ThelastthreerefreshratesfortheTotalYouthMembershipwithoutDualswere.5%,.51%,and.46%.Thesearelowerthanhistoricratesforthispopulation suggestingthattheunderlyingprocesshaschanged.thiswouldsuggestthestateisuptodateonenteringeligibilitydata.

6 PG2 YouthMedicaidMembership MembershipbyDCFStatus& BenefitGroup SelectGroupType DCFGroups SelectIndividualTypes Multiplevalues ChildWelfare/Commited VoluntaryServices JuvenileJustice DualyCommited FamilyWithServiceNeeds 14K 12K TotalYouthMembershipbyDCFGroup(-17) 1K Overview &Summary TheNon-DCFgroupdecreasedinCY216afterincreasing eachyearfrom 212to215.TheChildWelfare/Commited groupincreasedby1,97members(16.48%)incy216 drivenbyanincreaseof1,726inin-homechildwelfare.the threegroups,childwelfare/commited,in-homechild Welfare,andOut-of-HomeCommitedalincreasedinCY 216.TheVoluntaryServices,JuvenileJustice,andFamily withserviceneedsgroupshavebeentrendingdownwardin sizeeachyearsince212. Members 8K 6K 4K 2K K TotalUniqueMembership YouthDCF Types ChildWelfare/Commited In-HomeChildWelfare 12,219 8,999 1,998 7,93 11,438 8,17 11,575 8,245 13,482 9,971 Out-of-HomeCommited 4,937 4,661 4,71 4,886 5,249 VoluntaryServices 1, JuvenileJustice DualyCommited FamilyWithServiceNeeds YouthTotals DCF/Non-DCF DCF Non-DCF 13, ,761 12, ,232 12, ,921 12, ,656 14, ,7 Note:AyouthmaybeincludedinmorethanoneDCFcategoryinareportingperiodandthereforethevalueswilnotadduptothetotaluniqueyouth.The"Commited/CPSIn-Home"and"Commited/CPSOut-of-Home"are twosubcategorieswithinthetotal"commited/cps"category.youth,again,maybecountedineachgroup.eachcategoryisthenumberofuniqueyouththathadthatparticulardcfindicatorwithinthereportingperiod.

7 PG3 YouthMedicaidMembership DemographicCompositionbyGroupType(DCF& Eligibility) Overview TheNon-DCFgroupcontinuestobeover95% oftheyouthmembership.forboththedcfand Non-DCFgroupsthelargestagecohortisthe3-12yearolds;theymakeup5.7% and55.4% ofthe group,respectively.malesandfemalesareaboutequalydividedfortheyouthmembers. SelectGroupType DCFGroups SelectDCFGroups Multiplevalues ChooseDemographic NoDemographicBreakout DemographicSelection Al DCF CompositionofYouthMembershipbyDCFGroup NoDemographicBreakout Non-DCF 35K 3K 25K Members 2K 15K 1K 5K K Pleasenote,withinthisreport DCFInvolvement includesanyyouthundereighteenwhoisinvolvedwiththedepartmentofchildrenandfamiliesthroughanyofitsmandates.this includesyouthcommitedtodcfthroughchildwelfareorjuvenilejustice,andthosedualycommited.italsoincludesyouthforwhom thedepartmenthasnolegalauthority,butforwhom DCFprovidesassistancethroughitsVoluntaryServices,FamilywithServiceNeedsandIn-HomeChildWelfareprograms.

8 PG4 InpatientPsychiatricFacility:ExcludingSolnit(StateFacility) ChangefiltersbelowtoviewInorOut-ofStateHospitalsorSolnitHospitalonly. ClickforSummary GroupType AlMemberswithoutDuals DCF Non-DCF In-State/Out-of-State Al GroupType Al StateHospital ExcludingSolnit(StateFacility) ChooseDemographic NoDemographicBreakout InpatientPsychiatricFacility-ExcludingSolnit(StateFacility)-Youth(-17) AverageLengthofStay(ALOS) InpatientPsychiatricFacility-ExcludingSolnit(StateFacility)-Youth(-17) AverageLengthofStay K 1K K InpatientPsychiatricFacility-ExcludingSolnit(StateFacility)-Youth(-17) Days/1, InpatientPsychiatricFacility-ExcludingSolnit(StateFacility)-Youth(-17) Admits/1, 8 Days/1, 1 5 Admits/1, Theper1,ratesabovearecalculatedbasedonthetotaladmissionsordaysfortheidentifiedpopulationdividedbythetotalmembersofthesamepopulation,multipliedby1,.Totalmembersiscalculatedbyadding thenumberofuniqueeligiblemembersineachmonthwithinthereportingperiod.forexample,thedcfadmits/1,denominatoristhedcfyouthpopulation,nottheentiremedicaidyouthpopulation.

9 PG5 InpatientPsychiatric:ExcludingSolnit Summary Overview:ThetotalInpatientPsychiatricALOSforAlMembersincreasedby.72daysinCY216withboththeDCFandNon-DCFgroups increasingoverthelastyear.thiswasdrivenbytheadolescentcohort(the13-17year-olds),whichexperiencedanincreaseinalosin216to 12.16days.The3-12year-oldshadadecreaseinALOS.TheALOSfor3-12year-oldscontinuedtotrenddownwardsreaching13.2daysin216. Thisistheclosestthesetwometricshavebeeninthelastfouryears. Overal,admissionsdeclinedslightlyforthislevelofcareinthelastyearwithNon-DCFdecreasingandDCFincreasingslightly.Days/1,has beentrendingdownwardsince213andwasessentialyflatincy216. TheALOSforIn-StatePsychiatricHospitals(excludingStateHospital)increasedby.86daysinCY216withadmissionsdeceasingslightly. TheOut-of-StateHospitalALOSdecreased1.46daysto2.12daysinCY216withadmissionsunchanged.Thisdecreasewasdrivenbythe3-12 year-oldswhodecreasedby7.59daysto24.41days.theadolescentcohortincreasedby1.57daysto18.75days. Conclusions In216,BeaconstafmetwiththepediatricinpatienthospitalsincontinuedefortstoimproveaccesstocareandqualityofcareforMedicaidyouth.Measures reviewedincludeaveragelengthofstay(alos),dischargedelay,readmissionratesandhedisfolow-upafterhospitalizationformentalilnessrates(fuh).in additiontoindividualhospitalmeetings,twostatewideworkgroupswereheldinjuneanddecember. OnemainstatewidethemeidentifiedthroughthePARmeetingsisthehighacuityofcasesincluding,butnotlimitedtosignificanttraumahistory,autism,and intelectualdisability.duetothesechalenges,additionalprogramminghasbeenputinplaceatthehospitalleveltomeettheneedsoftheyouthoninpatientunits andpreventcrises.theseincludetheideateam athartfordhospital,theshowofsupportteam atst.vincent shospital,theimplementationofsensoryrooms anduseofsensorycarts,andtheadditionofadiversionaryroom.beaconstafhaveidentifiedthisadditionalprogrammingaspotentialbestpracticesandhave sharedandwilcontinuetosharethisinformationwiththepediatrichospitals.forexample,throughthespringpediatricinpatientworkgroupmeeting,st.vincent Hospitaldiscussedtheirsensoryroom.St.FrancisHospitalthenoutreachedtoSt.VincentHospitalwhoprovidedthem withatouroftheirsensoryroom,andthe hospitalisnowintheprocessofcreatingasensoryroom attheirfacility. TheHEDISFUHmeasurewasalsoreviewedinourPARmeetingsinaneforttounderstandthebarierstoconnectingyouthtocareandthepotentialimpacton readmissionrates.inaddition,bestpracticesweresharedinthepediatricinpatientworkgroupmeetingthroughahospitalspotlightfocusedonachievinghigher FUHrates.Ambulatoryfolow-upwilcontinuetobeafocusin217.

10 PG6 InpatientPsychiatric:ExcludingSolnit Summary Recommendations 1.DevelopaninfrastructurewhichsupportseasyaccessandconnectiontotreatmentservicesforspecializedpopulationssuchasthosechildrenwithanAutism Spectrum Disorderdiagnosis(ASD):MostchildrenwithanASDdiagnosiswhorequireacutecareservicesutilizeout-of-statefacilitiesforacutestabilizationwhich oftenleadstolongerlengthsofstaysecondarytotheincreaseddistancefrom theirhomeandtheinabilityoffamiliestoparticipateinthetreatmentdueto transportationissues.youthwithanasddiagnosisoftenstaylongerininpatientcarethantheirnon-asdidentifiedpeerswhoutilizethesameservices. Update-BeaconhascontinuedtocolaboratewithstateagenciestosupportefortstodevelopandconnectMedicaidyouthtoneededclinicalandcommunity services.thelackofin-networkcommunityabadirectcareprovidersandlackofspecializedinstateinpatientbedsisoftenabarierforyouthdiagnosedwith ASDtoreceivetimelyservices. Inpartnershipwithstateagencies,BeaconhascontinuedtocolaboratewiththeHospitalforSpecialCare(HSC)tomeettheclinicalinpatientneedsforchildren diagnosedwithautism Spectrum Disorder(ASD).TheHSCopenedan8-bedinpatientunitaboutayearagotoprovidethelongerterm behavioralandclinical treatmentneededforstabilizationtoyouthdiagnosedwithasd.duetothein-statelocation,familiesareabletoactivelyengageinthebehavioralplantolearnthe skilsneededtopromoteatimelytransitionhome.beaconhascontinuedtosupporttheseservicesthroughutilizationreview,casemanagementandcare coordinationtomedicaidmembersadmitedtotheunit.overthepastyear,beaconhasestablishedaweeklyonsiteclinicalroundsprocessandregular operationsmeetingswiththehsctopromotesuccessfulclinicaltreatment,dischargeplanningandoutcomes.beaconwilcontinuetocolaboratewiththehsc andmonitorutilizationtrends. BeaconalsocontinuestoauthorizeABAservicesandprovidesassistancetofamiliestoconnectMedicaidyouthtoABAcommunityproviders.Beaconhasworked withstateagenciesandthecommunitytoexpandthemedicaidabaprovidernetwork,andspecificalythedirectcareprovidernetwork.themedicaidaba providernetworkhasgrownsignificantlyinthepastyeartomeettheneedsofmanyyouths. TheDepartmentofChildrenandFamilies(DCF)andtheDepartmentofSocialServices(DDS)continuetocolaboratewithanAutism behavioralspecialtygroup toprovidetrainingtothepsychiatricresidentialtreatmentfacilities(prtfs)withinthemedicaidnetwork.thisefortwasfirstinitiatedwiththevilageforfamilies andchildrenandhasbeenexpandedthisyeartothechildren scenterofhamdenandboysandgirlsvilage.thegoalofthissupportivetrainingistopromote theoveralabilityoftheprtfstoprovidetreatmentandstabilizationofyouthrequiringspecializedtreatment,inadditiontopromoteincreasedadmissionsof youthwithspecializedclinicalneed.beaconhascontinuedtocolaborateonthisprojectwithregularreviewmeetingsandcaseconferences. BeaconcontinuestorecommendtheexpansionofEmergencyMobilePsychiatricServices(EMPS)toincludeaBoardCertifiedBehavioralAnalyst(BCBA).This hasthepotentialtoincreasetheavailabilityofrapidclinicalservicestofamiliesandchildrenincrisisandpreventaninpatientoranemergencydepartmentvisit. Thiscouldserveasamuchneededresourceandbridgeservicewhilememberswaitforcommunityservicestobeimplemented. Baseduponfeedbackfrom thepediatricinpatienthospitalproviders,dds-involvedyouthandfamilieswerereportedassomeofthemostchalengingintermsof navigatingthesystem andobtainingservicesforpost-discharge.asaresult,ddscolaborationwasafocusofindividualparmeetingsandthedecember216 inpatientworkgroup.beaconprovidedthehospitalswithanoverviewofddsservicesandacontactlistoftheddsregionaldirectors,thedirectorofwaiver ServicesandtheDirectorofPsychologicalServicesatDDS.AnoverviewofBeacon sasdprogram wasalsoprovided. Recommendationscontinueonthenextpage.

11 PG7 InpatientPsychiatric:ExcludingSolnit Summary,Continued Recommendations,continuedfrom previouspage 2.ContinuetoexpandtheimplementationanddevelopmentofRapidResponsemodel:TheRapidResponsemodelfocusesonthecolaborationamong community,stateagenciesandbeaconstaftoprovideemergencydepartmentssupportandcasemanagement.opportunitiesremaintoimplementarapid Responsemodelinotheremergencydepartments(ED)withhighpediatricbehavioralhealthvolume. Update-TheRapidResponsemodelcontinuestoprovidesuccessfulcolaborationbetweenConnecticutChildren smedicalcenter(ccmc),thedepartmentof ChildrenandFamilies(DCF),EmergencyMobilePsychiatricServices(EMPS),andBeaconHealthOptions.Frequentmeetingsanddailyclinicalroundscontinue. Inadditiontotheseeforts,Beacon,incolaborationwithstateagenciesandtheConnecticutHospitalAssociation(CHA),heldaforum injanuary216dedicated toraisingawarenessofedutilizationbyyouthforbehavioralhealthcrises.eddatawaspresentedto85providersacrossthestate,comprisedmainlyofhospitals andemergencymobilepsychiatric(emps)program staf.folowingpresentationofthedatathelargegroupthenbrokeoutintosmalergroupsbyregionto discussstrategiesforreducingoveraledvolume,visitsbyfrequentvisitors, stuck youthintheedandreadmissions.uponregrouping,eachregionreportedout onsuggestedsolutionsandresponses;manyofthem includedacalforalargerpresenceorenhancedroleofempsinthecommunityandenhanced partnershipsandcoordinationbetweenstakeholders.folowingthejanuary216forum,thernmsandclinicalteam havecoordinatedmeetingsacrossthestate tocontinuetheconversationandtodevelopregionalorhospitalspecificstrategies.astatewidemeetingwilbeheldin217toprovideanupdateontheregional activityandtoreviewupdateddata. Beaconcontinuestorecommenddevelopingarapidresponsemodelconsortium tosupportandassistconnecticutemergencydepartmentsinconnectingyouthto neededservicesinatimely,eficientmanner.thiswilservetopreventunnecessaryemergencydepartmentvisitsandinpatientstays,inadditiontoconnecting youthandfamiliestothecommunityservicesandsupporttheyneed. 3.Establish,ineachoftheregionalareas,acentralizedforum whichmeetsregularlytodiscussat-riskyouthwhohavehighutilizationofcrisisandbehavioral healthservices.beaconcontinuestorecommendtheestablishmentofacentralizedforum ineachregionalareatocoordinatecareforthoseyouthidentifiedasat riskforhighutilizationofinpatientandemergencydepartmentservices.thisforum wouldservetoengagecommunities,families,schools,andprovidersinthe planning,anddeliveryofbehavioralhealthservices. Update-TheIntegratedServiceSystem (ISS)meetinghasbeenestablishedineachregionalDCFareaofice.BeaconHealthOptions stafatendthese meetingstosupportcoordinationofcareanddialoguetoengagecommunitiesintheplanninganddeliveryofbehavioralhealthservices. Beaconhascontinuedtomeetwithemergencydepartmentsandproviderstodiscusscrisisandemergencyservices.Inaddition,Beaconcontinuestorecommend theforum oftheintegratedservicesystem meetingtoincludeemergencydepartmentsandcommunityproviderstopromotetheplanninganddeliveryofrapid behavioralhealthservices. Asnotedabove,afolowuptotheCHAforum heldinjanuary216,beaconstafcontinuetomeetwithpediatricemergencydepartmentpersonneltofurther discussedfrequentvisitors,volume,readmissionrates,andconnecttocarerates.strategicdiscussionsaredrivenbydataandemergencydepartmentspecific chalenges. Recommendationscontinueonthenextpage.

12 PG8 InpatientPsychiatric:ExcludingSolnit Summary,Continued Recommendations,continuedfrom previouspage 4.ContinuedStateAgencycolaborationwithBeaconHealthOptions:BeaconcontinuestorecommendongoingcolaborationwiththeStateAgenciesonmultiple levelstodevelopanintegrated,community-based,preventivehealthcaresystem. Update-BeaconHealthOptionshascontinuedtomeetwithStatepartnersonaweeklybasisinmultipleforums.TheDepartmentofDevelopmentalServices (DDS)hascontinuedtoparticipatewithDCFandBeaconinweeklyComplexCasediscussionstoreviewhigh-riskchildrenwhorequireadditionalescalationand stateagencyintervention.thefocusofthemeetingincludesemergencydepartment,inpatientfacilityanddcfareaoficeconcernswhichrequireescalation. DDSsupervisorshaveatendedcomplexcareroundsseveraltimesthisyeartodiscussMoneyFolowsthePerson(MFP).Thishasbeenhelpfulinconnecting youthtobehavioralhealthservicesandsupportswithinthecommunityfrom inpatientfacilities.inaddition,beaconhascontinuedtomeetweeklywithdcfand DSStodiscussandreviewASDoperations.

13 PG9 InpatientDischargeDelay:ExcludingSolnit PercentofDaysDelayed& DelaybyReason PercentofDaysDelayed Therewasa1.5percentagepointincreaseinthepercentofdaysdelayedforalyouthfrom 7.7% to9.2%.thisisthehighestpercentagesince212.thedcf grouphadanincreaseof5.1percentagepointswhichdrovetheincrease;thenon-dcfmemberswereessentialyunchangedin216.thenumberofcaseswith dischargedelaywasessentialyunchangedfrom 215to216. Inpatient(ExcludingSolnit)PercentofDaysDelayed:AlYouth TotalYouth Non-DCF DCF InpatientDischargeswithDelayedDays:AlYouth HovertoViewDelayedReason 15 % ofdaysdelayed 15% 1% 5% DelayedDischarges 1 5 % DaysinDelaybyReason Therehasbeenanincreaseinthe percentofdaysdelayedoverthe pastyear.mostchildrenwereon delayawaitinginpatientadmission intosolnit.thisispotentialyrelated todecreasedbedcapacitywhich occuredearlierintheyearatsolnit, inadditiontothedecreasedstafing availabletoprovideclinicaltreatment tocomplexyouth. AwaitingStateHospital AwaitingPRTF AwaitingSolnitPRTF AwaitingRTC/GH AwaitingDDSServices InpatientDelayedDischargesbyReasonCode Hoverformoreinformationonavg.delayeddaysandtotaldelayeddays AwaitingFosterCare Note:TheReasonCode"AwaitingSolnitPRTF" wasnotimplementeduntillate214. AwaitingOther

14 PG1 InpatientDischargeDelay:ExcludingSolnitTables PercentDelayDays& DelaybyReasonCode DCF % ofdaysdelayed CasesDelayed Non-DCF % ofdaysdelayed CasesDelayed Total % ofdaysdelayed CasesDelayed % % % % % % % % % % % % % % % Inpatient(ExcludingSolnit)Table(Ages-17) PercentofDaysDelayed&CasesDelayed Awaiting State Hospital DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting SolnitPRTF DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting PRTF DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting RTC DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting GH DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting FosterCare DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting Other DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting Comm Serv DDS DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges Awaiting DDS DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges 28 1, , , , , InpatientDischargeswithDelayedDaysbyReasonCode

15 PG11 InpatientPsychiatric:ExcludingSolnitDischargeDelay Summary Conclusions Therehasbeenanincreaseinthepercentofdaysdelayedoverthepastyear.MostchildrenwereondelayawaitinginpatientadmissionintoSolnit.Thisis potentialyrelatedtodecreasedbedcapacitywhichoccuredearlierintheyearatsolnit,inadditiontothedecreasedstafingavailabletoprovideclinicaltreatment tocomplexyouth. Recommendations 1.Developcommunity-basedbehavioralhealthserviceswhichmeetthehigheracuitybehavioralhealthneedsofchild/adolescents,includingcrisisand WraparoundTeams,whofolowchildrenthroughoutthelevelofcarecontinuum. Asthesystem movestowardscommunity-basedbehavioralhealthcare,with limitedoptionsregardingchildren s'placementincongregatecareandsolnit,thereisagreaterneedtodevelopbehavioralhealthservices.thoseservicescan providecoordinationofcare,familysupport,andclinicalservicestoaclinicalycomplexyouthcohort.thisactivityhasthepotentialtodecreaseemergency departmentutilization,inpatientlengthofstayanddischargedelay.beaconrecommendsapotentialexpansionofthecurentemergencymobilepsychiatric Servicescopeandcapacitytoservicefamiliesandyouthincrisis. Update-Beaconcurentlyprovidessupportofservicesthatfolowchildrenthroughoutthelevelofcarecontinuum.Beacon'sIntensiveCaseManagersprovide casemanagementandcoordinationtoassistwithclinicalfacilitationfrom theemergencydepartmentthroughinpatienttodischargeplanningintoanotherlevelof careorthecommunity.thisisachievedonvariouslevelssuchasco-locationandcolaborationwithdcfandemps.inaddition,beacon'sasdandiccteams ofercarecoordinationandpeerserviceswhichfocusoncolaborationwithinthecommunity. BeaconcontinuestorecommendapotentialexpansionofthecurentEmergencyMobilePsychiatricServicescopeandcapacitytoservicefamiliesandyouthin crisis,includingthosechildrenwithspecializedclinicalneedssuchaschildrendiagnosedwithautism and/orintelectualdisabilities.thisexpansionofanemps team wouldincludeabcbaandprovidedirectclinicalassessment,educationtofamiliesandprovideserviceswhilebridgingtheconnectiontoreadilyavailable communityteamstobegintreatment.

16 PG12 Inpatient:SolnitCenter AverageLengthofStay& DelayDays Overview TheALOSforSolnitremainedessentialyunchangedinCY216comparedto thepreviousyear.thecourt-orderedcohort'salosincreasedby43.5daysin CY216.Totaldischargesweredownto115inCY216,thelowestnumberin thelastfiveyears. BenefitGroup CourtOrdered Non-CourtOrdered Total IPFSolnitAverageLengthofStay(ALOS) Court-Ordered,Non-Court-Ordered,andTotal ThenumberofoverstaydaysdecreasedslightlyinCY216to952days. AwaitingRTChad33overstaydayswhileAwaitingGroupHomehad281 overstaydays. 2 IPFSolnitNumberofDelayedDays TotalYouth Avg.LengthofStay #ofdaysdelayed Discharges IPFSolnitTotalDischarges Court-Ordered,Non-Court-Ordered,andTotal 2

17 Inpatient:SolnitCenterTables AverageLengthofStay& DelayDays CourtOrdered ALOS Discharges Non-CourtOrdered ALOS Discharges Total ALOS Discharges InpatientSolnitCenterAverageLengthofStay Court-Ordered,Non-Court-Ordered&TotalYouth Total #ofdaysdelayed CasesDelayed , , ,55 InpatientSolnitCenterNumberofDelayedDays TotalYouth AwaitingPRTF DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingRTC DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingGroup Home DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges AwaitingFoster Care DelayedDischarges TotalDelayDaysforDischarges AverageDelayDaysforDischarges InpatientSolnitCenterDelayedDischargesbyReason PG13

18 PG14 InpatientPsychiatric:Solnit Summary Conclusions TheALOSforalyouthatSolnithasremainedstablethisyearwithminimalchange.TherewasanincreaseintheALOSforthoseyouthcourtorderedtoSolnit. Thenumberofyouthinoverstaystatushowevercontinuestobeminimal.Throughouttheyear,therehascontinuedtobeyouthondelayedstatusfrom inpatient facilitiesawaitingadmissionintosolnit.thiscontinuestoberelatedtotheincreasedininpatientproviderreferalsanddecreasedbedcapacityandstafingat SolnitInpatienttomanageyouthwithhighlyacutebehavioralhealthneeds. Recommendations 1.BeaconwilcontinuetocolaboratewithSolnitfacilitiesandStateagenciestoincreasetimelyaccessandefectivetreatmentanddischargeplanning. Update-Thisyear,BeaconincreasedcolaborationwithSolnitInpatienttosupporttimelyaccesstocareandefectivecareplanning.Beacon sintensivecare Managers(ICMs)arecurentlyonsitedailytoprovideutilizationreview,clinicalcasecoordination,triage,andparticipationwithinmultiplecaseconference forums.beacon'sicm team hasworkedwithcssdtoassistthoseyouthcourtorderedtosolnittoconnectwithservicesuponevaluationcompletionatsolnit. WeeklyclinicalroundsandtriagehasbeenestablishedthisyearwithaloftheunitsatSolnit

19 PG15 PRTF:ExcludingSolnit(StateFacility) Use"TypeofPRTF"filtertovieweitherPRTFExcludingSolnit(CommunityPRTFs)orSolnitOnlyPRTF(StateFacility) TypeofPRTF ExcludingSolnit(StateFacility) GroupType Al ChooseDemographic NoDemographicBreakout GroupType AlMemberswithoutDuals DCF Non-DCF PRTF:ExcludingSolnit(StateFacility)-Average LengthofStay PRTF:ExcludingSolnit(StateFacility)- PRTF:ExcludingSolnit(StateFacility)- Days/1, AverageLengthofStay Days/1, Overview TheALOSforCommunityPRTFdecreased12.39 daysincy216to16.72days.thiswasdrivenby thedcfyouthwithadecreaseof21.88daysto days.increasedby11inCY 216,againdrivenbytheDCFmembership. Days/1,isdownfrom ahighin214of18.3 daysto58.2daysin216. TheALOSforSolnitPRTFincreasedby13days (8.44%)inCY216.ThiswasdrivenbytheDCF youthwhichhadanincreaseof37.88days(25.2%) andadecreaseinadmissions.thenon-dcfyouth hadadecreaseinalosandanincreasein admissions. ordischarges BOYS&GIRLSVILLAGEINC CHILDRENSCENTEROFHAMDEN VILLAGEFORFAMILIES&CHILDREN Totals ordischarges PRTF:ExcludingSolnit(StateFacility)

20 PG16 CommunityPRTF:ExcludingSolnit(YouthAges5-13) OverstayDays& OverstayReasons Overview AftertrendingupwardforthreeyearstheTotalOverstayDaysdecreasedinCY216by17days.Almosthalfthecases(46.7%)wereAwaitingGoingHome while36.7% wereawaitingfostercare. PRTF(ExcludingSolnit)TotalOverstayDays PRTF(ExcludingSolnit)TotalOverstayCases #ofdaysinoverstay CasesinOverstay PRTF(ExcludingSolnit)Table PRTF(ExcludingSolnit)PercentofOverstayDischargesbyTopReasons #ofdaysdelayed 1,533 1,744 2,138 2,964 2,857 AwaitingFosterCare 73.3% 68.4% 43.5% 39.4% 36.7% CasesDelayed AwaitingGH 6.7% 5.3% 13.% 18.2% 13.3% AverageDaysDelayed AwaitingGoingHome 6.7% 5.3% 43.5% 42.4% 46.7%

21 PG17 PRTF:SolnitNorth& South(YouthAges13-17) OverstayDays& NumberofYouthinOverstaybyReasonCode NumberofOverstayDays ThenumberofOverstayDaysincreasedforthethirdstraightyearreaching 2,743daysinCY216.Thiswasan8.94% increasefrom CY215.The reasonsforoverstayweresplitevenlyamongthreegroups:awaitingfoster Care,AwaitingRTC/GH,andAwaitingOther.TheSolnitPRTFALOSincreased 13daysto167.6inCY216.TheDCFgroupincreased37.88dayswhilethe Non-DCFgroupdecreased8.21days.Forthefirsttimesince213the Non-DCFyouthhadmoreadmissionstoSolnitPRTFthantheDCFgroup PRTFSolnitOverstayDays(ages13-17) #ofoverstaycases PRTFSolnitOverstayCases(ages13-17) #ofdaysinoverstay PRTFSolnitNumberofYouthbyOverstayReasonCode(ages13-17) AwaitingCommunityServices AwaitingFosterCare AwaitingOther AwaitingPRTF AwaitingRTC/GH AwaitingStateHospital

22 PG18 PRTFExcludingSolnit:CommunityPRTFs& PRTFSolnit(StateFacility) Summary Conclusions Forthethirdstraightyear,thenumberofdaysinoverstayatSolnitPRTFhaveincreased.CommunityPRTF'shadcontinuedincreaseinoverstaydaysthrough 215withaslightdeclinein216.Theincreaseddaysindelaycontributestosystem delay.thisyear,themostsignificantreasonsfordelayatsolnitprtfwere awaitingfostercare,awaiting other,andawaitingrtc/gh,whileatcommunityprtfsyouthwereprimarilywaitingforfostercareandtogohome.this supportstherecommendationtoexpandcommunityservices,includingthefostercarenetwork,directcareproviderswhoservicefamiliesandchildrenwith complexbehavioralhealthneedsthatcanprovideacrisisresponseandeducationalcomponenttofamilies. CommunityPRTFRecommendations 1.ExpandPRTFscopeofservicestoincludeacontinuum ofcare,crisisstabilizationandcarecoordination.beaconcontinuestorecommendexpandingthe scopeofprtftoincludeanintegratedcontinuum ofservices,whichincludescrisisstabilizationandcoordinatedcare.withlimitedaccessfortheyounger populationtocongregatecareandsolnitcenter'sinpatientunit,prtf-referedyouthareaclinicalycomplexpopulation.inadditiontothealreadyexistingclinical servicesprovidedbyprtf,theadditionofmedicaidcoveredservicesforcrisisstabilizationaspartofacontinuum ofcaremodelisrecommended.thismodel wouldincludecarecoordinationtoprovideeducationandsupporttoparentswhileamemberisreceivingtreatment,andtocoordinatecareforthefamilywhenthe childisdischargedintothecommunity.itisalsorecommendedthatprtfsexpandcapacityandaddatrainedworkforcetoprovidetreatmenttothoseyouthwith developmentaldisabilitiesorchildrenwithautism Spectrum Disorder. Update-Beaconhascontinuedtosupportthisrecommendationincludingtheexpansionoftheseservicestoincludeyouthwithanintelectualdisability,in additiontothosechildrenwithcomplexbehavioralhealthneedswhichrequirefamilyeducationandtraining.theintegratedcarecoordination(icc)program throughdcfhassupportedthisrecommendation.theiccprogram providescarecoordinationandpeersupporttofamiliesutilizingawraparoundcommunity model.theprtfshavealsocolaboratedwithaspecializedbehavioralgroupinsupportfrom DCFandDSStotrainstafatthePRTFinadditiontoworkingwith familiesforthoseyouthwithanasddiagnosis. PRTFSolnitRecommendations 1.BeaconwilmonitortheSolnitPRTFlevelofcareforadditionaltrending,andincludedatarelevanttodischargedelayreasoncodes,specificalyforSolnitNorth campus.itisrecommendedthatweidentifythespecificdelayreasonsforthemalesatthesolnitnorthcampusandimplementincreaseddischargeplanningwith Beacon'sIntensiveCareMangers,DCFandSolnit.Beaconcontinuestohaveweeklycarecoordinationmeetingstoreviewcurenttreatmentanddischarge planningwithbothfacilities. Update-BeaconhascontinuedtomonitortheSolnitPRTFlevelofcareindicatingspecificreasoncodesforoverstaystatus.Onsitecolaborationandutilization reviewscontinueandhaveexpandedtoincludetriageofcasesandtheinclusionofbeacon'sicmswithincaseconferences.thisrecommendationhasbeen achieved,isnowmonitoredonanongoingbasis,andhasbecomestandardoperatingprocedure.thisrecommendationwilthereforebeconcluded. Beaconcontinuestorecommendearlierintensivecarecoordinationofclinicalservicesfocusedonsupportingandeducatingthefamilyinthemanagementof complexpsychiatricbehaviorandcrisisresponse.thiscouldincludeaclinicianwithspecialtycrisistrainingwhoworkswiththefamilyintheirhometopreparethe familyforthechild sdischarge. Additionaly,SolnitSouthandSolnitNorthPRTFsarenowparticipatinginBeacon sprtfparprogram.beaconanddcfstatepartnersmetwithsolnitprtfs indecemberof216toreviewtheirfirstparprofile.theyalsoatendedtheprtfworkgroupmeetingheldindecember.twoparareasoffocusmoving forwardwilbeinpatientstaysduringandpostprtfdischargeandoverstay.

23 PG19 Autism Spectrum DisorderServices & Admits/1, &Admits/1, WhilealAutism Spectrum Disorder(ASD)servicesincreased incy216thenumberofdiagnosticevaluationsincreased significantlyfrom 12inCY215to851inCY216.Similarly, Admits/1,increasedforeachserviceinCY215with diagnosticevaluationsgoingfrom.3incy215to.23in CY216. Autism Spectrum DisorderServices YouthAges-2 ServiceClass(group) DiagnosticEvaluation BehavioralAssessment TxPlanDev&ProgBookDev ServiceDelivery DirectObs&Direction HoveroverPuzzlePieceforDefinitionofEachServiceClass CorespondingBelow Autism Spectrum DisorderServicesAdmits/1, YouthAges Admits/1,

24 PG2 Autism Spectrum DisorderServices UtilizationDemographics UtilizationProfile InCY216therewassignificantgrowthinthenumberofuniqueyouthserved.InCY 215,293uniqueyouthwereservedintheprogram;inCY216thatnumberroseto 1,159uniqueyouth.Malescontinuetobethelargerpartofthisgroup;inCY216they were77.91% oftheasdprogram withfemalesat22.9%.thisisconsistentwithcurent researchthatindicatesthatboysarefivetimesmorelikelythangirlstoreceiveanautism diagnosis. TotalYouthbyGender:CY 216 Male Female 22.9% TotalYouthbyDCFStatus:CY216 Non-DCF Voluntary ChildWelfare/Commited 1.21% 1.44% AsofDecember3,216,datashows1,313uniqueyouthhaveobtainedauthorizations forasdservices;673youthareinvariousstagesofdeterminingeligibilityforasd services,536youthhaveopenauthorizationsandarereceivingdirectservicesand22 youthhaveopenauthorizationsforanautism DiagnosticEvaluation. Theyoungestmembers(-6years)hadsignificantincreasesinalservicesinCY216. ThenumberofDiagnosticEvaluationsincreasedfrom 55in215to54inCY216. Similarly,BehaviorAssessmentsincreasedfrom 61to12,TreatmentPlanDeliveryfrom 61to132,andServiceDeliveryfrom 37to12.Also,thisagegroupgrewasa percentageofeachservicecategoryin216comparedto215whilealotheragegroups haddecreases.the7-12agegroupalsohadalargeincreaseindiagnosticevaluations andservicedelivery.incy215therewere23authorizationsforevaluationsand4for servicedelivery;in216,theseincreasedto198and86,respectively. Therecontinuetobediferencesinthebreakdownofutilizationamongracialandethnic groupsacrossalasdservicesclasses.autism isreportedtooccurinalracial,ethnic, andsocioeconomicgroups.asfarasdiagnosticevaluations,44.9% werecompletedfor Whiteyouth,36.4% forhispanicand13.2% werecompletedforblackyouth.however, ConnecticutMedicaidisdoingabeterjobatidentifyinganddiagnosingyouthinthe Hispaniccommunityascomparedtothenationalaveragewherenon-HispanicWhite youthwerealmost5% morelikelytobeidentifiedwithasdthanhispanicyouth.the researchconsistentlynotesthatyouthofblack,hispanic,andasiandecentaremore likelytobeidentifiedlater.recentresearchhasfoundthatethnicminorityyouthmay havesubtlecommunicationdelayscomparedtonon-minorityyouththatmaybe undetectedorpresumedunremarkablebyparentsofminoritytoddlers.asaresult,for ethnicminorityyouthmoresignificantdelaysareneededtopromptearlyidentificationand thesearchforinterventionservices.inourctmedicaidasdprogram,thisdisparityis morepronouncedacrosstheservicesofbehaviorassessment,planofcaredevelopment andservicedeliverywherewhiteyouthaccessedservicesatasignificantlyhigherrate thanhispanic,black,asianorotheryouth % DiagnosticEvaluation BehaviorAssessment TxPlanDev&Prog BookDev ServiceDelivery DirectObs&Direction 88.35% Becausemembersmayhavemultipleauthorizationswithdiferencesin,specificaly,ageand DCFstatusatthetimeofadmission,demographicsarecapturedasofthelast/mostrecent authorizationrecord.eachmemberisonlycountedonceinthiscalculation. TotalYouthbyLevelofServiceandAgeGroup:CY DiagnosticEvaluation BehaviorAssessment TxPlanDev&Prog BookDev ServiceDelivery DirectObs&Direction 44.3% 42.% 38.9% 41.7% 64.8% 28.% 28.7% 32.1% 33.2% 23.8% 26.9% 28.% 28.2% TotalYouthbyLevelofServiceandRace:CY216 White Hispanic Black Asian AlOthers 44.9% 54.6% 56.7% 57.6% 54.1% 36.4% 26.2% 24.2% 23.3% 25.5% 24.3% 13.2% 14.4% 14.6% 14.1% 15.4% Thesevalueswilnotadduptothetotaluniqueyouthasyouthmayutilizemorethanone service.however,eachyouthisonlycountedonceineachdemograhiccategorywithineachse.

25 PG21 Autism Spectrum DisorderServices byprovider ServiceClass ProviderEnrolment Al TheprovidernetworkexperiencedminimalgrowthinQ1andQ2ofCY216.Onlyfour uniquepractices(individualsorgroups)enroledduringthistimeforavarietyofserviceswith atotalof42providersenroledasautism Serviceproviders.Thisisupfrom 34enroled Autism ServiceprovidersinCY215.19areenroledtocompletediagnosticevaluations,33 toprovidebehavioralassessmentsandplanofcaredevelopmentand39toprovideservice deliverywhiletheactualnumberofuniqueprovidersaccessingauthorizationsismuchlower. Someprogramshaveenroledandarestilgetingtheirservicedeliveryteamsoperational. AsofJuly1,216,BeaconHealthOptionsbecameresponsibleforqualifyingpotentialASD providerspriortoenrolmentwithmedicaid.sincethistime,44newprovidershaveenroled bringingourtotalto86individualproviders,53ofwhom areabletoprovideasddirect servicedeliveryservices.amongstotherprovidergrouptypes,these53arepartialy comprisedof3bcbagrouppractices,sixindividualbcbas,fivelcsw/lpcindividuals andtwolcsw groups. NewserviceclasseswereimplementedSeptember1,216.TheseincludedProgram Book Development,GroupTreatmentServices,andDirectObservationandDirection.Also, BCBA/LicensedClinicianDirectServiceDeliveryversusBCaBAandBehaviorTechnician DirectServiceDeliverywerebrokenoutwithseparaterates.ChangestothecurentAutism Servicesregulationsandrateswilbeimplementedinordertoencourageadditionalprovider enrolmentsometimeinq2orq3ofcy217. Ongoingrecruitingandoutreachtocurentbirthtothreeproviders,DDS/DSSandDCFASD providersandatendanceatregionalappliedbehavioralanalysis(aba)associationsin Connecticut,RhodeIsland,NewYorkandMassachusetsaretakingplace.Themonthly LearningColaborativeforASDproviderscontinuestocovertopicsrelatedtobestpractices forasdservices,identifytrendsandalowproviderstonetworkandgetquestionsanswered inatimelymanner.thenewasdproviderorientationishighlyindividualizedand streamlinestheprocessofeducatingnewprovidersregardingstafenrolment,accessing authorizationsanddocumentationexpectationsforclinicalreview. VolumeofUniqueProvidersProvidingASDServices ServiceClass(group) DiagnosticEvaluation BehavioralAssessment TxPlanDev&ProgBookDev ServiceDelivery DirectObs&Direction 21 ServiceClass(group) DiagnosticEvaluation BehavioralAssessment TxPlanDev&ProgBookDev ServiceDelivery DirectObs&Direction ASDProviderVolumeofAuthorizationsbyServiceClass CTCHILDREN'SSPECIA,LTYGRPCCMC ABLEHOMEHEALTH,CARELLC CONNECTICUTBEHAVIOR,ALHEALTHLLC FAMILYSTRONG CTLLC, YALEUNIVERSITYSCHL,OFMEDICINE SHORELINESOCIAL,LEARNING RUSSOLILLO,PATRICKJ FOCUSCTRFOR,AUTISM INC HOSPITALFORSPECIAL,CAREGROUP BEHAVIORALHLTHCONS,ULTING SVCSLLC STRONG,FOUNDATIONS ADELBROOKCOMM,SERVICEINC WHEELERCLINICINC CTBHCONSULTANTS,LLC HILTONBEHAVIOR,THERAPY TRADING SPACES,ABA,LLC ADVANCEDPSYCHOLOGIC,ALSERVICES EASTERSEALSCOASTAL,FAIRFIELDCNTY ROSALES,MANUELJ CLIFFORDBEERSGUIDANCECLINIC KOZODOY,PAUL COMKEYTHERAPYPLLC, ZABATHERAPYLLC, INTERLOCKING CONNEC,TIONSLLC ALLPOINTECARE,LLC BLOOM BEHAVIOR&,CNSLTSERVICES ALTERNATIVESERVICES,CTINC CREATIVEPOTENTIAL,LLC GROWING POTENTIAL,SERVICES ROGINSKY,BINA WEST,CYNTHIAW SelectYear

26 PG22 Autism Spectrum DisorderServices Summary Conclusions WhileaccesstoadiagnosticevaluationisquickandeasilyaccessibleforMedicaidyouth,accesstoin-homeandcommunity-basedservicescontinuestodevelop. Buildingtheprovidernetworkcontinuestobeofprimaryfocus.Continuedatentionisalsobeinggiventosendingreferalstoprovidersfrom areaswiththe greatestnumberofmedicaidmemberswaitingforservicedeliverytobegin.clinicalcaremanagers(ccms)weeklycommunicationwithprovidershelpsproviders identifywherestafisneededmostformedicaidmemberswaitingthroughoutthestateandmanyprovidersaretargetingtheirstafrecruitmentefortsinthese areas. MonthlyroundsandcaseconsultationwithNationalBeaconHealthOptionsAutism ServicesProgram alowstheconnecticutasdteam toshareandaccessbest practicemodelsandcontinueefortstoincreaseproviderenrolment.monthlylearningcolaborativesalowforcommunicationofbestpractices,standardsand Medicaidexpectationsonanongoingbasis. NetworkingwithASDprovidershasprovidedlowcosttonocostopportunitiestoimprovetrainingandqualityofbehaviortechnicianstafbyengagingwithstate universitiesandotherprovidersoferingregisteredbehaviortechnician(rbt)trainingtonewandprospectiveemployeesfortheprovidernetwork. Behavioraly-focusedtrainingsaresharedonamonthlybasiswiththeenroledAutism Servicesprovidernetworkaswel. Recommendations 1.Beaconcontinuestorecommendongoingworkforcedevelopment.Enrolingdirectcareproviderswithinthenetworkremainsapriority.Inordertogrowthe numberofprovidersaswelasimprovetheadequacyofthetreatmentbeingprovided.providerlearningcolaborativeswilcontinuetofocusonbothofthese areasandoutreachestocurentprovidersnotenroledwithmedicaidwilalsocontinue. Update-Informationalflyersspecifictofamiliesandcommunityproviderswilbedeveloped.Theflyerforfamilieswilfocusoneducatingfamiliesregarding accessingmedicaidservices,whatservicescanbeauthorizedundermedicaid,whattoexpectfrom ABAinhomeservicesandresources.Theflyerfor communityproviderswilfocusonhelpingfamiliestheyworkwithconnecttoasdmedicaidservices,howtomakeareferal,eligibilitycriteriaandservices provided. ProviderchartreviewsareexpectedtobeginQ3folowingfinalrevisionsonthechartreviewtool.Alongwiththis,ASDClinicalCareManagersaredeveloping clearcriteriafordocumentreviewsinordertomovetowardsproviders qualifying forbypasswhenreviewingdocuments. NewworkflowswilbedevelopedQ2andQ3totracktrendsintimelinesandlengthoftimebetweenserviceauthorizationsanddatesofservicedelivery.Thiswil helpeducatebeaconhealthoptionsonareasthatmayrequiremoretrainingandsupportforproviders. ColaborationwithStateagencies,BirthtoThreeandspecialtyhospitalsliketheHospitalforSpecialCare snewinpatientautism unitcontinues.newpartnerships havebeenformedwithsubcontractor,padresunidosofgreaterdanburyandfavortoincreaseparentsupportgroupoptionsforfamilieswhoareprimarily Spanish-speakingwithspecialneedsyouth.RenewedefortswilbefocusedonoutreachtoAFCAMPandcolaborationwiththeAfrican-AmericanandCaribbean parentsofchildrenwithspecialneeds.identificationofthecarecoordinationneedsfortransitionservicesfortheyoungadultpopulationfrom StatePlanservices intothedepartmentofmentalhealthandaddictionservices(dmhas)isalsobeingexamined.

27 PG23 OutpatientRegistrationVolume AdultandYouth 14K TotalOutpatientRegistrationVolume:ECCandNon-ECC ECC Non-ECC PercentofOutpatientRegistrationVolumeandTotalVolume:ECCand Non-ECC 8% OutpatientRegistrationVolume 12K 1K 8K 6K % ofoutpatientregistrationvolume 7% 6% 5% 4% 3% 2% 4K 2K 1% % ECC Non-ECC 211 K ECC 18,783 21,486 22,725 21,959 Non-ECC 49,191 55,46 63,116 83,969 18,993 2,877 1,8 117,773 Total 67,974 76,532 85,841 15, ,1 138,65 RegistrationVolume The TotalOutpatientRegistrationVolume measurecapturestheoveral volumeofnewlyregisteredmedicaidmembers,includingthoseevaluations excludedfrom meetingtheeccaccessstandards.from 211to216,thetotal outpatientregistrationvolumegreatlyincreasedfrom yeartoyear.most recently,thetotaloutpatientregistrationincreased16.51% from CY215toCY 216. Overthepastsixyears,thetotalECCregistrationvolumeremainedrather constant,whilenon-eccvolumecontinuedtoincrease,thereforeexpandingthe gapbetweeneccandnon-eccswitheachpassingyear.incy216,eccs accountedforapproximately15% ofthetotaloutpatientregistrationvolume, whilenon-eccsaccountedforapproximately85%.

28 PG24 YouthOutpatientRegistrationVolume EnhancedCareClinics(ECC)vs.Non-ECCProviders TypeofCare(Agegrp) YouthMeasures ECCYouth Non-ECCYouth ECCAdult ECCYouth TotalOutpatientRegistrationVolume:ECCYouth&Non-ECCYouth TotalOutpatientRegistrationVolume:ECCAdult&ECCYouth -ECCTotal 22K 2K 2K 18K OutpatientRegistrationVolume 16K 14K 12K 1K 8K OutpatientRegistrationVolume 15K 1K 6K 4K 5K 2K K K Overview Non-ECCyouthregistrationshavebeentrendingupwardsinceCY212andreachedthehighestpointinCY216,makingupapproximately71% ofyouth registrationvolume,whileeccyouthregistrationsslightlydeclined.

29 PG25 YouthOutpatientRegistrationVolume EnhancedCareClinic(ECC)vs.FreestandingClinics(FSC) Overview The RegistrationsRequiredtoMeetECCAccessStandards measurecapturesonlythoseevaluationsthatarerelevanttomeetingeccaccessstandards. Outpatientclinicsareabletoidentifyandexcludefrom calculationthe exemptregistrations whichinclude:1)thoseclientssteppingdownfrom ahigherlevelof carewithintheiragency;and/or2)thoseclientswhohavebeenintreatmentattheeccbutwhoexperiencedachangeininsurancecoveragetomedicaid.the accessmeasuresarebasedonlyonthetimelinessofappointmentsforthosememberswhoaretrulynewclientsintheeccs.totalevaluationsneedingtomeet theaccessstandardsaccountedforapproximately61% in216.thishasremainedfairlyconstantoverthereportingperiod,whilethetotaloutpatientregistration volumehasincreased.whencomparingeccsvs.fscsforyouth,eccshaveconsistentlyhadahighernumberofevaluations,however,thegapbetweeneccs andfschasdecreasedovertime. TotalOutpatientRegistrationVolume:VolumeofRegistrationsRequiredto MeetECCAccessStandardsandVolumeofExemptRegistrationsECC andnon-ecc SelectGroup YouthMeasures ECCYouth FSCYouth 14K 12K OutpatientRegistrationVolume ExemptEvals TotalNumberofEvaluationsRequiredtoMeetECCAccessStandards: ECCandNon-ECCFreestandingClinics(FSC) OutpatientRegistrationVolume 1K 8K 6K 4K 2K #ofevalsrequiredtomeeteccaccessstandards 8K 6K 4K 2K K 211 K

30 PG26 YouthOutpatientECCAccessStandards Routine,UrgentandEmergentRegistrations AccessStandards Youthurgentevaluationswerebelowthe95% accessstandardincys212and213,butincreasedthefolowingyearandremainedabovetheaccessstandard from 214through216.Emergentevaluationswereabovetheaccessstandardfrom 212through215,butdippedbelowinCY216at94%.Routine evaluationshaveconsistentlyremainedabovetheaccessstandardfrom CY212throughCY216. ThepercentoftotaloutpatientevaluationsoferedwithintheECCaccessstandardhavebeenconsistentlymetbyECCsforroutineandemergent.InCY214, totalurgentevaluationsincreasedandwasabletoriseabovethe95% accessstandard.urgentcontinuedtomeettheaccessstandardfrom CY214throughCY 216,althoughithasbeentrendingdownward. BothroutineandurgentevaluationshavebeenconsistentlyunmetbyFSCs,althoughurgentdramaticalyincreased22.5percentagepointsfrom 215to216. EmergentmettheaccessstandardinCY214at95.2% butdippedbelowthe95% accessstandardthefolowingyearandcontinuedtotrenddownwardin216. ECCEvaluationsthatMettheECCAccessStandards Youth PercentofRoutineOutpatientEvaluationsOferedwithintheECCAccess Standard:ECCandNon-ECCFreestandingClinics(FSC)-AlMembers % ofeccevaluationsthatmettheeccaccessstandards 1% 9% 8% 7% 6% 5% AccessStandard95% Routine Urgent Emergent % ofotpevaluationsoferedwithinaccessstandard 1% 9% 8% 7% 6% 5% AccessStandard95% ECC FSC Routine Urgent Emergent

31 PG27 OutpatientEnhancedCareClinics Compliance,Interventions,& Activities Compliance ProviderComplianceforCY'16 RoutineAccesscompliancewiththe14daystandardforthe38ECCsfelintothefolowingcategories: 1.Mettheaccessstandardof95%:35 2.ECCfalingbelowthe95% RoutineStandardforatleastonequarter: HartfordHospital(IOL):92.31% inq1216and94.12% inq2'16;cy216:94.87% CatholicCharities(Torington):91.3% inq4'16;cy % ConnecticutRenaissance(Bridgeport):9.34% inq3'16and94.67% inq4'16;cy216:92.54% UrgentAccesscompliancewiththe2daystandardfortheECCsfelintothefolowingcategories: 1.NumberofECCsthatreportedUrgentvolumeduringtheyear:33 2.Mettheaccessstandardof2days:27 3.ECCfalingbelowthe95% UrgentStandard: CharloteHungerford(Adult):5% inq1216(vol.of2);cy216:88.89% ClifordBeers:33.33% inq1216(vol.of3);cy216:33.33% CommunityHealthResources:33.33% inq2216(vol.of3);cy216:25.% CatholicCharities(Torington):75.% inq3216(vol.of4);cy216:83.33% ConnecticutRenaissance(Bridgeport):66.67% inq3216(vol.of3);cy216:66.67% ConnecticutRenaissance(Norwalk):5.% inq4216(vol.of2);cy216:5.% EmergentAccesscompliancewiththe2hourstandardfortheECCsfelintothefolowingcategories: 1.NumberofECCsthatreportedEmergentvolume:13 2.Mettheaccessstandardof2hours:9 3.ECCfalingbelowthe95% EmergentStandard: CentralCTChildGuidance:% inq4 16(vol.of1);CY216:% FamilyandChildren said:% inq4 16(vol.of1);CY216:% TheVilageforFamiliesandChildren:5.% inq3216(vol.of2);cy216:6.% YaleChildStudy:% inq2 16(vol.of1);CY216:% Continuedonthenextpage.