Executive Summary: Utilization Management for Adult Members On at least a quarterly basis, the reports mutually agreed upon in Exhibit E of the CT BHP contract are submitted to the state for review. This summary focuses on the utilization management portion of these reports evidenced in the 4A series which reviews utilization statistics such as average length of stay (ALOS) and admissions per 1,000 (Admits/1,000) members. NOTE: A detailed description of the measures can be found at the end of this document. Beginning in 2012, two changes were made from previous submissions. First, results were graphed only for benefit groups that had a sufficiently large number of members receiving each level of care. This change made the graphs much easier to read and focused the discussion on benefit groups that warranted greater attention. Second, if the analysis for a level of care did not reveal results or trends that warranted discussion, then those results were removed from the body of the analysis document. The graphs that display those findings that do not warrant discussion can be found in an Appendix at the end of the analysis document. For this quarter, the only level of care that did not warrant discussion was Outpatient Services. The appendix additionally includes all adult graphs for 18A-C. Also for this quarter, we have combined detox-related services into one section. This detox-related section includes Ambulatory Detox and Methadone Maintenance, both of which were discussed last quarter in the outpatient section. Membership Total Adult (18+) Membership Membership for the adult population has been relatively stable over time. There is a redetermination process conducted annually for all Medicaid recipients and every 6 months for members with spend downs, which may affect eligibility status. In Q1 2012, eligibility groups were analyzed and subsequently corrected when the state s enrollment file was not properly capturing dual eligible status. At this time, all eligibility groups are being reported accurately. Over the last year, there has been some fluctuation between quarters with most eligibility groups decreasing in membership. Some of the quarterly decrease is accounted for by the exclusion of temporary members from the membership counts. When the temporary members subsequently gain or regain eligibility, membership numbers are corrected retrospectively for previous quarters. While membership in several eligibility categories has decreased, MLIA membership has increased by almost 10,000 members from a year ago. Changes in membership will continue to be monitored over time. It is predicted that membership will increase as requirements loosen and healthcare reform progresses. Inpatient Level of Care Inpatient Admits/1,000 Inpatient Admits per 1,000 remained relatively stable across graphed benefit groups and across quarters reported to date. This quarter, three of the four graphed benefit groups had a decline in Admits/1,000. MLIA and Family Single have the fewest Admits/1,000 since we started tracking admissions. Family Single, for which the decrease in Admits per 1,000 was statistically significant when Q1 2012 was compared to Q2 2012, had a decrease of 13.2%. ABD Single continues to have the highest penetration rate at 6.64/1,000, followed by MLIA at 4.14/1,000, ABD Dual at 1.16/1,000, and Family Single at 0.79/1,000. Each of the above listed benefit groups had 100 or more admissions this quarter. Interestingly, MLIA Admits per 1,000 decreased slightly during the second quarter, even though the number of admissions remained stable. This result highlights the increase in membership over the year.
Inpatient Days/1,000 ABD Single members continue to use the greatest number of inpatient days per 1,000 at 60.37, which is a 6.6% decrease from the previous quarter. The complex and chronic nature of these members circumstances can require longer time to stabilize than for other members, leading to more days at this level of care. In addition, members with chronic conditions can have fewer discharge options as a result of issues involving housing and transportation needs. These situations add to the complexity of establishing comprehensive yet realistic follow-up care. Despite those potential barriers, the Days/1,000 did fall by 6.6%, as noted above. As data on readmission rates and successful connection to follow-up care is collected and analyzed over time, trends regarding interventions that are successful with this population should become more apparent. Understanding the barriers to discharge will be critical as we continue to manage this LOC. Inpatient Days/1,000 for the MLIA population decreased by 9.8% from Q1 2012 to Q2 2012. This is the lowest inpatient days per 1,000 recorded, excluding Q2 2011 data. As previously described, Q2 2011 was the first quarter that CT BHP was authorizing care and only included the days utilized by members admitted from April 1, 2011 forward. Therefore days were underreported. Inpatient Days per 1,000 also decreased for Family Single. The only benefit group that had an increase in days per 1,000 this quarter from last quarter was ABD Dual. We are cautiously optimistic that days per 1,000 will continue to decrease as Utilization Management Strategies are implemented. Average Length of Stay Based on discharge dates provided by the inpatient programs, the Average Length of Stay across all benefit groups in Q2 2012 was 8.05. This is the lowest ALOS in three quarters. Of benefit groups with more than 20 admissions, ABD Single and Dual had the longest lengths of stay at 9.36 and 9.16. As stated previously, ABD members have complex and chronic mental health needs, frequently needing longer periods of time to stabilize and having fewer discharge resources. Both factors contribute to a longer length of stay. The decrease in overall Average Length of Stay is primarily driven by the MLIA population. MLIA Average Length of Stay decreased from last quarter and is the lowest since the first quarter of reporting this measure (Q2 2011). Overall averages are strongly influenced by the MLIA population as MLIA consistently has the highest number of members inpatient in any given quarter. ALOS (in days) by Selected Benefit Group Q1 2012 Q2 2012 % Change MLIA 7.95 7.45-6.29% Family Single 7.06 6.76-4.25% ABD Single 9.25 9.36 +1.19% ABD Dual 8.51 9.16-7.64% Conclusions Inpatient Psychiatric Level of Care: Data that is collected in the initial year is considered baseline data. After reviewing the three measures for the past year, we now have better understanding of the inpatient utilization for each of the benefit groups. With some quarter-to-quarter variation, the LOS across all benefit groups has remained at around 8 days for the past four quarters, even as Admits per 1,000 have decreased slightly. We now undertake an organized and strategic effort to reduce length of stay, further explained below. CT BHP is focused on reducing length of stay for all members receiving inpatient care for acute behavioral health symptoms. An intervention that has already been implemented is the bypass program, which allows providers who meet criteria related to ALOS and readmission rate to bypass the initial concurrent review. Providers were notified of their status in April. Clinicians and Regional Network
Managers have worked closely and collaboratively with providers in an effort to help those who are on the bypass remain on the bypass, and those who are not on the bypass to achieve that status. There have also been focused discussions with several inpatient units identifying how we can improve collaboration and thus positively affect outcomes, including ALOS. Bypass eligibility will now be determined twice a year, giving providers more incentive to change practices necessary for bypass status. PAR (Provider Analysis and Reporting) is an additional tool utilized for length of stay reduction. Providers representing hospitals with adult inpatient units were invited to the initial PAR meeting in June and the follow up meeting is scheduled for September. At the upcoming meeting, providers will have access to their own profiles and will be able to compare their performance with other programs across the state. The PARs programs have proven to have a strong impact on utilization in the past and we anticipate that the implementation of the Adult Inpatient PARs program will effectively begin to decrease utilization of inpatient services. Some Provider-specific interventions have also been discussed or recently implemented, including on-site rounds concentrating on complex cases, education for staff and members about the roles of the CTBHP Peers and ICMs, and teaming with the Reaching Home initiative which will increase resources for CT s homeless population. We have also hired a medical director who has extensive experience treating adults with severe and persistent mental illness. She has already begun reaching out to inpatient programs, strengthening relationships, improving collaboration, identifying barriers to discharge and speaking candidly about expectations. In sharing the goals of the partnership and building on providers strengths, we expect that outcomes will be favorable. Inpatient Detox Hospital-based and Free Standing Admits/1,000 Only three benefit groups had as many as 10 admissions to hospital-based detox programs during Q2 of 2012. Those groups were MLIA (82 admissions), Family Single (26) and ABD Single (16). Benefit groups with fewer than 10 admits were not included in the graphs. Admits per 1,000 to hospital-based inpatient detoxes has shown a steady decline, we believe related to efforts made to ensure that members who can detox safely in a lower level of care do so. Authorization for detox in a full service hospital is only granted when a member s medical condition warrants medical monitoring. All benefit groups have seen a steady decline in admissions during the year. Between Q1 and Q2 2012, the decrease was the smallest in comparison to decreases between past quarters, most likely because members are now treated in the right level of care. It is probable that Admits per 1,000 will begin to plateau. Admits/1,000 to the Free Standing detox programs increased slightly for MLIA (up 1.7%) and fell slightly for Family Single members. ABD Single Admits/1,000 increased by 19.8% from Q1 2012 to Q2 2012. This increase is not fully understood at this time and further monitoring is needed. While not in direct proportion to the decrease in the Hospital-based programs, we have expected the Free Standing Admits/1,000 rate to increase as a result of the efforts to divert members to the more appropriate level of detox services. The emerging trend is that Hospital IPD is being utilized less often over time and Freestanding IPD is being utilized at a steady rate. Days/1,000 Similar to last quarter s results, as the Admits/1,000 have decreased in Hospital-based programs, so have the Days/1,000 for all benefit groups. Statewide there was a 20.3% decrease in days from Q1 2012 to Q2 2012. Days for MLIA decreased from Q1 2012 to Q2 2012 by 27.4 %. MLIA and ABD Single continue to record the highest rates of days/1,000 in both Hospital and Free Standing detox programs. At Free Standing programs, Days per 1,000 have remained relatively stable for MLIA members. It is important to note that while Admits per 1,000 increased, days per 1,000 did not. There was some concern that, when members utilized lower levels of care for detox, the Days per 1,000 would increase,
but this concern did not translate in the data. In fact, the data shows that the effort to divert members to lower levels of care is working and that this effort is not negatively affecting days per 1,000. ALOS The overall ALOS for members who receive detox in a hospital setting is 4.01 days. This ALOS is greatly influenced by the ALOS of MLIA (4.06) which consistently has the highest number of members receiving detox in a hospital setting, quarter after quarter. The hospital-based ALOS of 4.01 is a lower length of stay than Q1 2012 and is also the lowest to date. The range for ALOS in Q2 2012 for graphed benefit groups was 3.50 to 4.50. The range for Inpatient Detox lengths of stay is much narrower than for other levels of care. Each graphed benefit group saw a decrease in ALOS. ABD Single ALOS has fluctuated; this quarter ALOS is 1.5 days shorter than last quarter s. It is unclear what drives this fluctuation. One hypothesis is that when the number of member discharges is small, a few short or long lengths of stay would have a significant impact. At the Free Standing detox programs, ALOS is typically shorter than in Hospital settings because hospital settings treat members who need more intensive medical management, not just medical monitoring of withdrawal symptoms. In Q2 2012, Free Standing ALOS for all benefit groups is slightly longer than for Hospital settings at 4.16. This ALOS has been stable across all quarters to date. It is possible that, with fewer members receiving detoxes in Hospital settings, members with complex conditions (but still not meeting Hospital LOC) are detoxing in this lower level of care and need additional monitoring or time to detox at a free standing program. It is also possible that slight increases and decreases in ALOS are simply related to normal variation. In addition, providers use of treatment protocols still contributes to a highly stable ALOS. Ambulatory Detox Admits/1,000 There has been an overall increase in Admits per 1,000 for MLIA and Family Single. Although the actual number of admissions remains low (MLIA=108 and Family Single=44) the increase in admissions over the last year is notable. From Q3 2011 (first quarter to be graphed) to Q2 2012 there has been a 64% increase in admissions for MLIA and an 83% increase for Family Single. We believe that this increase is related to efforts made by the clinical staff to properly assess when a member could benefit from a community based detox, rather than an inpatient detox, and authorize accordingly. We anticipate that increases in Admits per 1,000 for Ambulatory detox will continue as we continue to divert members from inpatient programs. Methadone Maintenance Admits/1,000 Members of the MLIA benefit group have consistently had the greatest number of Admits per 1,000 for each quarter analyzed, followed by ABD Single and Family Single. For all three benefit groups, Admits per 1,000 have decreased slightly over the past year, despite the potential effectiveness of this level of care. There has been increased focus on the OATP initiative in Q2 2012. We are optimistic that with continued attention and commitment, Admits per 1,000 will begin to rise as members are inducted on methadone as part of the OATP protocol. Conclusions Detoxification and Methadone Maintenance: In the past two quarters we have seen an overall decrease in admissions to Hospital-based detox programs. We believe that this is related to our thorough evaluations of member needs that result in members being detoxed in the most appropriate setting.
Although most detox providers continue to follow taper protocols, we often challenge providers to consider individual needs and to establish detox regimens specific to the member s symptoms. Despite these interventions, the ALOS at Free Standing programs has remained stable over time. Conversations related to member care; including responses to detoxification, support services available, and discharge planning, continue to be a priority. CT BHP will continue to put pressure on the continuum of care, favoring community based care over more restrictive settings when that is appropriate for the member. It is important for members with substance dependence to receive treatment and support with the least disruption to daily life, being treated in community based programs whenever possible. Partial Hospital Admits/1,000 As previously explained, data from Q2 2011 has been excluded from this analysis because the results were misleading. In that quarter, registrations were created for members who were already in service before we assumed responsibility for authorizations. As a result, the Admits/1,000 rate was artificially inflated. The utilization rates for Partial Hospitalization Programs continue to vary considerably between benefit groups. LTC members do not utilize this LOC. Family Dual and ABD Dual participate minimally in Partial Hospital Programs. MLIA has consistently been the benefit group with the highest number of admissions per 1,000 members at 2.54. Admissions to Partial Hospital Programs decreased slightly from Q1 2012 to Q2 2012 for both MLIA and Family Single. One would expect that ABD Single and Dual would utilize this service more often, given their rate of inpatient admissions; however, ABD members may be returning to Mental Health Group Homes or discharging to an intermediate bed rather than discharging from an Inpatient setting to PHP. This LOC will be monitored to determine if trends related to seasonality emerge over time. Conclusions Partial Hospital: Partial Hospitalization programs include those specializing in Mental Health, Dual disorders, and Substance Abuse. This Level of Care tends to be used when a member is discharged from an inpatient setting and needs intensive treatment and medication management daily. PHP can also be used when a member needs additional support and is not making gains in an outpatient or intensive outpatient setting. PHP is most used by members in the MLIA benefit group which has been consistent over time. It is unclear why MLIA has the highest utilization of this level of care. There will be further examination of what factors contribute to utilization or a lack of utilization based on benefit group. Utilization of PHP continues to be lower than IOP. It is hypothesized that when community based IOPs began programming 5 days a week, the need for traditional PHP decreased, a trend that is expected to continue. Intensive Outpatient Admits/1,000 As previously explained, data from Q2 2011 has been excluded from this analysis because the results were misleading. In Q2 2011, registrations were created for members who were already in service before we assumed responsibility for authorizations. As a result, the Admits/1,000 rate was artificially inflated. Over the past four quarters, the rate at which adult Medicaid members have utilized Intensive Outpatient services has been highly stable across all benefit groups. MLIA members still utilize this LOC at a higher rate than other members, followed by ABD Single and Family Single. Utilization rates for all groups have remained essentially unchanged for the past year. Changes based on seasonality are not occurring at this time.
Conclusions Intensive Outpatient: Since the last quarterly report, we have continued to track utilization of IOP services, and have continued to develop plans for Provider Analysis and Reporting standards. Our discussion has included the recognition that different programs treat different members, and that we may need to evaluate the utilization of mental health, co-occurring and substance abuse program types separately. The findings of the 2012 performance target that focuses on the IOP level of care should inform utilization strategies for 2013. In the interim, we will continue to gather data in an effort to track and trend activity going forward. Once trends are highlighted, tailored interventions can be implemented. Outpatient Services: Admits/1,000 See Appendix Conclusions Outpatient Levels of Care: Outpatient authorizations are completed via the web. Outpatient services continue to be utilized at a much higher rate than more intensive levels of care which is expected. This measure will continue to be monitored. Mental Health Group Homes Admits/1,000 A total of 20 members were admitted to Mental Health Group Homes this quarter; admissions decreased from 34 in Q1 2012 to 20 in Q2 2012. As there are few discharges from this level of care, there are correspondingly few admissions. Members tend to remain in Group Home settings for extended periods of time and often have limited discharge options. The members treated in these settings have severe and persistent mental health issues and require the ongoing support necessary for maintaining selfsufficiency. In past quarters, there were several MLIA admits, but in Q 2 2012 Admits per 1,000 were recorded by ABD Dual and ABD Single only. Days/1,000 Days/1,000 rates are based on number of days members are receiving care during the identified quarter. The plateau for this LOC related to Days per 1,000 is becoming apparent. Unless alternative housing opportunities are identified that can support members discharging from Group Homes, this plateau will continue. ALOS The ALOS increased for all benefit groups (ABD Single and ABD Dual) during Q2 2012. This increase was expected because it reflects the long-term nature of these placements. To date, we have registered members in this level of care for only one year, less time than they typically reside in the Group Homes. The ALOS will continue to increase until it reflects the actual time members remain in this LOC, which can be 2-3 years or longer, depending on other available housing and community supports. Although this is considered transitional living, there are few discharge options. Conclusions Mental Health Group Homes: There are 19 mental health group homes in the state of Connecticut with 6-17 beds each. The primary goal for members receiving treatment in this setting is development of life skills necessary for independent living. A member discharges to a lower level of care when he/she demonstrates an ability to care for her/himself. The ABD population with Serious and Persistent Mental Illness (SPMI) frequently cannot be maintained in the community, resulting in long lengths of stay. Additional supportive housing programs would offer some step down options.
Home Health Services Home Health Admits/1,000 continued to decline during Q2 12, but the rate of decline has slowed from previous quarters. This change has occurred because nearly all authorizations previously approved by DSS have now been registered with VO, and the Admits/1,000 now more accurately reflects actual first-time authorizations for Home Health services, instead of existing authorizations that were being registered with VO for the first time. Conclusions Home Health Services: For the past year, only Admits/1,000 have been reported in the quarterly reports. This measure has been helpful in understanding the transition of cases from existing authorizations to the BHP, but is limited in usefulness as an ongoing measure. Throughout the past year, we also have worked with the Departments and providers to understand overall Home Health service delivery and utilization. Those efforts have revealed some significant complexity in how members are identified and served, and how decisions are made about frequency of visits and duration of care. We now have held an initial Provider Analysis and Reporting meeting that is directed at Medication Administration services and frequency, and we expect to be able to report on changes in service frequency in future quarterly reports. As the Home Health Provider and Analysis Program (PARs) is fully implemented, PARs data will be incorporated into the quarterly reports and will enhance the analysis. RECOMMENDATIONS: There are now five quarters of data measured for the adult population analysis. Although, the first year s data is usually considered baseline data, there is an abundance of information found in the measurements performed to date. With each Quarter, we develop a clearer understanding of how the adult Medicaid population is using the behavioral health services available to them. Some highlighted utilization recommendations and strategies are listed below as an update to the recommendations made to the Departments last quarter: Inpatient Recommendations and upcoming planned Strategies -- 1. Review and update the inpatient bypass program for adult members and facilities. The Adult bypass program has recently been reviewed and amended for 2012. Re-determination of bypass status will occur in August 2012, and then will occur every six months. The indicators for bypass status will include readmission rates, ALOS, and the percentage of discharges communicated to the CTBHP. Consideration should also be given to redefining the Bypass program parameters so that inclusion/exclusion criteria are re-evaluated in terms of their ability to provide relief of the administrative burden of frequent reviews for the hospitals as well as for ValueOptions clinical staff. Further, we would recommend that the Bypass involved hospitals be allowed to utilize our web technology for purposes of authorization to improve administrative efficiency, allowing hospitals to reallocate these resources to more creative discharge planning. 2. Resume consultations with inpatient programs for members with extended stays. Due to complications with the member benefit group assignments, the previous quarterly report was delayed, and was submitted only one month ago. In addition, the new Associate Medical Director arrived within the past 5 weeks. As a result of these factors, there has not been time to implement recommendations from the last quarterly report. The recommendations included in that report therefore remain unchanged. 3. Host PAR meeting. As noted in the last quarterly report, providers representing the hospitals with adult inpatient mental health units will reconvene at CT BHP in September to review their individualized PAR profiles. Data will be unblinded and providers will be able to compare their
own results with those of other programs This meeting will be followed by separate individual meetings with specific hospital programs, particularly those with findings on indicators that are different than expected.. 4. Begin/continue on-site rounds. Attendance at on-site rounds provides an opportunity for clinicians to establish more of a partnering relationship with hospital inpatient staff. The rounds are primarily focused on the treatment and discharge planning for high risk members. We will work closely with inpatient and community providers as well as DMHAS staff to ensure that follow-up care is appropriate and coordinated. 5. Team with regional Mental Health Agencies/Clinics for the Reaching Home initiative. This fall there will be an additional 160 housing certificates for homeless individuals in CT. This initiative will provide selected participants with multiple types of support, including physical and behavioral healthcare. ICMs will participate in this multi-disciplinary team of providers and support service workers, aiding individuals on their path to wellness. Inpatient Detox Recommendations and upcoming planned Strategies -- 1. Authorize detox based on presentation rather than provider protocol. The clinical department clinical will continue to make level of care and length of stay authorization decisions based on a member s unique needs. If medical management in a hospital-based detox setting is unnecessary, clinicians will work with EDs to assure that members are treated in more appropriate settings. When signs of withdrawal are not evident, providers will continue to be asked to provide additional information to support the member s need for the service. 2. Focus on discharge planning. There are multiple step down options for members, both traditional and non-traditional. We are increasingly making referrals for ABH case management and coordinating with ABH when they are already involved. We are also educating providers on resources available through CCAR. Members leave detox programs with aftercare plans secured; it is critical that we understand and promote the use of the resources available to members so that their recovery can be maintained. 3. Continued focus on OATP. Historically, this initiative has proven to be extremely successful in reducing recidivism. We would like to further support this program by providing data, educating providers, and assisting providers in overcoming barriers to the members participation in the program. When OATP works there are more members embracing recovery and fewer members relapsing. Partial Hospital and IOP Recommendations -- 1. Track and trend PHP utilization to determine areas for future discussion. This recommendation is the same as that presented in the last quarterly report, one month ago. Outpatient Recommendations -- 1. Track and trend Outpatient services. This recommendation remains in place from the last report. All outpatient LOC is web registered and has lengthy time frames for concurrent reviews. As a result, there are few opportunities to manage utilization meaningfully. Of note, National ValueOptions currently is engaged in an effort to determine opportunities related to UM for outpatient services. We will track activities closely in this arena and share information and activities with our State partners as they become available. Ongoing review will assist in
determining if there are targets for future consideration. Update: These efforts are continuing locally and at VO National. Mental Health Group Home Recommendations -- 1. Continue to monitor ALOS. Ongoing analysis of this LOC would allow for discussions about what kinds of residential options would supplement the existing service system. This is not at present a focus of our efforts because of the expectations that members will have extended stays in group homes Home Health Recommendations -- 1. Continue with planned PARs process. The 15 providers who serve at least 75 members have been included in a PARs program, and the first meeting of that group now has occurred. We will continue that group, with a focus on identifying differences between providers in how their members are served. 2. Conduct meetings with prescribers. High volume prescribers of Home Health services are being identified, and those prescribers will be invited to discuss clinical review criteria that are under development to guide best practices for prescribing such services.
DEFINITIONS OF THE MEASUREMENTS USED IN THE QUARTERLY REPORTS Per 1,000 calculations (denominator) All per 1,000 calculations are based on a numerator that is a count of the measure, i.e, a count of admissions for admits/1,000 and a count of days for days/ 1,000. The below definitions of admits/1,000 and days/1,000 include a more thorough explanation of the numerator. The denominator for the measure is calculated based on a measure called member months. Member months is the number of unique members enrolled for a particular month. (In the case of a report that is for a specific benefit group, the member months denominator is only made up of unique members enrolled for that particular benefit group.) For any time period greater than one month, the denominator of a per 1,000 measure is the sum of all member months in the time period. For example, three member months are added for a quarterly calculation and twelve member months are added for a yearly calculation. Admits/1,000 (numerator) This report is based on the number of admissions during the reporting period. If a member is admitted more than once, they are counted more than once. The count is NOT un-duplicated. The count of admissions is the numerator for the calculation of Admits/1,000. The denominator is described above. Days/1,000 (numerator) This measure is based on the number of days used during the reporting quarter. The report first determines the number of cases during the quarter. The case count includes any member who was authorized for care during the reporting period, whether they were admitted during that quarter or not. As a result, the number of cases in the table included with the graph will NOT necessarily match the number of admissions in the table attached to the admits/1,000 section. The number of cases will always be at least as large as the number of admissions and usually is larger because of the members who were admitted prior to the reporting period who are still in care and accruing days. Days associated with those cases are then totaled to get the numerator of total days in a quarter. The denominator is described above. Inpatient Average Length of Stay (ALOS) The Length of Stay calculation is based upon only those members who were discharged during the reporting period. The measure includes all days accrued by that member from the beginning of their stay, including days from previous reporting periods if applicable. The count of members discharged will not match the number of members admitted during the quarter nor will it match the number of cases during the quarter.
Counts or measures that change from previous quarters Any of the counts that are the basis for one of the measures described above included in a quarterly report may change in the next quarterly report. For example, the number of admissions reported for the 1 st quarter of the year may change when the 1 st quarter admissions are reported in the 2 nd quarter report. This may occur for several reasons: 1. Temp members are not included in utilization reports. If a member admitted in Quarter 1 as a Temp member obtains retrospective eligibility during Quarter 2, the Quarter 1 admission will be added to the Quarter 1 data. 2. Stays that are retrospectively authorized will be added retrospectively. 3. Stays that were denied and then overturned on appeal will be added retrospectively.
ADULT APPENDIX OUTPATIENT (OTP): 4A_2 Routine Outpatient, Methadone Maintenance and Ambulatory Detox: 18A-C