CMO Corner: Lawrence Magras, MD, MBA, FHM, FAAPL
Thank you for taking care of our members
As another challenging year closes, I would like to take this opportunity to thank you for your dedication in caring for our HUSKY Health members. We are committed to ensuring you have everything you need to stay current with program enhancements, benefit and policy changes, technology upgrades, and other news. Here are some recent updates....
There are new enhancements to our HUSKY Health secure member portal coming soon!. . . read more
HUSKY Health Member ID Cards
- HUSKY Health patients will be able to print their ID cards in the near future. Members may present a printed copy of their ID card to your office staff. These are valid ID cards. Please be sure you confirm a patient’s eligibility in the HUSKY Health program. Members will also be able to view their HUSKY Health ID cards on their mobile devices and tablets.
Gaps in Care Information
- Members will also be able to view their gaps in care for certain preventive services. This is only based on the claims information that the HUSKY Health program has received. We may not have all of their claims history, so this is not a complete collection of their health claims information. They may be due for other types of healthcare services that are not listed on the HUSKY Health secure member portal. Members should continue to work closely with their PCPs and specialists for any needed preventive and chronic disease management services.
HUSKY Health members may be eligible for no-cost phone service through the Lifeline program. By enrolling, they may qualify for a free smartphone with talk, text and data.* HUSKY Health members can opt-in to receive additional benefits outside of the standard plan. If they already have their own phone, they can select the “Keep your own smartphone” option when they apply. For details, or to apply, they can go to www.safelink.com or call SafeLink at 1.877.631.2550.
Provider bulletins are published by the Connecticut Department of Social Services (DSS) for Connecticut Medical Assistance Program (CMAP) enrolled providers and are the primary source for communicating information about benefit coverage, policy requirements, procedural changes, enrollment, claims submission, and reimbursement. Bulletins are available on the Connecticut Medical Assistance Program website at: www.ctdssmap.com. Once on the home page, select “Publications” from the “Information” sub-menu. On the Information page, bulletins can be searched by year, year and bulletin number, provider type, or bulletin title.
Providers may also sign-up to receive online publications via email, including provider bulletins, workshop invitations, newsletters, and other important messages. To begin, go to www.ctdssmap.com. On the left side of the home screen, under “Provider,” select “Provider Services.” On the Provider Services page, select “e-mail subscription” from the navigation bar at the top of the screen. Once on the E-mail Subscriptions page, scroll down to “New Subscriber” and enter your email address to register.
Where to Send Claims
As a reminder, claims are processed by Gainwell Technologies on behalf of DSS. If you are a CMAP enrolled provider, paper claims are not accepted; claims need to be submitted electronically. Claim submission information can be reviewed by visiting www.ctdssmap.com and selecting “Information,” “Publications,” and “Provider Manuals – Chapter 6 Electronic Data Interchange Options.” If you have questions on the claim submission process, please contact the Provider Assistance Center at 1.800.842.8440, Monday – Friday, from 8:00 a.m. - 5:00 p.m. (excluding holidays).
*some limits may apply
HUSKY Plus Change
On May 1, 2022, the HUSKY Plus Program merged into the HUSKY B benefit as a result of a change in state law. All of the supplemental services that were provided separately under HUSKY Plus, are now available as part of the basic HUSKY B benefit.
- The current supplemental services/goods did not change in any way. Instead, these services/goods are available directly through HUSKY B. Children need not apply. They will continue to receive the same services (e.g., diapers and pull-ups for members over the age of three, custom foot orthotics, motorized wheelchairs, hearing aids, and physical/occupational/speech therapies), as long as they are medically necessary. These goods and services continue to have no co-payments or cost-sharing. The current quantity limits apply and you, as their provider, would need to provide authorization for these services, when applicable.
Outpatient Dialysis Coverage
HUSKY Health members who have been diagnosed with acute or chronic kidney failure are covered under HUSKY Health’s Outpatient Dialysis benefit, which is part of Emergency Medicaid. The benefit includes routine outpatient dialysis; the treatment of complications directly related to routine outpatient dialysis care; and services offered as part of, or as follow-up to, outpatient dialysis.
Covered Services for Outpatient Dialysis Treatment and/or Related Complications:
- Outpatient dialysis
- Doctor visits about outpatient dialysis treatment and/or related complications
- Lab and radiology services to monitor dialysis treatment or complications
- Medications from the pharmacy related to dialysis treatment and complications
- Skilled nursing visits provided by home health agencies to provide nursing care
- Non-emergency medical transportation to doctor visits related to outpatient dialysis treatment and/or related complications
Please note: HUSKY Health will only pay for these services for members who see doctors, advanced practice registered nurses, physician assistants, medical clinics, and medical Federally Qualified Health Centers (FQHCs) who participate in the HUSKY Health Program.
This program ONLY covers services related to outpatient dialysis treatment and/or treatment for related complications. It does not cover any other services related to treatment/conditions not related to outpatient dialysis or its complications. HUSKY Health members are also covered under Emergency Medicaid if they have a medical emergency.
Important benefit and program updates for individuals who are pregnant or have recently given birth. . . read more
New Eligibility Group – HUSKY B Prenatal Care
DSS has added a new eligibility group, HUSKY B Prenatal Care, beginning April 1, 2022. This new group allows pregnant individuals, who are not citizens or who are qualified non-citizens, to receive full HUSKY B benefits, including prenatal care. For more information, please see DSS Provider Bulletin: PB 2022-34 New Eligibility Group HUSKY B Prenatal Care.
Extension of Postpartum Care
DSS has extended coverage of postpartum care from 60 days to 12 months for eligible Medicaid and HUSKY B members whose pregnancy ended on or after April 1, 2022. The extension also allows coverage for individuals whose pregnancy ended prior to April 1, 2022, but who are still within the 12-month postpartum period. Pregnant individuals eligible for Medicaid, and pregnant adolescents who are eligible as a “targeted low-income child” under the HUSKY B Program, are eligible for all covered services (medical, dental, and behavioral health) during the extended postpartum period. For more information, please see DSS Provider Bulletin: PB 2022-33 Extension of Postpartum Care.
Maternity Bundled Payment Model
In 2023, DSS will transition to a bundled payment model for reimbursement of maternity care for HUSKY Health members. The new model will pay providers prospectively for the vast majority of care that a pregnant individual will need from 40 weeks before birth, to 12 months postpartum. The bundle will cover most services related to maternity care during the prenatal and postpartum periods, as well as labor and delivery. Newborn care, behavioral health, substance use services, long-acting reversible contraceptives, certain high-cost medications, and non-maternity care will be reimbursed separately. For more information, including implementation updates, please click here.
Resources Available for Patients with Hypertension in the Perinatal Population
The HUSKY Health program has resources available to help perinatal HUSKY Health members with hypertension manage their condition, and to help members recognize the warning signs to seek emergent care. A recent analysis by the CDC on data from the National Inpatient Sample found that the prevalence of hypertensive disorders of pregnancy (HDP) increased from 13.3% in 2017 to 15.9% in 2019, with HDP highest among delivery hospitalizations of non-Hispanic, Black/African American women, non-Hispanic American Indian and Alaska Native women, women aged ≥35 years, and those residing in zip codes in the lowest median household income quartile.1 Additionally, the researchers found that nearly 32% of the maternal deaths that occurred during hospital delivery were associated with a diagnosis code for HDP.
To help ensure your perinatal HUSKY Health patients get the care they need, we provide access to low-dose aspirin, blood pressure cuffs, and the Care Management Perinatal Program to high-risk members.
DSS covers and pays for low-dose (81 mg) aspirin for HUSKY Health members who are pregnant. It can be an important piece of a member’s care regimen since aspirin causes vasodilation due to prostaglandin production, and that is vital in the management of the disease process. To prescribe low-dose aspirin for your pregnant HUSKY Health patients, just write them a prescription, which can be presented to any pharmacy participating in the HUSKY Health program. For additional information regarding clinical practice guidelines for use of low-dose aspirin in pregnancy, we recommend this link.2
Blood Pressure Cuffs
The use of a blood pressure cuff can help to identify potential health complications in pregnancy or in general. This benefit is not just for pregnant members. Any HUSKY Health member with a diagnosis of hypertension may obtain a blood pressure cuff for self-monitoring. As with the aspirin, all that is needed is a prescription indicating the diagnosis, type of cuff, and length of time needed (e.g., lifetime). The HUSKY Health member can present this prescription to any pharmacy that carries durable medical equipment (DME). Prior authorization is not required.
The DME benefit covers three different types of blood pressure devices:
A4660 Sphygmomanometer/blood pressure apparatus with cuff and stethoscope
A4663 Blood pressure cuff only
A4670 Automatic blood pressure monitor
Care Management Perinatal Program
The Perinatal Program is offered by the Care Management department within Community Health Network of Connecticut, Inc.® (CHNCT), the medical administrative services organization for DSS’ HUSKY Health Program. The Perinatal Program is a voluntary, member-centered program designed to support high-risk pregnant members as they work towards optimal maternal and newborn health outcomes. The primary focus of the program is to support members in successfully engaging in recommended care with their provider. Upon outreach to these members, Care Management nurses are able to assess for risk factors and social determinants of health, including those which may affect their ability to manage hypertension or other chronic health conditions that may be present. Care Management nurses can also help to address barriers to obtaining blood pressure monitoring supplies and medications such as low-dose aspirin.
If you have any questions about the covered benefits mentioned here (low-dose aspirin, blood pressure cuffs) or how our Care Management department can work with you, please call us at 1.800.440.5071, x2024, Monday through Friday, from 8:00 a.m. to 6:00 p.m.
1Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization — United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2022;71:585–591. DOI: https://www.cdc.gov/mmwr/volumes/71/wr/mm7117a1.htm
2Please Note: While this information is based on the USPSTF recommendations, AHRQ and the United States Department of Health and Human Services (HHS) cannot endorse or appear to endorse, derivative or excerpted materials, and cannot be held liable for the content or use of adapted materials that are incorporated on other websites.