UTILIZATION MANAGEMENT FOR YOUTH MEMBERSExecutive Summary & Analysis by Level of Care

Quarters 1 & 2: January-June 2016 - Submitted September 1, 2016

By Robert Plant, PhD with Ann Phelan,Bonni Hopkins, PhD, Laurie Van Der Heide, PhD,Sherrie Sharp, MD, Lynne Ringer, Heidi Pugliese,

Ellen Livingston, Jennifer Krom,Joe Bernardi, Ivan Theobalds, Rebecca Neal, Stella Ntate,

Wallace Farrell, and Lindsay Betzendahl,as well as the entire Reporting, Clinical, and Quality Departments.

For any inquiries, comments, or questions related to the use of Tableau, or its interactive functions,please contact Lindsay Betzendahl at Lindsay.Betzendahl@beaconhealthoptions.com.

This report was created by Beacon Health Options on behalf of the CT Behavioral Health Partnership. However the opinions, conclusions, and recommendations contained herein aresolely those of Beacon Health Options, and may not represent those of DSS, DMHAS, and DCF.

UTILIZATION REPORT FOR YOUTH MEMBERSQuarters 1 & 2: January-June 2016

The data contained in this report are based on authorization admissions and are refreshed for each subsequent set of updates during the year. Due to changes ineligibility, the results for each quarter may change from the previously reported values. The reports and analyses for all levels of care are affected by this change.Therefore, the graphical presentations of the data use a vertical line to designate a particular quarter as the most recent quarter that includes the refreshed data.Please note that utilization metrics may change with the refresh of the data. Therefore, the reader should be cautious when interpreting the latest quarter of data.The contractor will monitor the post-refresh changes closely. If warranted, methodology will be revisited.

The methodology for membership totals remains unchanged. For the Total Membership counts, each member is only counted once per quarter, even if he/shechanges eligibility groups or experiences gaps in eligibility. For instance, if a member changes benefit groups within the quarter, that member is included in thetotals for each benefit group, but only once for the total membership. This methodology is referred to in the graphs as “Unique Membership". For the benefitgroups, members are counted in each group in which they were eligible during the time period (quarter or year). This means that the individual benefit groupmembership counts cannot be added to obtain an overall total since members can shift between benefit groups. The methodology for calculating age has changed, resulting in a slight shift in adult and youth membership totals. Previous to this report, counts for adults andyouth were based on if a member met that age criteria during the time period. This meant that youth who were both 17 and 18 years old in a quarter were countedin both the adult and youth totals. In order to allow for the drill-down of demographic and age information, it was required that members be counted in only onegroup during a time period. Age group is now based on the age that a member was for the majority of the time period (quarter or year). Other demographics suchas gender and race/ethnicity are based on the most recently updated eligibility. These demographics will update as needed as we want to report on the mostaccurate gender or race/ethnicity that a member identifies with. Additionally, while generally unchanged from previous reporting periods, it is worth noting that the per 1,000 measures compare the utilization rates of thepopulation to the number of members in the identified population. However, previously Beacon reported the per 1,000 rates for the DCF and non-DCF populationcompared to the entire youth population instead of the identified group. This is a change for this report. This means that when viewing the Admits/1,000 of DCFmembers the rate is based on the number of admissions within the DCF population, not the entire youth population. This helps to analyze which populations arepotentially more chronic, acute, or in need.

On at least a semiannual basis, the reports mutually agreed upon in Exhibit E of the CT BHP contract are submitted to the State for review. Thisreport covers 10 consecutive quarters with a focused analysis on the most recent two quarters. The shift to semiannual reports was designed tominimize noise created by quarter-to-quarter fluctuations that do not reflect a true trend in the data. However, as agreed, this semiannual report willcontinue to include quarterly level detail rather than a simple roll-up of six month periods. This achieves the balance of making sure that significantand meaningful quarterly fluctuations are not missed while maintaining a focus on more persistent trends. The format is displayed in Tableau, amore interactive data visualization product. This report focuses on the utilization management portion of these reports, evidenced in the 4A series, which reviews utilization statistics such asadmissions per 1,000 members (Admits/1,000), days per 1,000 members (Days/1,000), and average length of stay (ALOS). Within this interactive report, all utilization data is available via drop-down filters, but the narrative highlights the areas of interest related to certainutilization trends. In some cases, demographic breakouts is available to enhance the understanding of utilization. Additionally, the narrativeidentifies the underlying factors, which drive the trends and associated programmatic responses taken by Beacon Health Options to impact/mitigateor support the trend. Beacon also presents recommendations to address remaining challenges and reports progress related to these plannedrecommendations. The areas of focus are listed on the following page.

Select for Listof ReportsUsed

UTILIZATION MANAGEMENT FOR YOUTH MEMBERSExecutive Summary & Analysis by Level of Care

Quarters 1 & 2: January-June 2016 - Submitted September 1, 2016

Areas of Focus

MembershipTotal UniqueDCF & Non-DCF

Composition of DCF MembershipDemographics

Inpatient FacilitiesAdmits/1,000 & Days/1,000Average Length of Stay

In-State PAR Hospital Average Length of StayPercent of Days Delayed & Discharge Delay Reason Code(s)

Inpatient Solnit CenterAverage Length of StayNumber of Days Delayed

Discharge Delay Reason Code(s)

Community & Solnit PRTFAdmissions & Days/1,000Average Length of Stay

Total Overstay Days & Overstay Reason Code(s)

Short-Term Family Integrated Treatment (S-FIT)Discharge Volume & Average Length of Stay

Autism Spectrum Disorder ServicesAdmissions & Admits/1,000

Utilization ProfileProvider Volume

Outpatient Enhanced Care Clinics (ECC)Registration VolumeAccess Standards

Table of ContentsSelect Bookmark Icon to View "Areas of Focus"

And Go Directly to Selected Page

For this report, the following utilization data points have been placedin the Appendix and are not discussed:

RTCAdmissions &ALOS

PHP, IOP, &EDT

Admits/1,000

IICAPSAdmits/1,000

Outpatient(OTP)

Admits/1,000

Youth Medicaid MembershipTotal Membership Volume

PG 1

Youth Members without DualsDCFNon-DCF

Select to Show Table or Text

Membership CountMethodology

Dual EligibilityInformation

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0K

50K

100K

150K

200K

250K

300K

Members

Last Refreshed Quarter

Total Unique Membership

Select to View TotalsMultiple values

Total MembershipThe Youth Members without Duals comprises approximately 38% (317,377 of 842,292) of the total Medicaid membership in Q1 ‘16. Youth Members without Dualsremained stable in Q1 and Q2 ’16 after decreasing between Q3 and Q4 ‘15. With the majority of the Youth Members without Duals being comprised of non-DCFMembers, a similar trend is seen in this membership. The DCF membership, on the other hand, continues to increase since reaching a low in Q2 ’15. The increasebetween Q1 and Q2 ’16 was the most notable at 5.6%.

Data RefreshThe data refresh rate in Q1 ’16 did not spike as it historically does in first quarter of each year with a refresh rate of 0.50%. The Q1 ’14 rate was 2.18% while theQ1 ’15 rate was 2.07%. These higher rates were attributed to the yearly enrollment for the Affordable Care Act which closes in the first quarter of the year. This iscontrary to expectation as open enrollment is in the first quarter of each year. Also, this last quarter had the lowest refresh rate over the previous 2 years.

Youth Medicaid MembershipMembership by DCF Status & Benefit Group

PG 2

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0K

2K

4K

6K

8K

Members

Total Youth Membership by DCF Group (0-17)

Select Individual TypesMultiple values

Select Group TypeDCF Groups

The DCF membership comprises an even smaller percentage (2.9%, N=9,106) ofthe overall youth membership in Q2 ‘16. DCF membership has grown eachquarter over the past year reaching 9,106 in Q2 ’16. This growth is driven by theCommitted/Child Protective Services (CPS) group which increased 13.2% from Q2’15 (N=7,684) to Q2 ’16 (N=8,698).

The inclusion of Autism Services to Medicaid coverage has prompted oversight toan additional youth population. This addition, in concert with state budgetary andorganizational changes within the Department of Developmental Services (DDS),may have contributed to the growth of DCF youth involvement.

Both the Juvenile Justice and Voluntary Services have decreased significantlyover the past year. Juvenile Justice membership has declined 46.0% from Q2 ’14(N=213) to Q2 ’16 (N=116) and Voluntary Services has decreased by 41% fromQ2 ‘14 (N=476) to Q2 ’16 (N=281). Beacon will continue to monitor the changeswithin DCF membership, in addition to the demographic composition of youthmembership.

CPS and CommittedVoluntary ServicesJuvenile JusticeDually Committed

Family With Service Needs

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

Youth DCFTypes

Voluntary Services

CPS and Committed

CPS In-Home

Committed Out-of-Home

Juvenile Justice

Dually Committed

Family With Service Needs

Youth TotalsDCF/Non-DCF

DCF

Non-DCF

5

26

116

3,907

5,131

8,698

281

5

26

118

3,667

4,830

8,198

300

6

25

138

3,692

4,662

7,991

317

7

29

148

3,675

4,591

7,855

326

4

33

163

3,555

4,383

7,684

337

7

22

185

3,560

4,632

7,916

375

9

28

196

3,642

4,709

8,035

404

15

29

209

3,648

4,717

8,037

457

16

30

213

3,571

4,572

7,857

476

21

29

215

3,450

4,338

7,495

473

310,449

9,106

310,450

8,623

308,601

8,458

317,817

8,346

316,565

8,202

318,942

8,482

318,238

8,649

314,381

8,719

308,450

8,544

303,169

8,214

Total Unique Membership

Note: A youth may be included in more than one DCF category in a quarter and therefore the values will not add up to the total unique youth. The "Committed/CPS In-Home" and "Committed/CPS Out-of-Home" are twosubcategories within the total "Committed/CPS" category. Youth, again, may be counted in each group. Each category is the number of unique youth that had that particular DCF indicator within the time period.

Youth Medicaid MembershipDemographic Composition by Group Type (DCF & Eligibility)

PG 3

OverviewDuring Q1 and Q2 '16, HUSKY A Family Single continues to be, by far, the largest benefit group within the youth membership accountingfor almost 95% of the youth population, with HUSKY B being around 5%. During both Q1 and Q2 '16, approximately 45% of the membersof HUSKY A Family Single were white, 35% were Hispanic, and 16% were black. The largest age group in both quarters was the 3 to 12year-olds, representing just over 56% of the membership with the 13 to 17 year-olds at 26% and about 18% younger than 2 years of age.

Within the DCF population, 52% of youth are involved with CPS In-Home Services, followed by Committed Out-of-Home. For both of theseDCF groups, youth ages 3-12 make up the majority. While gender is generally split evenly within the DCF groups, males make up asignificant majority in the Juvenile Justice group in both reported quarters. White youth are the majority in each of the DCF groups exceptfor Juvenile Justice and Dually Committed. While these are small groups, in both Q1 and Q1 '16 black youth were the majority.

CPS In-Home Committed Out-of-Home Voluntary Services Juvenile Justice Dually Committed Family With Service Needs

All

All

All

All

All

All

0K

1K

2K

3K

4K

5K

Members

5,131

3,907

281116 26 5

Composition of Youth Membership by Benefit GroupQ2 '16

Select a QuarterQ2 '16

Select Group TypeDCF Groups

Select Benefit GroupsMultiple values

Choose DemographicNo Demographic Breakout

Please note, within this report “DCF Involvement” includes any youth under eighteen who is involved with the Department of Children and Families through any of its mandates. Thisincludes youth committed to DCF through child welfare or juvenile justice, and those dually committed. It also includes youth for whom the Department has no legal authority, but for whomDCF provides assistance through its Voluntary Services, Family with Service Needs and In-Home Child Welfare programs.

PG 4

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

2

4

6

Admits/1,000

Inpatient Psychiatric Facility - Youth (0-17)Admits/1,000

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

50

100

Days/1,000

Inpatient Psychiatric Facility - Youth (0-17)Days/1,000

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

5

10

15

Average Length of Stay

Inpatient Psychiatric Facility Excluding State-Run - Youth (0-17)Average Length of Stay (ALOS)

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

200

400

600

Admissions or Discharges

Inpatient Psychiatric Facility - Youth (0-17)Admissions

Admissions or Discharges (chart below)Admissions

Group TypeAll Members without DualsDCFNon-DCF

Click for Summary

Inpatient Psychiatric Facility: Excluding State-Run

Group TypeAll

State HospitalExcluding State-Run

Choose DemographicNo Demographic Breakout

In-State / Out-of-StateAll

The per 1,000 rates above are calculated based on the total admissions or days for the identified population divided by the total members of the same population, multiplied by 1,000. Total members is calculated by addingthe number of unique eligible members in each month within the quarter. For example, the DCF Admits/1,000 denominator is the DCF youth population, not the entire Medicaid youth population.

PG 5Inpatient: In-State Pediatric Hospitals

Includes the Seven In-State Hospitals Serving Youth (Ages 3-17)

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

5

10

15

20

Average Length of Stay

Inpatient Psychiatric Facility Excluding State-Run - YouthIn-State Pediatric Hospitals' Average Length of Stay (ALOS)

■ HARTFORD HOSPITAL ■ Statewide

Highlight a HospitalHARTFORD HOSPITAL

Q1 '14

Q2 '14

Q3 '14

Q4 '14

Q1 '15

Q2 '15

Q3 '15

Q4 '15

Q1 '16

Q2 '16

HARTFORD HOSPITAL

MANCHESTER MEMORIALHOSPITAL

NATCHAUG HOSPITAL INC

ST FRANCIS HOSPITAL& MEDICAL CTR

ST VINCENTS MEDICALCENTER

WATERBURY HOSPITAL

YALE NEW HAVEN HOSPITAL

Inpatient Psychiatric Facility Excluding State-Run - YouthIn-State Pedicatric Hospitals' Average Length of Stay Rank

1 (blue) is the lowest, 7 (red) is the highest in the quarter

1 7ALOS Rank

OverviewThe overall ALOS for in-state hospitals for youth ages 3-17 increased from Q4’15 to Q2 ’16 by 21.4% (10.19 to 12.37). St. Francis and Waterbury Hospitalshad the greatest increase in their average length of stay from Q4 ’14 to Q2 ’16.

The statewide ALOS increased in both Q1 ’16 (10.94 days) and Q2 ’16 (12.37days). In Q2 ’16, six of the seven in-state pediatric hospitals had an increase inALOS. Waterbury’s ALOS increased 38.56% in Q2 ’16 (from 14.50 days to20.09 days). Only Hartford Hospital had a decrease in Q2 ’16.

The total ALOS for youth ages 3-12 was unchanged from Q4 '15 to Q1 ’16, butthen increased from 10.98 days to 11.40 days in Q2 ’16. The DCF 3-12 year-oldgroup increased in both quarters starting at 12.96 days in Q4 ’15 and reaching14.21 days in Q2 ’16.

The 13-17 year old age group had an 11.09% increase in Q1 ’16 (to 10.92 days)followed by a 17.12% increase in Q2 ’16 (to 12.79 days). Both the DCF andnon-DCF 13-17 year-old groups increased in both quarters. The DCF 13-17year-old group increased 29.23% to 14 days from Q4 ’15 to Q1 ’16.

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

5

10

15

Average Length of Stay

Inpatient Psychiatric Facility Excluding State-Run - YouthIn-State Pediatric Hospitals' Average Length of Stay (ALOS)

DCF and Age Groups

DCF, Age GroupDCF, 3 - 12DCF, 13 - 17

Non-DCF, 3 - 12Non-DCF, 13 - 17

Inpatient Psychiatric: Excluding State-RunSummary

PG 6

Conclusions

Regional Network Managers continue to work with inpatient psychiatric hospitals in identifying regional and systemic gaps in access to care post-discharge.Hospitals attribute longer lengths of stays to youth involved with DDS, families who refuse to take youth back home, and waitlists for IICAPS and PRTF.

Regional Network Managers (RNMs) will continue to assess gaps, barriers, and best practices amongst the psychiatric hospitals. Furthermore, the PediatricInpatient Workgroup presentations/discussions will begin to include and focus on performance indicators broken out not only by provider but also by geographicalregion in comparison to a statewide perspective. HEDIS® ambulatory follow-up data will continued to be shared with hospitals. For hospitals whose data has beenstable over the long-term, it may not be necessary to meet, but data will be reviewed and shared electronically. RNMs will target these hospitals for best practices.For hospitals whose data has been inconsistent or where trends are noted that require action, communication will be regular and meetings will occur biannually ata minimum.

In addition, the RNMs and Clinical Supervisors continue to focus on identifying and sharing best practices that have a significant impact on performance. Thesebest practices were the high point of the Pediatric Inpatient Psychiatric Workgroup held in June 2016.

Overview: The total youth Admits/1,000 rate had increased 3 out of four quarters in the past year with a recent decrease in Q2 ’16. Therewas an overall decrease in the past year from Q4 ’15 (0.75) to Q2 ’16 (0.69) by 8%, which was driven by the decrease in non-DCF rates.DCF continues to have higher Admits/1,000 rates (5.88 in Q2 ’16) compared to non-DCF members (0.55 in Q2 ’16); however the majorityof those using this level of care are non-DCF.

The overall Days/1,000 had been stable for 3 of the last 4 quarters, but like Admits/1,000 had a sharp change in Q2 ’16. Days/1,000 forthe total youth increased from 8.0 in Q1 ‘16 to 9.7 in Q2 ‘16. Both the DCF and non-DCF Days/1,000 rate increased during this timeperiod. DCF increased by 9.6% from Q4 ’15 to Q2 ’16 (74.0 to 81.1) and non-DCF increased by 18.2% (6.6 to 7.8). Overall the ALOS foryouth has increased over the past 2 quarters. The ALOS for DCF members increased by 26.4% from Q4 ’15 to Q2 ’16 (11.74 days to14.84 days). The ALOS for non-DCF members also increased by 26% from Q4 ’15 to Q2 ’16 (10.67 to 13.44 days). Overall, the averagelength of stay and Days/1,000 rates are higher for DCF members.

Inpatient Psychiatric: Excluding State-RunSummary

PG 7

Beacon Health Options (Beacon) continues to recommend the development of a preventive model of integrated care, which can provide families easy access andrapid connection to treatment services. The following recommendations are opportunities to enhance this type of healthcare delivery.

1. Develop an infrastructure which supports easy access and connection to treatment services for specialized populations such as those children with an AutismSpectrum Disorder diagnosis (ASD): Most children with an ASD diagnosis who require acute care services utilize out-of-state facilities for acute stabilization whichoften leads to longer lengths of stay secondary to the increased distance from their home and the inability of families to participate in the treatment due totransportation issues. Youth with an ASD diagnosis often stay longer in inpatient care than their non-ASD identified peers who utilize the same services. Update: Beacon has continued to authorize ABA services for children with an Autism diagnosis which began in January 2015. Care Managers, Care Coordinatorsand Peer Specialists continue to support community efforts to connect Medicaid youth and families to ABA providers. While the provider network has increasedover the past year and a half, Beacon continues to direct its efforts to expand the direct care provider network to address timely and efficient discharge planningfrom inpatient units. The lack of in-network direct care providers is often a barrier to timely discharge. In addition, Beacon continues to collaborate efforts within-state and out-of-state inpatient units who can service children with specialized clinical needs. Beacon also continues its collaboration with the Department ofDevelopmental Services, Department of Social Services and the Department of Children and Families weekly to review operations, cases, and networkdevelopment.

Beacon has continued collaboration in partnership with the State agencies with the Hospital of Special Care which opened a specialized ASD 8-bed inpatient unitin early 2016. This unit has admitted Medicaid members with an ASD diagnosis to provide the specialized longer term behavioral and clinical treatment requiredfor stabilization and transition. A key component of the unit’s therapeutic intervention has been the increased ability for families to participate within the behavioralplan due to the in state location. Beacon will continue to collaborate with State partners and the Hospital of Special Care to provide utilization review, and casecoordination to the members admitted to the unit to ensure successful outcomes.

Another effort to increase timely discharge from inpatient facilities is the current collaboration with the Department of Children and Families, the Department ofSocial Services with an Autism behavioral specialty group to provide training to the Psychiatric Residential Treatment Facilities (PRTFs) within the Medicaidnetwork. This has been initiated with the Village for Families and Children with plans to expand training to the Children’s Center of Hamden, in addition to theBoys and Girls Village. The goal of this supportive training is to promote the overall ability of the PRTFs to provide treatment and stabilization of youth requiringspecialized treatment, in addition to promote increased admissions of youth with specialized clinical need. Beacon has continued to collaborate on this project withregular review meetings and case conferences.

In addition, Beacon has met with emergency departments, the Department of Children and Families and the Department of Social Services to expand the scopeand network of providers who can potentially service this population. Expanding Emergency Mobile Psychiatric Services (EMPS) to include a Board CertifiedBehavioral Analyst (BCBA) is one recommendation which may increase rapid clinical services to families and children. This can potentially support children incrisis and prevent an inpatient or an emergency department visit, as well as serve as a bridge while members wait for community services to be implemented.

Based upon feedback from the pediatric inpatient hospital providers, DDS-involved youth and families were reported as some of the most challenging in terms ofnavigating the system and obtaining services for post-discharge. During the next PAR cycle, RNMs will discuss and explore with the psychiatric units specificchallenges, regional services/providers, and discharge barriers associated with DDS-involved youth and families. Additionally, efforts will focus on engaging DDSregional administrators in regular participation in the Pediatric Psychiatric Inpatient Workgroups. We will continue to monitor this recommendation as we continueto focus efforts on developing rapid access to care for children with specialized clinical needs...

Inpatient Psychiatric: Excluding State-RunSummary, Continued

PG 8

Recommendations, continued from previous page

2. Integrate behavioral health services for youth within a Family Care Model Urgent Care Center: There is a need to develop easy, rapid access to behavioralhealth care treatment in local communities as an alternative to emergency departments. The addition of behavioral health services with an already establishedurgent care center to provide integrated care in a family care model has the potential to reduce both behavioral health and medical emergency department andinpatient utilization.

Update: We are recommending that this suggestion be sunsetted for the present time. While theoretically a good idea, the system cannot, at the present time,focus on this recommendation.

3. Continue to expand the implementation and development of Rapid Response model: The Rapid Response model focuses on the collaboration amongcommunity, State agencies and Beacon staff to provide emergency departments support and case management. Opportunities remain to implement a RapidResponse model in other emergency departments (ED) with high pediatric behavioral health volume.

Update: The Rapid Response model continues to provide successful collaboration between Connecticut Children’s Medical Center (CCMC), the Department ofChildren and Families (DCF), Emergency Mobile Psychiatric Services (EMPS), and Beacon Health Options. Frequent meetings and daily clinical rounds continue.

In addition to these efforts, Beacon coordinated a meeting in early 2016 with the Connecticut Hospital Association, the Department of Social services and theDepartment of Children and Families to bring together statewide emergency departments (ED), inpatient providers, state agencies and educational providers toinitiate conversations regarding building regional partnerships to address the increased volume of youth in the ED. The focus of the meetings was how to addressthe increased volume of youth in the statewide emergency departments, in addition to the development of a rapid response consortium to address connectingyouth to needed clinical services. In follow-up to this statewide meeting, Beacon, in collaboration with State agencies, has arranged many regional meetings heldthroughout the state to implement this vision.

Beacon continues to recommend developing a rapid response model consortium to support and assist Connecticut emergency departments in connecting youth toneeded services in a timely, efficient manner. This will serve to prevent unnecessary emergency department visits and inpatient stays, in addition to connectingyouth and families to the community services and support they need.

Recommendations continue on the next page.

Inpatient Psychiatric: Excluding State-RunSummary, Continued

PG 9

Recommendations, continued from previous page

4. Establish, in each of the regional areas, a centralized forum which meets regularly to discuss at-risk youth who have high utilization of crisis and behavioralhealth services. Beacon continues to recommend the establishment of a centralized forum in each regional area to coordinate care for those youth identified as atrisk for high utilization of inpatient and emergency department services. This forum would serve to engage communities, families, schools, and providers in theplanning, and delivery of behavioral health services.

Update: The Integrated Service System (ISS) meeting has been established in each regional DCF area office. Beacon Health Options’ staff attend thesemeetings to support coordination of care and dialogue to engage communities in the planning and delivery of behavioral health services.

In follow-up to establishing a rapid response model which includes a continuum of care within the community, Beacon has held regional meetings with emergencydepartments and providers which focused on crisis and emergency services. Beacon continues to recommend expanding these meetings and this type of forum tobuild a preventative behavioral health care system.

Beacon continues to recommend the forum of the Integrated Service System meeting to include emergency departments and community providers to promote theplanning and delivery of rapid behavioral health services.

As follow up to the CHA forum held in January 2016, RNMs and clinical staff are in the process of meeting with and establishing relationships with PediatricEmergency Department personnel to further discuss ED frequent visitors, volume, readmission rates, and connect to care rates. At a minimum, partners include,local area DCF administrators, Board of Education staff, and EMPS personnel. Strategic discussions are driven by data and Emergency Department specificchallenges.

5. Continued State Agency collaboration with Beacon Health Options: Beacon continues to recommend ongoing collaboration with the State Agencies on multiplelevels to develop an integrated, community-based, preventive healthcare system.

Update: Beacon Health Options continues to meet with State partners on a weekly basis in multiple forums. The Department of Developmental Services (DDS)has continued to participate with DCF, and Beacon in weekly Complex Case discussions to review high-risk children who require additional escalation and stateagency intervention. The focus of the meeting includes emergency department, inpatient facility and DCF area office concerns which require escalation. Thecomplex case rounds has now included participants from DDS who oversee Money Follows the Person (MFP) which has been supportive in connecting youth tobehavioral health services and supports within the community from inpatient facilities. Beacon and DCF will continue to have weekly complex case rounds todiscuss all HUSKY inpatient children who require additional escalation and collaboration.

The RNM’s goal is to initiate and engage DDS regional administrators to become active partners demonstrated by regular involvement in the Pediatric InpatientWorkgroup and work to address system issues.

PG 10Inpatient Discharge Delay: Excluding Solnit

Percent Delay Days & Delay by Reason

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0%

5%

10%

15%

% of Days Delayed

Quarterly Inpatient (Excluding Solnit) Percent of Days Delayed: All Youth

■ Total Youth ■ Non-DCF ■ DCF

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

10

20

30

40

Delayed Discharges

Quarterly Inpatient Discharges with Delayed Days: All YouthHover to View Delayed Reason

Percent of Days DelayedThe percentage of days delayed for all youth has increased over the past year, as well as from Q4 ’15 to Q2 ’16. While there has been an increase in both the DCFand non-DCF percent of days delayed over the past year, and from Q4 ’15 to Q2 ’16, the percent of discharge delay days has increased the most for the DCFyouth from Q4 ’15 to Q2 ’16 (5.50% to 13.6%). However, the majority of the unique youth on delay were non-DCF during the 2 quarters (31 out of 44).

The percent of days delayed for bothnon-DCF and DCF youth haveincreased over the past year. In Q2’16, most youth were awaitingadmission into Solnit Inpatient. Theaverage days in delay and the totaltime youth awaited admission intoSolnit has increased over the past 3quarters. Since 2015, the reason fordelay has transitioned from youthawaiting community PRTF to youthawaiting Solnit Inpatient.

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Awaiting State Hospital

Awaiting PRTF

Awaiting Solnit PRTF

Awaiting RTC/GH

Awaiting DDS Services

Awaiting Foster Care

Awaiting Other

17

5

5

2

2

22

7

4

0

0

13

14

3

1

0

13

6

1

1

2

12

7

5

1

3

3

0

12

13

2

1

2

0

0

14

9

4

8

1

0

0

15

7

3

2

0

0

0

20

8

2

1

1

0

1

16

7

7

4

3

1

1

Quarterly Inpatient Delayed Discharges by Reason CodeHover for more information on avg. delayed days and total delayed days

Note: The Reason Code "Awaiting Solnit PRTF"was not implemented until late 2014.

PG 11Inpatient Discharge Delay: Excluding Solnit Tables

Percent Delay Days & Delay by Reason Code

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

DCF % of Days Delayed

Cases Delayed/in Overstay

Non-DCF % of Days Delayed

Cases Delayed/in Overstay

Total Youth % of Days Delayed

Cases Delayed/in Overstay

19

14.50%

19

13.50%

15

8.10%

21

14.70%

10

5.50%

16

7.70%

11

7.30%

13

12.40%

13

13.60%

11

8.70%

16

4.80%

22

5.20%

29

5.90%

14

2.30%

25

6.20%

22

5.50%

22

6.80%

30

10.90%

31

9.70%

33

7.90%

35

7.30%

41

7.80%

44

6.50%

35

5.90%

35

6.00%

38

6.10%

33

6.90%

43

11.30%

44

10.60%

44

8.10%

Quarterly Inpatient (Excluding Solnit) Table (Ages 0-17)Percent of Days Delayed & Cases Delayed

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Awaiting StateHospital

Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting Solnit PRTF Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting PRTF Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting RTC Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting GH Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

Awaiting Foster Care Delayed DischargesTotal Delay Days for DischargesAverage Delay Days for Discharges

29.01746

25.633313

17.41227

13.6685

12.618915

13.318614

27.833412

31.838212

39.663316

19.939820

22.7683

10.0404

29.0582

9.0275

21.31287

6.062

15.820513

16.022414

12.327122

13.322617

17.91257

11.71059

27.335513

16.01127

19.71387

13.01048

20.0201

9.0273

12.0242

43.71313

0.000

15.0906

0.000

17.0171

27.5552

0.000

0.000

0.000

5.0102

22.5452

8.5172

8.0162

4.041

0.000

58.01162

28.0281

0.001

7.071

0.000

11.0222

0.000

0.000

0.000

16.0483

3.031

0.000

Quarterly Inpatient Discharges with Delayed Days by Reason Code

Discharge Delay ReasonMultiple values

Inpatient Psychiatric: Excluding State-Run Discharge DelaySummary

PG 12

Conclusions

There has been an increase in the percent of days delayed over the past year, more recently from Q4 ’15 to Q2 ’16. Most children are on delay awaiting inpatientadmission into Solnit. In addition to more children awaiting admission, there has also been a longer wait for admission. This is potentially related to decreased bedcapacity at Solnit in addition to the decreased staffing available to provide clinical treatment to complex youth.

Recommendations

1. Expand PRTF capacity and develop alternatives for the children 12 years and under to include crisis stabilization. – Beacon continues to recommend expandingthe current PRTF capacity and increasing additional community services for those children under 12 with complex, highly acute behaviors, including those childrenwith developmental delays and autism. Update: This recommendation is currently being addressed with the expansion of training provided to the PRTFs with an Autism specialty behavioral practice.The current data suggests recommendation for an expansion of PRTF can be concluded. However, Beacon continues to recommend the expansion of direct careprovider capacity to service children with complex, highly acute behaviors in the community, including those youth with specialized clinical needs. There continuesto be a gap within the community which focuses on support to the family to learn how to meet the needs of their children and youth when in crisis. This oftenprohibits timely discharge from inpatient and PRTF levels of care, and promotes unnecessary utilization of the emergency departments.

2. Develop community-based behavioral health services which meet the higher acuity behavioral health needs of child/adolescents, including crisis andWraparound Teams, who follow children throughout the level of care continuum. – As the system moves towards community-based behavioral health care, withlimited options regarding children’s' placement in congregate care and Solnit, there is a greater need to develop behavioral health services. Those services canprovide coordination of care, family support, and clinical services to a clinically complex youth cohort. This activity has the potential to decrease emergencydepartment utilization, inpatient length of stay and discharge delay. Beacon recommends a potential expansion of the current Emergency Mobile PsychiatricService scope and capacity to service families and youth in crisis.

Update: Beacon currently provides support of services that follow children throughout the level of care continuum. Beacon's Intensive Care Managers providecare coordination and assist with clinical facilitation from the emergency department through inpatient through discharge planning into another level of care or thecommunity. This is achieved on various levels such as co-location and collaboration with DCF and EMPS. In addition, Beacon's ASD and CME teams offer carecoordination and peer services which focus on collaboration within the community.

Beacon recommends a potential expansion of the current Emergency Mobile Psychiatric Service scope and capacity to service families and youth in crisis,including those children with specialized clinical needs such as children diagnosed with Autism and/or intellectual disabilities. This expansion of an EMPS teamwould include a BCBA and provide direct clinical assessment, education to families and provide services while bridging the connection to readily availablecommunity teams to begin treatment.

Inpatient: Solnit CenterAverage Length of Stay & Delay Days

Benefit GroupCourt-OrderedNon-Court-Ordered

Total Youth

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

50

100

150

Avg. Length of Stay

Quarterly Solnit Inpatient Average Length of StayCourt-Ordered, Non-Court-Ordered, and Total

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

50

100

150

200

250

300

350

# of Days Delayed

Quarterly Solnit Inpatient Number of Delayed DaysTotal Youth

PG 13

OverviewThe ALOS for Solnit decreased in both Q1 ’16 and Q2 ’16. This was driven bynon-court-ordered members who decreased 12.13% in Q1 ’16 and 18.62% inQ2 ’16, while there was an increase in ALOS for court-ordered youth over thepast year.

The number of delayed days increased to 332 in Q1 ’16 (11 cases) thendecreased to 261 in Q2 ’16 (7 cases). While there is some minor fluctuations,overall in the past year, the number of days delayed has decreased by 28%from Q2 ’15 to Q2 ’16 (N=364 to 261) for the same amount of youth (7 cases).

The number of youth on overstay at Solnit is small (4 cases). The two youthawaiting a group home placement and a foster care placement waited thelongest, while the two others awaiting PRTF Solnit level of care waited onaverage 20 days for admission.

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

10

20

30

40

50Discharges

Quarterly Solnit Inpatient Total DischargesCourt-Ordered, Non-Court-Ordered, and Total

Inpatient: Solnit Center TablesAverage Length of Stay & Delay Days

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Court-Ordered ALOS

Discharges

Non-Court-Ordered ALOS

Discharges

Total Youth ALOS

Discharges

7

57.90

8

42.80

17

62.70

12

78.80

6

45.00

2

53.50

15

21.90

1

36.00

5

74.20

6

81.00

31

107.60

23

116.10

31

106.70

24

134.80

20

158.30

37

114.50

24

172.40

24

104.50

33

113.20

26

139.10

38

98.40

31

97.20

48

91.10

36

116.10

26

132.20

39

111.40

39

114.50

25

101.76

38

108.10

32

128.20

Quarterly Inpatient Solnit Center Average Length of StayCourt-Ordered, Non-Court-Ordered & Total Youth

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Total Youth # of Days Delayed/in Overstay

Cases Delayed/in Overstay 9

213.0

6

127.0

7

251.0

9

205.0

5

188.0

5

158.0

7

364.0

8

310.0

7

261.0

11

332.0

Quarterly Inpatient Solnit Center Inpatient Number of Delayed DaysTotal Youth

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Awaiting PRTF Delayed Discharges

Total Delay Days for Discharges

Average Delay Days for Discharges

Awaiting RTC Delayed Discharges

Total Delay Days for Discharges

Average Delay Days for Discharges

Awaiting GroupHome

Delayed Discharges

Total Delay Days for Discharges

Average Delay Days for Discharges

Awaiting FosterCare

Delayed Discharges

Total Delay Days for Discharges

Average Delay Days for Discharges

29.5

59

2

0.0

0

0

0.0

0

0

23.0

23

1

0.0

0

0

9.0

9

1

0.0

0

0

0.0

0

0

20.5

41

2

23.0

46

2

0.0

0

0

27.0

27

1

23.0

23

1

13.0

13

1

40.0

80

2

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

37.0

37

1

86.0

86

1

49.5

99

2

0.0

0

0

0.0

0

0

96.0

96

1

0.0

0

0

156.0

156

1

70.0

70

1

0.0

0

0

119.0

119

1

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

0.0

0

0

111.0

111

1

0.0

0

0

Quarterly Inpatient Solnit Center Delayed Discharges by Reason

PG 14

Inpatient Psychiatric: SolnitSummary

PG 15

Recommendations

1. Beacon will continue to collaborate with Solnit facilities and State agencies to increase timely access and effective treatment and discharge planning.

Update: Beacon has increased collaboration with Solnit Inpatient to support timely access to care and effective care planning. Beacon’s Intensive Care Managers(ICMs) are currently on site daily to provide utilization review, clinical case coordination, triage, and participation within multiple case conference forums. Beacon'sICM team will also work with CSSD and the court-ordered population to assist with appropriate linkage to services upon evaluation completion at Solnit. Weeklyclinical rounds and triage has been established with the boy’s PRTF Solnit North, however as yet, not at the girl’s PRTF.

Beacon had previously recommended increased collaboration in a forum such as triage/clinical rounds with the Solnit girl’s PRTF facility. That has been initiatedduring this time to include the Beacon Intensive Care Manager in discussion both on the North and South Solnit campuses. This has been helpful in supportingconnection to the community in addition to facilitation of communication with the DCF Regional Area Offices.

Conclusions

The ALOS for youth at Solnit has decreased over the past 2 quarters. The youth in overstay continues to be minimal. The decrease in throughput noted frominpatient facilities is related to an increase in inpatient provider referrals with decreased bed capacity and staffing at Solnit Inpatient to manage youth with highlyacute behavioral health needs.

PG 16

PRTF: Excluding State-Run

Type of PRTFExcluding State-Run

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

5

10

15

20

25

30

Admissions or Discharges

PRTF: Excluding State-Run - Admissions

Admissions or DischargesAdmissions

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

50

100

150

Average Length of Stay

PRTF: Excluding State-Run - Average Length ofStay

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

1

2

3

4

5

6

Days/1,000

PRTF: Excluding State-Run - Days/1,000

Choose DemographicNo Demographic Breakout

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

BOYS & GIRLS VILLAGEINC

CHILDRENS CENTER OFHAMDEN

VILLAGE FOR FAMILIES& CHILDREN

Quarterly Totals

8879132124118

96867799115

79586688710

24232023261529212923

PRTF: Excluding State-Run Admissions

2 29Admissions or DischargesOverview

The ALOS for Community PRTF wasessentially unchanged over the twoquarters; it was 173.45 days (with 20discharges) in Q1 ’16 and 176.64 days(with 22 discharges) in Q2 ’16.

Solnit PRTF's ALOS increased23.62% in Q1 ’16 to 182.30 days thendecreased 22.95% to 140.47 days inQ2 ’16. Days/1,000 increased from2.45 in Q4 ’15 to 6.54 in Q1 ’16 andthen decreased to 4.89 in Q2 ’16.There has been minimal variance tothe number of Solnit PRTFadmissions.

PG 17 Community PRTF: Excluding Solnit (Youth Ages 5-13)Overstay Days & Overstay Reasons

OverviewThe number of overstay days increased by 25% to 790 days from Q4 ’15 to Q1 ’16 then decreased 32.53% in Q2 ’16 to 533 days. While overstay reason canchange during the course of a youth’s treatment, the most common final reason for overstay in Q1 ’16 and Q2 ’16 was awaiting going home.

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

200

400

600

800

1000

# of Days in Overstay

PRTF (Excluding Solnit) Total Overstay Days

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Awaiting GoingHome

Awaiting FosterCare

Awaiting GH 22.2%

22.2%

55.6%

22.2%

33.3%

44.4%

12.5%

50.0%

37.5%

9.1%

63.6%

27.3%

16.7%

41.7%

41.7%

21.4%

35.7%

42.9%

26.3%

36.8%

36.8%

26.7%

40.0%

33.3%

15.4%

30.8%

53.8%

12.5%

25.0%

56.3%

PRTF Ex Solnit Percent of Overstay Discharges by Top Reason Code2014

Q1 Q2 Q3 Q42015

Q1 Q2 Q3 Q42016Q1 Q2

# of DaysDelayed/inOverstay

Cases Delayed/inOverstay

Average DaysDelayed/inOverstay

38.4

10

384

43.8

10

438

47.2

10

472

64.9

13

844

52.7

12

632

46.0

14

644

52.1

19

989

46.6

15

699

41.0

13

533

49.4

16

790

PRTF (Excluding Solnit) Table

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

5

10

15

20

Cases in Overstay

PRTF (Excluding Solnit) Total Overstay Cases

PG 18 PRTF: Solnit North & South (Youth Ages 13-17)Overstay Days & Number of Youth in Overstay by Reason Code

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0

100

200

300

400

500

600

700

800

900

1000

# of Days in Overstay

Solnit PRTF Overstay Days (ages 13-17)The ALOS has stabilized this quarter to the expected three-month timeframe; however, the number of overstay days increased in Q1 ’16 to958 days, the highest value for this metric in the last nine months. Itdecreased 35.91% in Q2 ’16 to 614 days. While the number of cases indelay (N=11) is minimal in Q2 ‘16 the amount of days spent in delay issignificant (614).

Of the 11 children on overstay status, 3 were awaiting group home, 4were awaiting foster care and 4 were awaiting other. Those awaitingother status were more than likely awaiting the stability of the familyand services prior to going home. This again highlights the need forexpansion of community services which focus on direct treatmentservices which include family education and crisis services.

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

10

20

# of Overstay Cases

Solnit PRTF Discharge Delay Cases (ages 13-17)

2014Q1 Q2 Q3 Q4

2015Q1 Q2 Q3 Q4

2016Q1 Q2

Awaiting Foster Care

Awaiting RTC/GH

Awaiting Other

Awaiting CommunityServices

1

2

1

2

3

1

2

2

3

2

1

7

4

1

7

5

5

3

4

1

4

2

3

1

7

3

2

1

8

5

9

1

4

3

4

Solnit PRTF Number of Youth by Overstay Reason Code (ages 13-17)

PRTF Excluding State-Run: Community PRTFs & PRTF State-Run: SolnitSummary

PG 19

PRTF Solnit Recommendations

1. It is recommended that Beacon monitor the Solnit PRTF level of care for additional trending, and include data relevant to discharge delay reason codes,specifically for Solnit North campus. It is recommended that we identify the specific delay reasons for the males at the Solnit North campus and implementincreased discharge planning with Beacon's Intensive Care Mangers, DCF and Solnit. Beacon continues to have weekly care coordination meetings to reviewcurrent treatment and discharge planning with both facilities.

Update: Beacon has continued to monitor the Solnit PRTF level of care indicating specific reason codes for overstay status. Onsite collaboration and utilizationreviews continue and are have expanded to include triage of cases and he inclusion of Beacon's Intensive Care managers within case conferences.

Beacon continues to recommend earlier intensive care coordination of clinical services focused on supporting and educating the family of the management ofcomplex psychiatric behavior and crisis response. This could include a clinician with specialty crisis training who works with the family in their home to prepare thefamily for the child’s discharge.

The ALOS was essentially unchanged over the past 2 quarters. The number of cases and days in overstay however remain significant. The total bed capacity forthe three community PRTF facilities is 44 youth. With 13 cases in delay an of average 41 days with total days impacting the system of 533 days, this createssystem delay throughout. The reason for delay continues to be awaiting going home.

This supports the recommendation to expand community services and direct care providers who service families and children with complex behavioral healthneeds and provide a crisis response and educational component to families.

Community PRTF Recommendations

1. Expand PRTF scope of services to include a continuum of care, crisis stabilization and Care Coordination. Beacon continues to recommend expanding thescope of PRTF to include an integrated continuum of services, which includes crisis stabilization and coordinated care. With limited access for the youngerpopulation to congregate care and Solnit Center's inpatient unit, PRTF-referred youth are a clinically complex population. In addition to the already existing clinicalservices provided by PRTF, the addition of Medicaid covered services for crisis stabilization as part of a continuum of care model is recommended. This modelwould include care coordination to provide education and support to parents while a member is receiving treatment, and to coordinate care for the family when thechild is discharged into the community. It is also recommended the PRTFs expand capacity and add a trained workforce to provide treatment to those youth withdevelopmental disabilities or children with Autism Spectrum Disorder.

Update: Beacon has implemented the Integrated Care Coordination (ICC) program through DCF which has supported this recommendation. The focus of the ICC(formally the CME) is to provide care coordination and peer support to families. The PRTFs have also collaborated with a specialized behavioral group in supportfrom DCF and DSS to train staff at the PRTF in addition to work with families for those youth with an ASD diagnosis.

..

PG 20

Q3 '15 Q4 '15 Q1 '16 Q2 '16

0

20

40

60

80

Admissions or Discharges

All S-FIT Program: DCF and Non-DCFAdmissions

Q3 '15 Q4 '15 Q1 '16 Q2 '16

0

5

10

15

20

25

30

Average Length of Stay

Expected LOS, 15

All S-FIT Program: DCF and Non-DCFAverage Length of Stay

Short-Term Family Integrated Treatment (S-FIT)Summary

Q3 '15 Q4 '15 Q1 '16 Q2 '16

0

20

40

60

80

Admissions or Discharges

All S-FIT ProgramAdmissions by Demographic

DemographicSelection

ChooseDemographicNo Demographic Bre..

SummaryThe number of discharges increased from 52 in Q4 ’15 to 64in Q1 ’16 and to 85 in Q2 ’16. Both DCF and non-DCF hadincreases in both quarters. The ALOS for all membersincreased to 27.78 in Q1 ’16 and then decreased to 24.08 inQ2 ’16. The DCF members showed increases in bothquarters.

ConclusionsThe ALOS for all members has remained steady and hascontinued above the expected length of stay of 14 days. Thiswas noted in both the DCF and non-DCF youth.

RecommendationsBeacon will continue to monitor this level of care for trendingrelated to DCF, non-DCF utilization.

Admissions or DischargesAdmissions

Group TypeAll Members without DualsDCF

Non-DCFChoose Provider to FilterAll

PG 21 Autism Spectrum Disorder ServicesAdmissions & Admits/1,000

Hover over Puzzle Piece for Definition of Each ServiceClass Corresponding Below

Admissions & Admits/1,000Autism Spectrum Disorder (ASD) Serviceadmissions/authorizations continue to increase since thebeginning of the program in January 2015. The mostsubstantial growth is seen in diagnostic evaluations.Behavior assessments remain flat and plan of caredevelopment and service delivery dropped somewhat in Q2’16 due to a reported shortage in provider staffing ofBCBAs and behavior technicians.

Diagnostic evaluations grew at a significant rate over thelast two quarters; increasing from 69 in Q4 ’15 to 144 in Q1’16 and 258 in Q2 ’16. This is due to the enrollment oflarger diagnostic groups such as Yale DevelopmentalPediatric Group and CCMC’s Children’s’ Specialty Group.Smaller provider organizations like Wheeler Clinic andClifford Beers enrolled as Autism Service providers withMedicaid are also creating increased access to diagnosticevaluations by qualified, licensed clinicians. Q1 ’16 and Q2’16 saw an increase to 19 diagnostic evaluation providersup from 13 the previous year. The increase in diagnosticproviders and overall volume of diagnostic evaluationsmeans early identification, assessment, and access todiagnosis for Medicaid youth in Connecticut.

Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0

50

100

150

200

250

Admissions

Quarterly Autism Spectrum Disorder Services AdmissionsYouth Ages 0-20

Service ClassDiagnostic EvaluationBehavioral AssessmentPlan of CareService Delivery

Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0.00

0.05

0.10

0.15

0.20

Admits/1,000

Quarterly Autism Spectrum Disorder Services Admits/1,000Youth Ages 0-20

Autism Spectrum Disorder ServicesUtilization Demographics

PG 22

There were 555 unique youth that were authorized for Autism SpectrumDisorder Services in Q1 and Q2 ’16. Males make up 77.48% of the ASDProgram with females at 22.52% across the ASD service classes,consistent with current research that indicates that boys are five timesmore likely than girls to receive an autism diagnosis.

There was variance in ASD service class utilization by age group andrace. Youth ages 0-6 continue to account for the largest volume ofdiagnostic evaluations (67.9%) up from 57% at CY 2015 resulting fromthe enrollment of several larger volume diagnostic evaluation practices.The increase in youth 0-6 years of age for diagnosis trickled down to aslight increase across behavior assessment with an almost 7% increasein authorizations from CY 2015 and a 3.4% increase in plan of caredevelopment for the same age group.

Among racial and ethnic groups, there was a difference in the breakdownof utilization across all ASD services classes. Autism is reported to occurin all racial, ethnic, and socioeconomic groups. As far as diagnosticevaluations, 46.6% were completed for White youth, 37.3% Hispanicyouth, 12.0% were completed for Black youth, and even fewer werecompleted for Asian or Multi-racial members. This corresponds with someof the current research from the Autism and Developmental DisabilitiesMonitoring Network (ADDMN) stating that non-Hispanic white childrenwere approximately 30% more likely to be identified with ASD thannon-Hispanic black children. However, Connecticut Medicaid is doing abetter job at identifying and diagnosing children and youth in the Hispaniccommunity as compared to the national average where non-Hispanicwhite children were almost 50% more likely to be identified with ASD thanHispanic children. The research consistently notes that children of Black,Hispanic, and Asian decent are more likely to be identified later. Recentresearch has found that ethnic minority children may have subtlecommunication delays compared to non-minority children that may beundetected or presumed unremarkable by parents of minority toddlers. Asa result, for ethnic minority children more significant delays are needed toprompt early identification and the search for intervention services. In ourCT Medicaid ASD Program, this disparity is more pronounced across theservices of behavior assessment, plan of care development and servicedelivery where White children accessed services at a significantly higherrate than Hispanic, Black, Asian or other youth.

77.48%

22.52%

Total Youth by Gender: Q1 & Q2■ Male ■ Female

87.57%

10.99%1.44%

Total Youth by DCF Status: Q1 & Q2■ Non-DCF ■ Voluntary ■ Committed

Diagnostic Evaluation

Behavior Assessment

Plan of Care

Service Delivery

10.5%

29.0%

30.0%

33.6%

21.3%

33.6%

35.6%

36.0%

67.9%

37.4%

34.4%

29.6%

Total Youth by Level of Service and Age Group: Q1 & Q2■ 0-6 ■ 7-12 ■ 13-18 ■ 19-20

Diagnostic Evaluation

Behavior Assessment

Plan of Care

Service Delivery

12.0%

11.2%

37.3%

23.4%

18.9%

19.2%

46.6%

62.6%

68.9%

66.4%

9.3%

7.8%

Total Youth by Level of Service and Race: Q1 & Q2 2016■ White ■ Hispanic ■ Black ■ Asian ■ All Others

Because members may have multiple authorizations with differences in, specifically, age and DCF status at the time ofadmission, demographics are captured as of the last/most recent authorization record. Each member is only countedonce in this calculation.

These values will not add up to the total unique youth as youth may utilize more than one service. However, eachyouth is only counted once in each demograhic category within each service class.

PG 23 Autism Spectrum Disorder ServicesAdmissions by Provider

0 20 40 60 80 100 120 140 160 180 200Admissions

CT CHILDREN'S SPECIA, LTY GRP CCMC

ABLE HOME HEALTH, CARE LLC

CONNECTICUT BEHAVIOR, AL HEALTH LLC

YALE UNIVERSITY SCHL, OF MEDICINE

RUSSOLILLO, PATRICK J

FOCUS CTR FOR, AUTISM INC

HOSPITAL FOR SPECIAL, CARE GROUP

SHORELINE SOCIAL, LEARNING

BEHAVIORAL HLTH CONS, ULTING SVCS LLC

FAMILY STRONG CT,

ADVANCED PSYCHOLOGIC, AL SERVICES

KOZODOY, PAUL

WHEELER CLINIC INC

ADELBROOK COMM, SERVICE INC

ALTERNATIVE SERVICES, CT INC

STRONG, FOUNDATIONSABA OF CONNECTICUT, LLC

ASD Provider Volume of Authorizations by Service Class

Service ClassBehavioral AssessmentService DeliveryDiagnostic EvaluationPlan of Care

Select Year2016

Service ClassAll

Service Class2015

Q1 Q2 Q3 Q42016Q1 Q2

Diagnostic Evaluation

Behavioral Assessment

Plan of Care

Service Delivery 19

22

22

13

19

22

22

13

19

22

22

13

19

22

22

13

19

16

16

19

19

16

16

19

Volume of Unique Providers Providing ASD ServicesProvider EnrollmentThe provider network experienced minimal growth in Q1 and Q2 of 2016. Only nine uniquepractices (individuals or groups) enrolled during this time for a variety of services with a total of 33providers enrolled as Autism Service providers. This is up from 32 enrolled Autism Serviceproviders in CY 2015. Nineteen are enrolled to complete diagnostic evaluations, 16 to providebehavioral assessments, 16 to provide plan of care development, and 19 to provide servicedelivery. Some programs have enrolled and are still getting their service delivery teamsoperational.

New Autism service classes will be released in Q3 with the hopes of enticing more providers toenroll in the network for all types of services. Ongoing recruiting and outreach to regional AppliedBehavioral Analysis (ABA) associations in Connecticut, Rhode Island, New York andMassachusetts are taking place. The monthly Learning Collaborative for ASD providerscontinues to cover topics related to best practices for ASD services, identify trends and allowproviders to network and get questions answered in a timely manner. The new ASD providerorientation is highly individualized and streamlines the process of educating new providersregarding staff enrollment, accessing authorizations and documentation expectations for clinicalreview.

Autism Spectrum Disorder ServicesSummary

PG 24

ConclusionsWhile access to a diagnostic evaluation is quick and easily accessible for Medicaid children and youth, access to in home and community based servicescontinues to develop. Building the provider network continues to be of primary focus. Continued attention is also being given to sending referrals from areas withthe greatest number of Medicaid members waiting for service delivery to begin to providers. Clinical Care Managers (CCMs) weekly communication with providershelps providers identify where staff is needed most for Medicaid members waiting throughout the State and many providers are targeting their staff recruitmentefforts in these areas.

Monthly rounds and case consultation with National Beacon Health Options Autism Services Program allows the Connecticut ASD team to share and access bestpractice models and continue efforts to increase provider enrollment. Monthly Learning Collaboratives allow for communication of best practices, standards andMedicaid expectations on an ongoing basis.

Networking with ASD providers has provided low cost to no cost opportunities to improve training and quality of behavior technician staff by engaging with stateuniversities and other providers offering Registered Behavior Technician (RBT) training to new and prospective employees for the provider network.Behaviorally-focused trainings are shared on a monthly basis with the enrolled Autism Services provider network as well.

Recommendations

New service classes as well as changes to the current Autism Service regulations will be implemented in order to encourage additional provider enrollmentsometime in Q3 or Q4 2016.

A large number of children and youth with an ASD diagnosis are showing up on discharge delay and within the Intensive Care Coordination (ICC formerly CME)program due to a lack of available community services. Network of Care Managers, Care Coordinators and Peer Specialists continue to develop resources fornon-traditional and alternative community supports for families with complex, special needs.

Peer Specialists and Care Coordinators within the ASD program will be trained to work with families specifically around “Preparing to Use the EmergencyDepartment (ED)” in an effort to increase the use of statewide crisis services, reduce trauma to the individual and possibly reduce hospital visits. Peers and CareCoordinators will be continuing to stress the importance of a proactive crisis or safety plan with families and utilizing a social story on “Going to the ED” should theneed arise. Pilot projects are being discussed regarding connecting community hospitals with consultation and training on topics surrounding DevelopmentalDelay and Autism Spectrum Disorder diagnoses.

Collaboration with State agencies, Birth to Three and specialty hospitals like the Hospital for Special Care’s new inpatient Autism unit continues. New partnershipshave been formed with subcontractor, Padres Unidos of Greater Danbury and FAVOR to increase parent support group options for families who are primarilySpanish-speaking with special needs children. Renewed efforts will be focused on outreach to AFCAMP and collaboration with the African-American andCaribbean parents of children with special needs. Identification of the care coordination needs for transition services for the Young Adult population from StatePlan services into the Department of Mental Health and Addiction Services (DMHAS) is also being examined.

PG 25 Outpatient Registration VolumeAdult and Youth

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

% of Outpatient Registration Volume

Percent of Outpatient Registration Volume and Total Volume: ECC andNon-ECC

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0K

5K

10K

15K

20K

25K

30K

35K

Outpatient Registration Volume

Total Outpatient Registration Volume: ECC and Non-ECC

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

ECC

Non-ECC

Total 32,852

28,133

4,719

35,205

29,885

5,320

29,955

25,320

4,635

30,087

25,427

4,660

30,492

25,795

4,697

28,234

23,466

4,768

27,427

22,578

4,849

28,068

22,902

5,166

25,180

19,231

5,949

Registration VolumeThe “Total Outpatient Registration Volume” measure captures the overallvolume of newly registered Medicaid members, including those evaluationsexcluded from meeting the ECC access standards. From Q4 ’15 to Q1 ’16, therewas a 17.5% increase in total outpatient registration volume, and from Q1 ’16 toQ2 ’16 there was a 6.7% decrease.

Total ECC registration volume have been trending downward and non-ECCvolume have been trending upward since Q2 ‘14. The gap between ECCs andnon-ECCs has been expanding over this time. ECCs accounted forapproximately 15% of the total outpatient registration volume during Q1 and14% in Q2 '16, while non-ECCs accounted for approximately 85% and 86%,respectively.

ECCNon-ECC

PG 26Youth Outpatient Registration VolumeEnhanced Care Clinics (ECC) vs. Non-ECC Providers

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0K

1K

2K

3K

4K

5K

6K

Outpatient Registration Volume

Total Outpatient Registration Volume: ECC Youth & Non-ECC Youth

OverviewNon-ECC youth registrations have been trending upward since Q4 ’13 and reached the highest point in Q1 ’16, making up approximately 72% of youth registrationvolume, then decreased in Q1 ‘16. ECC youth registrations have been trending downward.

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0K

1K

2K

3K

4K

5K

6K

Outpatient Registration Volume

Total Outpatient Registration Volume: ECC Adult & ECC Youth-- ECC Total

Type of Care (Age grp)Youth Measures

ECC YouthNon-ECC Youth

ECC AdultECC Youth

PG 27 Youth Outpatient Registration VolumeEnhanced Care Clinic (ECC) vs. Freestanding Clinics (FSC)

OverviewThe “Registrations Required to Meet ECC Access Standards” measure captures only those evaluations that are relevant to meeting ECC access standards.Outpatient clinics are able to identify and exclude from calculation the “exempt registrations” which include: 1) those clients stepping down from a higher level ofcare within their agency; and/or 2) those clients who have been in treatment at the ECC but who experienced a change in insurance coverage to Medicaid. Theaccess measures are based only on the timeliness of appointments for those members who are truly new clients in the ECCs. Evaluations needing to meet the access standards accounted for almost 64% across Q3 and Q4 ’15. This has remained fairly constant over the reporting period. When comparing ECCs vs. FSCs for youth, ECCs have consistently had a higher number of evaluations, but they have been slightly trending downward over time.FSCs have been slightly trending upward.

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '160K

5K

10K

15K

20K

25K

30K

35K

Outpatient Registration Volume

Total Outpatient Registration Volume: Volume of Registrations Required toMeet ECC Access Standards and Volume of Exempt Registrations ECC

and Non-ECC

Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

0

500

1000

1500

2000

# of Evals Required to Meet ECC Access Standards

Total Number of Evaluations Required to Meet ECC Access Standards:ECC and Non-ECC Freestanding Clinics (FSC)

Select GroupYouth Measures

ECC YouthFSC Youth

Outpatient Registration VolumeExempt Evals

PG 28Youth Outpatient ECC Access StandardsRoutine, Urgent and Emergent Registrations

Access StandardsAfter a decrease in Q4 ’15, Emergent evaluations that met the ECC access standards increased back up to meeting the 95% access standard for both quarters.Both routine and urgent evaluations remained consistently meeting or exceeding the 95% access standard.

The percent of outpatient evaluations offered within the ECC access standard have been consistently met by ECCs for routine and urgent, and increased in Q1and Q2 for emergent and are now meeting the access standard. Both routine and urgent have been consistently unmet by FSCs, although urgent has beentrending upward since Q3 ’15. Emergent decreased both quarters and has remained under the access standard for both Q1 and Q2 ’16.

Q3 '14 Q1 '15 Q3 '15 Q1 '16

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

% of Evaluations that Met the ECC Access Standard

Access Standard 95%

ECC Evaluations that Met the ECC Access StandardsYouth (0-17)

Q3 '14 Q1 '15 Q3 '15 Q1 '16

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

% of OTP Evaluations Offered Within Access Standard

Access Standard 95%

Percent of Routine Outpatient Evaluations Offered within the ECC AccessStandard: ECC and Non-ECC Freestanding Clinics (FSC) - All Members

ECCFSC

RoutineUrgentEmergent

RoutineUrgentEmergent

PG 29Outpatient Enhanced Care ClinicsCompliance, Interventions, & Activities

Compliance

Provider Compliance for Q1 '16

Routine Access compliance with the 14 day standard for the 30 ECCs fell into the following categories:1. Met the access standard of 95%: 282. ECC falling below the 95% Routine Standard: Catholic Charities (Norwich): 89.32% (volume 103); Hartford Hospital (IOL): 90.91% (volume 10)

Urgent Access compliance with the 2 day standard for the ECCs fell into the following categories:1. Number of ECCs that reported Urgent volume: 202. Met the access standard of 2 days: 183. ECC falling below the 95% Urgent Standard: Charlotte Hungerford (Adult): 50% (volume 2); Clifford Beers: 33.33% (volume 3)

Emergent Access compliance with the 2 hour standard for the ECCs fell into the following categories:1. Number of ECCs that reported Emergent volume: 72. Met the access standard of 2 hours: 53. ECC falling below the 95% Emergent Standard: United Services: 91.67% (volume 11); The Village for Families and Children: 0.00% (volume 1)

As a result of Catholic Charities – Norwich’s performance in Q3 ‘15 (routine) and Q4 ‘15 (urgent), they are on probation through the end of Q3 ‘16. They submitteda Corrective Action Plan on April 14 which was accepted on April 21, 2016. Charlotte Hungerford and the Village for Families and Children reported that theappointments where they did not meet the measure were data entry errors. This is still under evaluation. Clifford Beers reported having to put aside plans to hirenew staff to help absorb the volume of clients they see as an indirect impact from budget cuts at the agency. This may explain their failure to meet the urgentmeasure with one client. However, in spite of this issue, they met every measure in Q2 ‘16.

Provider Compliance for Q2 '16

Routine Access compliance with the 14 day standard for the 30 ECCs fell into the following categories:1. Met the access standard of 95%: 30

Urgent Access compliance with the 2 day standard for the ECCs fell into the following categories:1. Number of ECCs that reported Urgent volume: 172. Met the access standard of 2 days: 163. ECC falling below the 95% Urgent Standard: Community Health Resources: 33.33% (volume of 3)The Regional Network Manager is in discussion with CHR to better understand why they missed the Urgent measure.

Emergent Access compliance with the 2 hour standard for the ECCs fell into the following categories:1. Number of ECCs that reported Emergent volume: 62. Met the access standard of 2 hours: 6

Continued on next page.

PG 30Outpatient Enhanced Care ClinicsCompliance, Interventions, & Activities

Compliance, continued

Annual Measure Status – Agencies Not Meeting Measure:Routine: Catholic Charities Norwich – 94.09%Urgent: Charlotte Hungerford (Adult) – 85.71%; Clifford Beers – 33.33%; Community Health Resources – 33.33%Emergent: The Village for Families and Children – 50%

Although two agencies (Hartford Hospital and United Services) did not meet a measure in Q1 ‘16, by the end of Q2 ’16, their numbers had improved to meet theannual measure as of the end of Q2 ‘16. Hartford Hospital’s routine percentage moved from 90.91% to 96.15%, and United Services’ emergent percentage movedfrom 91.67% to 96.87%.

Interventions and Activities

Interventions to address ECC performance on Access Standards: ECC Mystery Shopper Calls for Q1 16 and Q2 '16:

Quarter 1: Middlesex Adult Clinic, Southern CT Child Guidance, and Child and Family Agency of SE CT-GrotonEvery agency listed passed the two mystery shopper calls to each agency successfully. This means that they both successfully triaged calls and responded in theappropriate time frame.

Follow-Up Calls: Family and Children’s Aid – Follow Up from Q4 ‘15In Q4 ‘15, Family and Children’s Aid did not return the Mystery Shopper calls made to them; however, the agency reported not being able to find a record of thecalls. A decision was made to repeat the calls in Q1 ‘16. Family and Children’s Aid passed both those calls.

Quarter 2: Hartford Hospital IOL; CHR Manchester; CMHAEvery agency listed passed the two mystery shopper calls to each agency successfully. This means that they both successfully triaged calls and successfullyoffered appointments to clients in the expected time frame. Of note though is CHR Manchester whose process through calling their centralized Assessment Centernumber is able to have clinicians answer the calls and do appropriate triaging of a call along with the offer of an appointment in less than 4 minutes. It is a smoothand seamless process that only involves the member potentially talking to one person.

In doing the calls to Hartford Hospital IOL, although the calls were successful, it was noted that the clinic’s process takes two calls to get a screening and anadditional call to generate an appointment to the member. A decision was made to have a meeting with the clinic and discuss their current workflow for triagingcalls as well as discuss any possible improvements to the process that would eliminate the number of calls to an appointment and also examine the possibility ofthe screening happening in a more timely manner in order to clearly identify members in crisis from the first call to the clinic. The meeting is set up for WednesdayAugust 17, 2016. The Hartford Hospital IOL calls also helped us identify the need to update the language in PB 2007-44 on Access Requirements to be morespecific and clear. The process of updating the language in PB 2007-44 will include getting provider feedback. This will be done at a provider meeting inSeptember. The date is yet to be determined.

CMHA passed two mystery shopper calls without incident.

Continued on next page.

PG 31Outpatient Enhanced Care Clinics

Compliance, Interventions, & Activities, continued

Interventions and Activities, continued

ECC Operations:The meeting met regularly and discussions were around the issues discussed above.

ECC Provider Workgroup on Capacity and Access:This provider workgroup did not meet for Q1 '16 and Q2 '16. However, because there is the need to explore updating PB 2007-44, there is a projected providermeeting that will happen in Q3 '16 in order to gather provider feedback.

Orientation for New ECC locations: June 28th, 2016

The new ECC clinics are:1. Recovery Network of Programs - Bridgeport2. Catholic Charities – Waterbury, Torrington3. McCall – Torrington4. CT Renaissance – Norwalk, Bridgeport, Stamford*Although Wellmore was approved to go forward with an adult ECC location, after further consideration, the agency decided to withdraw their application as anadult location.

The ECC Orientation for the new adult locations covered: Access requirements, referrals, triaging urgent, emergent, and routine appointments, follow-ups,transportation, extended hours and after-hours coverage, documentation, collaboration with Primary Care Practices, measurement of ECC compliance,measurement of timely access and web registration. All new ECC locations will attend a follow-up meeting on October 11th at 1:30 PM at CTBHP. The purpose ofthe follow up meeting will be to prepare them for the on-site survey that will take place at each location immediately following their first 6 months as well as reviewa chart, make recommendations and identify opportunities for improvement.

Continued on next page.

PG 32Outpatient Enhanced Care Clinics

Compliance, Interventions, & Activities, continued

Interventions and Activities, continued

Interventions:

Meeting with Community Mental Health Affiliates (CMHA):During the course of Q2 ‘16, a complaint was received by CTBHP regarding the timely access of services at CMHA. In response to this complaint, a record reviewwas done at CMHA on May 20t, 2016. While record review was inconclusive, as a result of the process of responding to this complaint, a decision was made to:a) Review what percentage of members by agency request a later appointment even though they have been offered an appointment within the required timeframeb) To begin doing Spanish speaking mystery shopper calls.

Spanish Speaking ECC Mystery Shopper Calls:Spanish speaking ECC mystery shopper calls will be made in Q3 ‘16. The following steps though have taken place in Q2 ‘16:a) The identification of three CTBHP Spanish speaking staff members who have agreed to make the mystery shopper callsb) An initial orientation of those 3 staff members to the ECC’s.One step remains before the calls will be done, which is role-playing. This will take place in Q3 ‘16 before the calls are made.

Percentage of Members Requesting Later Appointment Even Though They Have Been Offered Appointment Within Required Time Frame:

Although the 18E reports traditionally capture these numbers, they had never been quantified into percentages and reviewed by agency across the board. A reviewwas done of the percentages by agency for all of 2015 and Q1 ‘16. Three agencies stood out as having percentages that gradually increased all 5 quarters:CMHA, Child and Family Agency of SE CT (Groton) and Clifford Beers. Their percentages for those quarters are listed below:

We will continue to have conversations about next steps to do with this data. In Q3 ‘16 and Q4 ‘16, the RNMs will share this information with providers as a basisfor gaining a better understanding of what the information means based on agency practice. That information will then be used to determine if there are some nextsteps needed.

Residential Treatment FacilitiesIn and Out-of-State Utilization

PG 33

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

5

10

15

20

25

30

35

40

Admissions or Discharges

Residential - Youth: Ages AllAdmissions

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

500

1000

1500

2000

2500

Average Length of Stay

Residential - Youth: Ages AllAverage Length of Stay

RTC In/Out of State ProvidersIn-State RTCsOut-of-State RTCs

Admissions or DischargesAdmissions

Age GroupAll

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16

In-StateRTCs

Admissions

Discharges

Average Length of Stay

Out-of-StateRTCs

Admissions

Discharges

Average Length of Stay

326.03

39

31

357.69

32

35

268.21

39

28

249.54

28

32

333.53

36

40

272.60

43

30

273.74

34

32

257.19

48

36

284.45

53

42

272.04

50

39

2,414.00

1

1

320.00

2

0

0

2

176.00

1

1

1,228.25

4

0

1,125.50

2

1

0

0

1,201.50

4

2

1,080.50

4

1

697.75

4

1

Residential - Youth: Ages AllData Table

PG 34 Lower Levels of CareAdmissions & Admits/1,000

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0

2

4

6

8

10

Admits/1,000

Lower Levels of Care - Youth: Ages AllAdmits/1,000

Q2 '14 Q4 '14 Q2 '15 Q4 '15 Q2 '16

0K

2K

4K

6K

8K

Admissions

Lower Levels of Care - Youth: Ages AllAdmissions

Select Benefit Group TypeAll Members without Duals

Filter by Age GroupAll

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16Partial Hospitalization(PHP)

AdmissionsAdmits/1,000

Intensive Outpatient(IOP)

AdmissionsAdmits/1,000

Extended DayTreatment (EDT)

AdmissionsAdmits/1,000

IICAPS AdmissionsAdmits/1,000

FFT AdmissionsAdmits/1,000

MDFT AdmissionsAdmits/1,000

MST AdmissionsAdmits/1,000

Outpatient AdmissionsAdmits/1,000

0.34258

0.39294

0.38282

0.31235

0.43338

0.41319

0.45353

0.35274

0.42325

0.39294

0.55419

0.59449

0.60452

0.45344

0.61477

0.52409

0.57445

0.51398

0.64489

0.57429

0.27209

0.27207

0.24180

0.22172

0.27207

0.23179

0.29227

0.23176

0.31234

0.22166

0.69531

0.77589

0.68512

0.72550

0.71554

0.71553

0.72567

0.72560

0.75571

0.77575

0.13101

0.0972

0.1292

0.0864

0.0754

0.0969

0.1077

0.0757

0.1185

0.1179

0.19147

0.24185

0.22168

0.23177

0.23179

0.20157

0.19152

0.22170

0.25193

0.22164

0.1184

0.14108

0.1185

0.1294

0.14107

0.13103

0.1187

0.1080

0.17130

0.1291

9.098,366

10.299,463

9.348,437

7.947,332

8.507,991

8.487,997

8.277,848

7.467,022

8.237,627

8.137,368

Lower Levels of Care Table - All Members without Duals 0 - 2, 13 - 17, 3 - 12

Service ClassPartial Hospitalization (PHP)Intensive Outpatient (IOP)Extended Day Treatment (EDT)IICAPSFFTMDFTMSTOutpatient

Filter by Level of CareAll

Global Youth RecommendationsPG 35

Recommendations:This section documents activity since the previous quarterly report.

1. Beacon recommends a preventive model of integrated health care which includes behavioral health and physical health. We continue to recommend thispreventative model incorporate crisis services and intervention for both adults and youth. Update: Many HUSKY members experience co-occurring medical, behavioral health and substance use disorders. These members often present with complexclinical needs resulting in frequent high utilization of services and associated higher Medicaid costs. Integrated approaches to health care delivery has evolvedfrom an optional activity to an essential system requirement. Integrated case management models which incorporate prevention, and crisis services/ educationcan reduce unnecessary emergency department utilization and reduce inpatient utilization and promote improved overall health outcomes.

2. Increase collaboration with CHN to establish preventative integrated care:

Update: This recommendation will be concluded as Beacon and CHN continue to collaborate on an ongoing basis.