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Thank you for participating in HUSKY Primary Care, Connecticut’s Primary Care Case Management pilot program. In HUSKY Primary Care, HUSKY A members enroll directly with participating Primary Care Providers instead of enrolling in a HUSKY managed care health plan. 

The program began in February 2009 in the greater Waterbury and Windham areas.  For enrollments beginning January 2010, it is available in the greater Hartford and New Haven areas.

If you have a change in staff, please notify Rivka Weiser as soon as possible. New PCPs can find the application and contract here.

For more information on specific topics, please see below.  Also see the list of main contacts.

Contents:

Mental health and chemical dependency services in HUSKY are administered by the Connecticut Behavioral Health Partnership (ValueOptions).  Providers and services are the same for all HUSKY A members.  Visit www.ctbhp.com for more information.  For an introduction to CT BHP and a summary of CT BHP resources, please follow this link.

Billing / Claims
Billing for services in HUSKY Primary Care is the same as in Medicaid / Title 19. The same fees for services and billing rules apply. See www.ctdssmap.com or call 800-842-8440 or 860-269-2028 for more information. The monthly case management fees are based on member enrollment and are automatically paid to your practice (see below).

Brochures
Brochures for HUSKY A members are available in English and Spanish, and for each of the four HUSKY Primary Care sites. 

To order multiple copies of brochures, please follow this link and follow the instructions for ordering bulk quantities. The brochures have different publication numbers depending on geographic area and language (English or Spanish). Please be sure to use the publication number (above) when ordering the brochure the area and language that you need.

Case management / care coordination fees
Each month, you will be paid the total monthly care management fee for all clients enrolled with a Primary Care Provider in your practice in the previous month. Fees are $7.50 per member per month. These payments will appear in the first Remittance Advice (RA) of the month. This payment will appear in the Financial Transaction portion of the RA as one or more Non-Claim Specific Payout transactions with a reason code of 8391 “Primary Care Case Management (PCCM) Payment.” More than one payment may be listed because in some cases multiple funding sources exist for the client population you serve. The sum of these payments will equal the monthly case management fee for all clients reported on your roster.

Dental services in HUSKY are administered by the Connecticut Dental Health Partnership (BeneCare).  Providers and services are the same for all HUSKY A members.  

Member enrollment procedures
HUSKY A members can call the HUSKY Enrollment Center at 1-800-656-6684 or use the enrollment form below to enroll (in HUSKY Primary Care or one of three HUSKY managed care health plans).  Information about applying for HUSKY can be found here. All HUSKY A members in towns where HUSKY Primary Care is available can enroll in the program. Additionally, on an exception basis, clients who are current patients of participating PCPs but do not live in these towns can also enroll (along with the rest of their family members who are in HUSKY A).

In order to enroll, all family members who are in HUSKY A need to enroll with PCPs who are in the HUSKY Primary Care program. Family members can choose to see different PCPs. HUSKY enrollments are usually effective the first of the following month after an enrollment is processed (there is a cutoff of a few days before the end of the month).  Members can enroll, or switch PCPs within the program, at any time.

Member identification/information cards
HUSKY Primary Care members use the gray CONNECT card for all covered services. There is no additional card that is specific to HUSKY Primary Care; eligibility verification systems indicate member enrollment information. Some participating practices have wanted to give members a tangible card with information that is specific to the program. Follow this link for informational cards, which the Department has developed for this purpose. Providers are welcome to use these cards.

Member notices
All HUSKY A members in each HUSKY Primary Care pilot area were sent notices about the program when it opened. On an ongoing basis, those who become newly eligible for HUSKY A and live in the pilot program towns (see below) receive a notice and enrollment form that includes the managed care health plans and HUSKY Primary Care, as well as our publication Choosing a Health Care Option.

Member rosters
A member roster of HUSKY A clients enrolled with each PCP in your practice will be reported to you on a monthly basis (in report #ELG-0401). It will be available by the first working day of the month. It includes members’ name, date of birth, Medicaid ID, sex, head of household name, address, phone number, and primary language. The roster will identify each participating PCP in your practice, followed by the list of clients who enrolled with the specific PCP. In addition to a complete list of current clients, changes in the client roster by PCP will be provided to highlight the clients who were added or who disenrolled since the previous month (in report #ELG-0402). The roster will also provide a total count of clients enrolled with your practice and a total of the case management fees ($7.50 per member per month). Case management fees will be automatically generated.

The member roster will be located on the www.ctdssmap.com website under your secure Trading Partner Web account by clicking on Trade Files, then download. The format of this report is a Portable Document Format (PDF) and will be identified as Transaction Type “PCCM Enrollment – PDF” located within the File Download Search. Note that the Report Period will be the month that the clients are enrolled with a PCP in your practice. The “Primary Manager” is the group or organization (billing provider) in which the PCPs are enrolled.

Office signs
If you would like to put up signs in your office informing members about your participation in the program, please see the files below.  Please contact Rivka Weiser [Rebecca.weiser@ct.gov] if you would like color copies of them sent to you.  You are welcome to make other signs or marketing materials, but any materials should be submitted to the Department for review.

Pharmacy
Pharmacy services, pharmacies, and prior authorization are the same for all HUSKY members, whether they are in HUSKY Primary Care or a managed care health plan.  See the pharmacy websitefor more information.

Provider contract and enrollment
The application and contract for Primary Care Providers can be found here.  
Please note that Primary Care Providers (PCPs) must also be enrolled in Medicaid in order to participate. For providers who bill Medicaid independently or as part of a physician or nurse practitioner group, see www.ctdssmap.com for information on how to enroll in Medicaid. For FQHC or hospital-based Primary Care Providers, there is a different process; contact Rivka Weiser (Rebecca.weiser@ct.gov, 860-424-5843) for more information.

Specialists in HUSKY Primary Care
The network of specialists, facilities, and other providers is the same as in fee-for-service Medicaid / Title 19 network.  Most providers who are in a HUSKY health plan are also enrolled in Medicaid / Title 19, but not all are. All general hospitals in Connecticut are enrolled in Title 19.  Note that while specialty referrals should be coordinated by Primary Care Providers, if a client self-refers to another Medicaid-enrolled provider, the provider’s claims will still be paid.

A provider lookup can be found here. Please note that the lookup only contains billing providers (which are generally groups), not individual providers at those groups.

If you have any issues with specialists who are not accessible to your HUSKY Primary Care members, or would like the Department to look into the enrollment of any particular specialists to which you refer, please use the attached template to identify them. The Department can then reach out to specialists, as needed. This letterby Dr. Robert Zavoski can also be shared with specialists.

For information on behavioral health, dental, and pharmacy providers, please see the other sections of this page.

Towns
HUSKY A members and Primary Care Providers who live in the following towns can enroll in the program on an ongoing basis. Additionally, on an exception basis, clients who are current patients of participating PCPs but do not live in these towns can also enroll (along with the rest of their family members who are in HUSKY A).

Transportation for members
Non-emergency medical transportation to health care appointments is available to HUSKY Primary Care members via the same transportation brokers that are in Medicaid / Title 19.

Verifying eligibility of members
Information on how HUSKY Primary Care members appear in various eligibility verification systems can be found here. Systems indicate the name and phone number of the Primary Care Provider.